Knopman reported the Index of Cerebrovascular Disease (CVD) to help identify a patient with vascular dementia. Cerebrovascular disease is a heterogenous disorder that can produce any pattern of cognitive deficits and evolve in complex ways. The author is from the Mayo Clinic.
Parameters:
(1) history of stroke
(2) number of focal signs
(3) white matter hyperintensities on imaging studies
(4) lacunae on imaging studies
(5) cortical infarcts
(6) involvement of critical regions
Parameter
Low Risk
Moderate Risk
High Risk
history of stroke
none
any stroke above midbrain with no apparent impact on cognition
stroke temporally related to onset or worsening of impaired cognition
focal signs suggestive of CVD
0 or 1
2 or 3
>= 4
white matter hyperintensity
none or minimal
mild to moderate
severe
lacunae
0 or 1
2 or 3
>= 4
cortical infarcts
none or 1 small one
single large
multiple large
involvement of critical regions
none
lacunae or small infarcts in a critical region
larger infarcts in hippocampus, caudate, and/or thalamus
where:
• Focal signs may include an asymmetrical reflex or an unexplained extensor toe sign.
Interpretation:
• The presence of multiple high risk features favors vascular dementia.
• The presence of multiple low risk features suggests another cause for any cognitive impairment.
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