Differential diagnosis of Alzheimer’s disease and vascular dementia using visual rating scales

Abstract

Purpose: To determine the differential diagnosis of Alzheimer’s disease (AD) and vascular dementia (VaD) using visual rating scales. Material and Methods: 119 brain Magnetic Resonance Imaging (MRI) examinations of patients diagnosed ei- ther with AD (n=85) or VaD (n=34) were assessed. Double blinded visual evaluation was performed by two neu- roradiologists. Final clinical diagnosis was set by a be- havioural neurologist. The following rating scales were valued: Pasquier rating scale (GCA), Fazekas Scale assess- ing both periventricular (PV) and white matter (WM) lesions. Posterior Cortical Atrophy (PCA) and scales re- garding specific cortical regions: dorso-frontal (DF), or bito-frontal (OF), anterior-cingulate (AC), basal ganglia (BG), anterior-temporal (AT), insula, lateral-temporal (LT), entorhinal (ERC), perirhinal (PRC), anterior-fusi- form cortex (AFC), anterior-hippocampus (AHIP) and posterior-hippocampus (PHIP). Both Left (L) and Right (R) hemispheres were examined. Results: The indicators with the highest value of area under the curve (AUC) were Fazekas-WM (AUC: 0.906), Fazekas-PV (AUC: 0.894), R-ERC (AUC: 0.858) and L-ERC (AUC: 0.820). Best sensitivity for distinguishing VaD from AD was achieved by PCA (91%), R-ERC (91%), Fazekas-WM (89%) and L-ERC (87%). Highest specificity was achieved by Fazekas-WM (97%), R-PHIP (91%), L-PHIP (91%), R-AC