Revised Ischemic Score of Small

Clinical features used for scores:

(1) onset of cognitive symptoms

(2) history of strokes

(3) fluctuating course

(4) neurologic symptoms

(5) stepwise deterioration

(6) nocturnal confusion

(7) relative preservation of personality

(8) emotional incontinence

(9) history of hypertension

(10) evidence of atherosclerosis

(11) focal neurologic signs

(12) depression

(13) somatic complaints

 

Subscales:

(A) severity

(B) confidence: takes into account confidence and uncertainty in the findings

 

The ultimate score for first 10 items =

= (points for item severity) * (points for confidence in finding).

 

Item	Feature	Finding	Points
1A	onset of cognitive symptoms	> 6 months (gradual)	0
		over 1 - 6 months	1
		onset in < 1 month period	2
1B		possible	1
		well-documented	2
2A	history of stroke	none	0
		mild symptoms	1
		moderate to severe symptoms	2
2B		possible	1
		well-documented	2
3A	fluctuating course	absent	0
		1 – 2 episodes (mild)	1
		>= 3 episodes (moderate to severe)	2
3B		possible	1
		well-documented	2
4A	neurologic symptoms	absent	0
		mild	1
		moderate-to-severe	2
4B		possible	1
		well-documented	2
5A	stepwise deterioration	absent (gradually progressive decline)	0
		at least 1 episode	1
		>= 2 episodes	2
5B		possible	1
		well-documented	2
6A	nocturnal confusion	absent	0
		occasional or mild	1
		frequent or moderate	2
6B		possible	1
		well-documented	2
7A	relative preservation of personality	extreme personality deterioration	0
		mild to moderate deterioration	1
		personality relatively intact	2
7B		possible	1
		well-documented	2
8A	emotional incontinence	absent	0
		mild	1
		moderate to severe	2
8B		possible	1
		well-documented	2
9A	history of hypertension	absent	0
		mild	1
		moderate to severe	2
9B		possible	1
		well-documented	2
10A	evidence of atherosclerosis	absent	0
		mild	1
		moderate to severe	2
10B		possible	1
		well-documented	2
11	focal neurologic signs	absent	0
		mild	2
		moderate	4
12	depression	absent	0
		found on questioning	2
		spontaneously reported	4
		nonverbally evident	4
13	somatic complaints	absent	0
		1 or 2 (mild)	2
		>= 3 (moderate)	4

 

where:

• history of stroke: mild if there was mild aphasia or a brief history of one-sided weakness; moderate if hemiparesis lasting at least 1 month or similar findings

• fluctuating course = episodes of delirium with clouding of consciousness lasting days to weeks

• neurologic symptoms: mild if transient dizziness or diplopia or occasional falls; moderate with seizures or several falls per week

• stepwise deterioration = cognitive decline, aside from onset, is noted to occur over days to weeks, followed by plateaus

• nocturnal confusion includes wandering and/or disorientation

• nocturnal confusion: occasional is once per month while frequent is two or more times a month

• If the person is severely demented now, then score relative preservation of personality according to an earlier time when the person was less demented.

• relative preservation of personality: the person is considered relatively intact if the person retains his or her original sense of humor; with deterioration the person becomes more egocentric with coarser expression of emotions and less initiative.

• emotional incontinence: mild if there are occasional displays of intense emotional expression mixed with some control; moderate if the patient cries several times during the interview

• hypertension: mild if there is a history of a blood pressure of 150/95 for 6 months; moderate if blood pressure is 170/110 or if there is poor compliance with drug treatment for a year or more

• evidence of atherosclerosis: mild if there is exertional angina or claudication; moderate if the patient has a history of a myocardial infarction

• focal neurologic signs: mild symptoms include rigidity, diminished deep tendon reflexes, possible extensor plantar response, nystagmus, or decreased vibration sense; moderate if the pupils are sluggish, definite extensor plantar response, unequal deep tendon reflexes

• depression: mild if only found  by questioning the patient or informant; more severe if spontaneously reported or if indicated by appearance (facial expression, posture, weeping, etc.)

• somatic complaints = headache, tinnitus, chest pain, malaise, etc.

• data confidence possible = suggested by history or informant, but not clearly documented

• data confidence well-documented = definite evidence in medical history, physical examination, imaging studies, etc.

 

revised ischemic score =

= (1A * 1B) + (2A * 2B) + (3A * 3B) + (4A * 4B) + (5A * 5B) + (6A * 6B) + (7A * 7B) + (8A * 8B) + (9A * 9B) + (10A * 10B) + (points for 11) + (points for 12) + (points for 13)

 

Interpretation:

• minimum score: 0

• maximum score: 52

• The higher the score, the more likely the patient has infarct-related dementia.

NOTE: I could not find a method to map the score to diagnosis in the article.