NINDS-AIREN Criteria for the Diagnosis of Vascular Dementia

I. The criteria for the clinical diagnosis of probable vascular dementia include all of the following:

A. Dementia, defined by cognitive decline from a previously higher level of functioning and manifested by impairment of memory and of two or more cognitive domains (orientation, attention, language, visuospatial functions, executive functions, motor control, and praxis), preferably established by clinical examination and documented by neuropsychological testing; deficits should be severe enough to interfere with activities of daily living not because of physical effects of stroke alone.

Exclusion criteria: cases with disturbance of consciousness, delirium, psychosis, severe aphasia, or major sensorimotor impairment precluding neuropsychological testing. Also excluded are systemic disorders or other brain diseases (such as Alzheimer’s disease [AD]) that in and of themselves could account for deficits in memory and cognition.

B. Cerebrovascular disease, defined by the presence of focal signs on neurological examination, such as hemiparesis, lower facial weakness, Babinski sign, sensory deficit, hemianopia, and dysarthria consistent with stroke (with or without history of stroke), and evidence of relevant cerebrovascular disease (CVD) by brain imaging (computed tomography or magnetic resonance imaging [MRI]) including multiple large-vessel infarcts or a single strategically placed infarct (angular gyrus, thalamus, basal forebrain, or posterior cerebral artery or anterior cerebral artery territories), as well as multiple basal ganglia and white matter lacunes, or extensive periventricular white matter lesions, or combinations thereof.

C. A relationship between the above two disorders, manifested or inferred by the presence of one or more of the following:

a. Onset of dementia within 3 months following a recognized stroke.

b. Abrupt deterioration in cognitive functions.

c. Fluctuating, stepwise progression of cognitive deficits.

II. Clinical features consistent with the diagnosis of probable vascular dementia include the following:

A. Early presence of gait disturbance (small-step gait or marche a petits pas, or magnetic, apraxic-ataxic or parkinsonian gait).

B. History of unsteadiness and frequent, unprovoked falls.

C. Early urinary frequency, urgency, and other urinary symptoms not explained by urological disease.

D. Pseudobulbar palsy.

E. Personality and mood changes, abulia, depression, emotional incontinence, or other subcortical deficits including psychomotor retardation and abnormal executive function.

III. Features that make the diagnosis of vascular dementia uncertain or unlikely include the following:

A. Early onset of memory deficit and progressive worsening of memory deficit and progressive worsening of memory and other cognitive functions, such as language (transcortical sensory aphasia), motor skills (apraxia), and perception (agnosia), in the absence of corresponding focal lesions on brain imaging.

B. Absence of focal neurological signs, other than cognitive disturbance.

C. Absence of cerebrovascular lesions on brain CT or MRI.

IV. Clinical diagnosis of possible vascular dementia may be made in the presence of dementia (section I-A) with focal neurological signs in patients in whom brain imaging studies to confirm definite CVD are missing; or in the absence of clear temporal relationship between dementia and stroke; or in patients with subtle onset and variable course (plateau or improvement) of cognitive deficits and evidence of relevant CVD.

V. Criteria for diagnosis of definite vascular dementia are:

A. Clinical criteria for probable vascular dementia.

B. Histopathological evidence of CVD obtained from biopsy or autopsy.

C. Absence of neurofibrillary tangles and neuritic plaques exceeding those expected for age.

D. Absence of other clinical or pathological disorder capable of producing dementia.

VI. Classification of vascular dementia for research purposes may be made based on clinical, radiological, and neuropathological features, for subcategories or defined conditions, such as cortical vascular dementia, subcortical vascular dementia, Binswanger’s disease, and thalamic dementia.