Hachinski Ischemic Score Research Articles

Aplicação da versão brasileira da escala de avaliação clínica da demência (Clinical Dementia Rating - CDR) em amostras de pacientes com demência

The objective of the study was the analysis of agreement between the CDR scale with diagnostic criteria and mini mental state examination (MMSE), as well as correlation with Blessed scale, in a sample of Southern Brazilian patients. The CDR scale was cross-sectionally evaluated in 269 dementia patients' Alzheimer's disease (AD) vascular dementia, and questionable. The NINCDS-ADRDA criteria for probable AD and the NINDS-AIREN for probable vascular dementia were the gold standard. The MMSE, the Blessed scale, the Hachinski ischemic score, and a battery of cognitive tests were also applied. The agreement to gold standard was good (kappa=0.73), while to MMSE categorized was moderate (kappa=0.53). A significant correlation with the Blessed scale (r=0.96; p=0.001) was observed. Education and age were similar among CDR categories. The global score agreement of the CDR scale with the gold standard was good, and with the MMSE was moderate. We also observed face validity for dementia severity. No impact of education was observed upon CDR global scores.

Validation of clinical criteria for possible vascular dementia in the oldest-old

Although vascular dementia (VaD) is a main pathology in nonagenarians and centenarians, the validity of clinical criteria for this diagnosis is unknown. We analyzed 110 autopsy cases and reported sensitivities and specificities of the State of California Alzheimer's Disease Diagnostic and Treatment Centers (ADDTC) and National Institute for Neurological Disorders and Stroke (NINDS-AIREN) criteria for possible VaD as well as Hachinski ischemic score (HIS). Among them, there were 36 neuropathologically confirmed VaD cases. All criteria displayed comparable sensitivities (0.56–0.58). Specificities values were 0.74, 0.73 and 0.66, respectively. There was an age-related decrease on ADDTC criteria sensitivity due to the fact that 42% of pure VaD cases did not present with stroke. Thirty percent of mixed dementia (MD) cases were diagnosed as VaD by both NINDS-AIREN and ADDTC criteria. This proportion reached 45.9% for the HIS. These data demonstrate that the new diagnostic criteria for possible VaD do not provide a substantial gain of sensitivity compared to the HIS. Although their specificity was significantly lower in this age group compared to younger cohorts, all of them successfully exclude AD cases.

Methodology for measuring cerebrovascular disease burden

Biological aging of the brain is partly attributable to aging of the cerebrovascular circulation and the effects of these vascular changes on the brain. A variety of techniques ranging from simple, clinical scores to complex radiological techniques have been used in an attempt to understand, describe and quantify this process. Simultaneously attempts have been made to relate these changes to cognitive and physical changes and the risk of dementia and stroke associated with brain aging. The most frequently used clinical scores are the Framingham Stroke Risk Profile and the Hachinski Ischemic Score for vascular dementia. Radiological techniques to estimate cerebrovascular burden include many varieties of ultrasonographic, computerized tomography (CT), magnetic resonance imaging (MRI) and nuclear medicine techniques. The radiological techniques evaluate the nature and extent of disease in the vessels supplying the brain and the pattern and extent of radiological evidence of damage to the brain both on static and dynamic imaging and are briefly outlined in this review. There are several studies using these techniques to study ‘normal’ aging populations, and the techniques used in the most widely known of these studies are briefly highlighted in this review.

Do Vascular Lesions and Related Risk Factors Influence Responsiveness to Donepezil Chloride in Patients with Alzheimer’s Disease?

The purpose was to identify vascular influences on the responsiveness to donepezil chloride. The study included 50 untreated probable Alzheimer’s disease patients with the Modified Hachinski Ischemic Score <4. We assessed baseline cognitive status using the Revised Hasegawa Dementia Scale (HDS-R), Clinical Dementia Rating (CDR) and the clock drawing test (CDT). The response to 5 mg of donepezil was monitored by the CDT for 12 months. Patients were classified as true responders (TR), unchanged (UC) and non-responders according to changes on the CDT in response to treatment. High HDS-R scores, low CDT scores, low CDR and presence of hypertension (HBP) and periventricular hyperintensities (PVH) predicted a TR- or UC-type outcome. Aggravation of executive function by HBP and/or PVH and its improvement by donepezil may have been detected by the CDT.

Are serum lipid and lipoprotein levels related to dementia?

Although hyperlipidemia is known to contribute to vascular disease and it may play a role in dementia, specific studies for elderly are limited. The aim of this study is to examine the relationship between dyslipidemia and dementia. In this study, 1251 patients admitted to the Hacettepe University Division of Geriatric Medicine were enrolled. On the basis of the mini mental state examination (MMSE), the clock drawing test (CDT) scores, the APA DSM-IV and the NINCDS-ADRDA criteria and the Hachinski ischemic score (HIS), the subjects were divided into four groups: Alzheimer's disease (AD), vascular dementia (VD), mild cognitive impairment (MCI) and normal cognitive status (NCS). The lipoprotein levels were measured, and we analyzed the data using χ 2 and the one-way analysis of variance methods. Among the subjects, 14.8% had low high-density lipoproteins (HDL), 58.5% had high triglyceride (TG), 73.6% had high low-density lipoproteins (LDL), and 21.6% had high lipoprotein-a (Lp(a)) of our study population. There was no difference between the dementia subgroups and the NCS group in the lipoprotein levels. The only significant relationship was between high TG levels and the AD, as well as the MCI groups. Low HDL and high LDL are important problems in elderly. Although serum lipid levels, especially of Lp(a), has recently been thought to be related with dementia, our study suggests the absence of such a relationship. The national data regarding the elderly population should be evaluated on the basis of genetic and environmental factors in each country. The present study showing no significant relationship between Lp(a) and the cognitive status adds new information to the available literature.

A Synopsis of the Practice Parameters on Dementia From the American Academy of Neurology on the Diagnosis of Dementia

The objective of this paper is to review the current practice guidelines as developed by the American Academy of Neurology (AAN) for the diagnosis of dementia. The data sources were the Report of the Quality Standards Subcommittee of the American Academy of Neurology paper, which was published in the May 2001 issue of the journal Neurology. The studies used in this paper are those reviewed by the AAN Practice Parameter Committee, which reviewed the literature for evidence-based human studies pertaining to the diagnosis of dementia. Studies on Alzheimer's disease (AD) included had to have more than 25 subjects. Each article was classified based on the quality of evidence. After review of the evidence, the committee drafted recommendations and placed the evidence into Practice Standards, Guidelines, or Options. The main results of this review were the guidelines for diagnosing dementia of various forms. To diagnose dementia, the Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised (DSM-IIIR) should be used. For AD, the NINCDS-ADRDA (National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer s Disease and Related Disorders Association) criteria should be used. The Modified Hachinski Ischemic Score criteria can be used in the diagnosis of vascular dementia. The Consortium for DLB (Dementia with Lewy Bodies) criteria may be of use in clinical practice. Neuroimaging with a noncontrast CT or MRI scan in the routine initial evaluation of persons with dementia is appropriate; other methods of neuroimaging are not recommended at this time. Genetic testing and use of apolipoprotein E (ApoE) genotyping is not recommended at this time. Depression, B12 deficiency, and hypothyroidism should be screened for and treated in patients with dementia. Unless the patient lives in an area in the United States with a high rate of syphilis, screening for tertiary syphilis is not warranted. The guidelines and their clinical applications are pertinent and important knowledge for consultant pharmacists. This practice parameter will need to be updated every few years to include new studies and information that becomes available.

Using a Rasch scale to characterize the clinical features of patients with a clinical diagnosis of uncertain, probable, or possible Alzheimer disease at intake.

This study examined the clinical features of patients with clinical diagnoses of probable Alzheimer disease (AD), possible AD, and uncertain. Case study comparing three groups of AD patients diagnosed at their initial visit to an Alzheimer outpatient clinic. Southern Illinois University School of Medicine's Center for Alzheimer Disease and Related Disorders (CADRD) assessment sites (20) in rural Illinois. 300 patients assessed at CADRD between January 1, 1994 and July 1, 2000. Patients were given an extensive clinical battery consisting of physical and neurologic examination, mental status testing including the Mini-Mental State Exam (MMSE), Short Blessed Dementia (SBD) and Blessed Dementia Scale (ADL), medical history evaluation, and laboratory tests. Other data included age at visit, gender, and medical history variables. Mean MMSE, SBD, and ADL scores differed significantly between groups (p's < 0.01). In all three cognitive tests, the uncertain group was the least impaired while the probable AD group was the most impaired. A Rasch model indicated that only the cognitive measures were useful in discriminating between the three diagnostic groups. In general, probable AD patients were distinguished from possible AD patients by the severity of their dementia as measured by the MMSE, ADL and SBD as well as Hachinski-Ischemic Score (HIS) scores. A Rasch model did well at predicting group membership based upon dementia measures only. The uncertain group differed from the AD groups in age and dementia severity as measured by the MMSE, ADL and SBD. Noting differences between this and previous studies, we speculate disparity may be related to differences in population ethnicity.

The Consortium to Investigate Vascular Impairment of Cognition: methods and first findings.

The Consortium to Investigate Vascular Impairment of Cognition (CIVIC) is a Canadian, multi-centre, clinic-based prospective cohort study of patients with Vascular Cognitive Impairment (VCI). We report its organization and the impact of diagnostic criteria on the study of VCI. Nine memory disability clinics enrolled patients and recorded their usual investigations and care. A case report form included all vascular dementia (VaD) individual criteria for each of four sets (National Institute of Neurological Disorders and Stroke (NINDS-AIREN), Alzheimer's Disease Diagnostic Treatment Centers (ADDTC), the ICD-10 Classification of Mental and Behavioural Disorders (ICD-10), and the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV)) of consensus-based diagnostic criteria and for the Hachinski Ischemia Score (HIS). Investigators, having completed the case report form, were asked to make a clinical judgement about the cognitive diagnosis based on the best available information, including neuroimaging. Of 1,347 patients (mean age 72 years; 56% women), 846 (63%) were diagnosed with dementia and 324 (24%) were diagnosed with VCI. The proportion of patients diagnosed with VaD by the diagnostic criteria was: 23.9% (n = 322) by DSM-IV, 10.2% (n = 137) by HIS, 4.3% (n = 58) by ICD-10, 3.8% (n = 51) by ADTCC, and 3.6% (n = 48) by NINDS-AIREN. Judged against a clinical diagnosis of VaD, the sensitivity/specificity of each was: DSM-IV (0.77/0.80); HIS (0.41/0.92); ICD-10 (0.29/0.98); ADTCC (0.24/0.98); NINDS-AIREN (0.42/0.995). Compared with a clinical diagnosis of VCI, sensitivities were lower for the diagnostic criteria, reflecting the exclusion of patients who did not have dementia. Consensus-based criteria for VaD omit patients who do not meet dementia criteria that are modeled on Alzheimer's disease. Even for patients who do, the proportion identified with VaD varies widely. Criteria based on empirical analyses need to be developed and validated.

Alzheimer's disease and brain infarcts in the elderly. Agreement with neuropathology.

Clarifying the etiology of dementia is one of the most difficult diagnostic challenges, especially in the elderly. We examined the accuracy of clinical criteria to distinguish Alzheimer's disease (AD) and dementia associated with infarcts of the brain, either isolated (vascular dementia) or associated with degenerative lesions (mixed dementia). We carried out a prospective clinico-neuropathological study in a selected series of hospitalized patients. We evaluated the clinical aspects of 33 patients aged over 75 years by use of the criteria and scores of DSMIII, NINCDS-ADRDA, Loeb and Gandolfo, ADDTC and NINDS-AIREN and the Hachinski Ischemic Score. The neuropathological diagnosis was considered to be the gold standard. When comparing clinical criteria and neuropathology, the agreement was moderate for Hachinski's score (0.50) and Loeb's score (0.43) and substantial for the ADDTC (0.63) and the NINDS-AIREN (0.67). When mixed dementias were excluded, the agreement between all clinical criteria and scores and the pathological diagnosis rose to 0.88. Hachinski's score was the most sensitive (0.89) and the NINDS-AIREN the most specific (0.86) for the diagnosis of vascular dementia. In conclusion, all sets of clinical criteria distinguished pure AD from vascular dementia with a high accuracy whereas mixed dementia was clinically under-recognized. The NINDS-AIREN criteria were the most discriminating for the accurate identification of patients with mixed dementia.

Correlates of delayed referral for the diagnosis of dementia in an outpatient population.

Early diagnosis of dementia is critical, but there is usually a time lag between onset of symptoms and referral for neuropsychological testing and dementia diagnosis. We aimed to identify factors correlated with this delayed referral. We studied 140 patients with cognitive deterioration referred to the Memory Clinic of the Catholic University (Rome) between 1995 and 1996. Alzheimer's disease or multi-infarct dementia was diagnosed according to National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer's Disease and Related Disorders Association (NINCDS-ADRDA) criteria and Hachinski ischemic score. Global cognitive and neuropsychological functions were assessed with the Mini-Mental State Exam (MMSE) and the Mental Deterioration Battery. The performance on the Activities of Daily Living was used to measure physical function. The time between onset of signs of cognitive deterioration and referral for diagnosis (time to diagnosis: TTD) was estimated through a semistructured interview of the caregiver. Independent correlates of TTD were identified after adjustment for potential confounders and stratifying patients based on level of physical function. Of 127 eligible patients, 63% had Alzheimer's disease, 26% multi-infarct dementia, and 11% had dementia of other types. Mean age was 73.9 +/- 8.2 years, and 59% of patients were females. The mean TTD was 13.8 +/- 10.8 months and did not differ by gender, household composition, or type of dementia. For patients with normal physical function, increased age (beta = .50), female sex (beta = .51), and low MMSE score (beta = .36) were associated with longer TTD. Among patients with physical impairment, only MMSE score showed an association with TTD, but it was of opposite direction (beta = -.31). These associations were consistent by type of dementia. Age, gender, and degree of cognitive impairment are important correlates of the time between onset of signs/symptoms and referral for dementia diagnosis. These factors are independent of the type of dementia but are influenced by the level of physical function.

Diffusion-weighted MRI in vascular dementia.

To examine the ability of diffusion-weighted MRI (DWI) to detect ongoing cerebral ischemia in patients with vascular dementia (VaD). VaD due to small-vessel disease results from the cumulative impact of recurrent cerebral ischemia. Cerebral ischemia may produce clinical manifestations, producing the "stepwise" decline characteristic of VaD. Conventional MRI can detect small regions of ischemic damage but cannot determine when injury developed. In contrast, DWI shows sensitivity in detecting ischemia of recent onset. Patients with VaD (n = 30) underwent DWI in addition to standard MRI sequences. Patients were divided into two groups according to the presence of new focal deficits or mental change within 10 days before MRI. In 10 patients of positive group, symptomatic neurologic decline occurred an average of 4.2 days before the imaging procedure. Seven (70%) of 10 patients with a recent neurologic event showed 15 new regions of signal abnormality on DWI. The anatomic distribution of signal change could account for the patients' new symptoms or signs in all but one patient. Similar signal abnormality was detected in 4 (20%) of 20 patients without a recent neurologic event. New foci of altered signal intensity were distinguishable from prior injuries only with DWI. No significant difference was found between patients with and without DWI abnormalities in gender, age, Mini-Mental State Examination score, Hachinski Ischemic Score, vascular risk factors, or severity of increased signal on T2-weighted MRI scans. Small foci of abnormal signal on diffusion-weighted MRI (DWI), presumably representing recent small infarcts, occur often in vascular dementia (VaD) from small-vessel disease, even in patients without a recent "stepwise decline." The results suggest that DWI might be used to monitor VaD progression in future observational and interventional studies of this disorder.

Frequency and Distribution of Vascular Dementia

It remains difficult to draw conclusions about the frequency and distribution of vascular dementia (VaD). The data from current studies cannot be compared and reconciled easily. Disagreement on diagnostic criteria and their field implementation remains the major problem. In particular, there is uncertainty about the classification of patients who show both vascular and degenerative features, about the advantages and disadvantages of using brief clinical scales (e.g., the Hachinski Ischemic Score), about the use of imaging findings in defining VaD, and about the minimal level of severity to be included in epidemiologic studies. Nevertheless, we can tentatively summarize current epidemiologic data in four points. (1) Both the prevalence and the incidence of VaD increase steeply with age. (2) The prevalence of VaD is generally higher among men than among women; the sex difference is more controversial for incidence. (3) There are sizeable differences in both incidence and prevalence across countries. (4) A declining trend in both the prevalence and the incidence of VaD was reported from one population; however, the decline was restricted to the age class 80-89 years. No trends data are available after the 1970s.

Eptastigmine led to cognitive, clinical, and functional benefits in Alzheimer's disease

Imbimbo BP, Martelli P, Troetel WM , et al, and the Eptastigmine Study Group. Efficacy and safety of eptastigmine for the treatment of patients with Alzheimer's disease. Neurology1999 Mar 10;...

Penetrance and Phenotypic Expression of a Mutation Linked to Creutzfeldt-Jakob Disease in the Elderly

We have previously reported several carriers of the PRNP E200K point mutation among subjects aged over 65 years. In order to examine the prevalence of this mutation among demented subjects of Libyan and Tunisian origin and the clinical characteristics associated with it, we screened 58 elderly subjects belonging to this ethnic group. Five mutation carriers were identified, all of whom had cognitive deterioration consistent with primary degenerative dementia. All had low Hachinski ischemic scores (0.8 ± 0.8, mean ± SD) as compared with noncarriers (6.7 ± 3.0; p = 0.011, Wilcoxon rank sum test). In addition to the cognitive decline, 4 carriers had additional cerebellar, pyramidal, or extrapyramidal findings compatible with the diagnosis of possible or probable Creutzfeldt-Jakob disease.

痴呆の有病率 高齢化率２５％（６５歳以上）の町における疫学調査

The prevalence of dementia in Japan in 1985 for people aged 65 years or older was 4.8%. Vascular dementia (VD) has been reported to be the commonest subtype A report from Tokyo in 1970 showed that it was 2.8 times more frequent than Alzheimer type dementia (SDAT). We assessed the prevalence of dementia in a rural area (population: 12,931, 25.3% were 65 years or older in 1994) in Kyoko. First, we questioned subjects about their demographic circumstances, memory disturbance, apraxia (agnosia) and daily activities. Our questionnaire was answered by 3.132 (95.8%) subjects, and 2,280 of them agreed to be examined by neurologists. Those who met the appropriate criteria of the DSM-III-R and NINCDS-ADRDA were diagnosed with dementia. By use of the Hachinski ischemic score (HIS), we distinguished VD from non-vascular dementia. In this study patients with non-vascular dementia were diagnosed with SDAT by the neurologists. Analysis of the data revealed that 4.8% of the study population was demented. According to the HIS results, only 3 of 15 had vascular dementia. The prevalence of dementia was the same as the average prevalence in Japan even though the elderly population of this town was twice as high as the average. It is hard to determine the prevalence of dementia in any community. Many factors must be taken into consideration: the coverage rate, the criteria for dementia, and whether to include institutionalized residents. The prevalence of dementia will increase with the aging of the population, and we must collect accurate data in order to plan efficiently.

Vascular risk factors and lipoprotein(a) levels in the differential diagnosis of dementias

Summary Several vascular risk factors, including lipoprotein(a) (Lp(a)) levels, and its apo(a) isoforms were evaluated in 104 consecutively hospitalized demented patients, with the aim of comparing their prevalence in dementias of different etiology. The sample included 67 vascular dementias (VD), 29 senile dementias of Alzheimer's type (SDAT), and 8 hemorrhagic dementias (HD). The NINDS-AIREN and NINCDS/ADRDA criteria were used for the diagnosis. Hypertension, and signs of left ventricular hypertrophy (LVH) were more frequent in VD and HD, than in SDAT, and were positively associated with cortical-subcortical infarction; signs of LVH were also associated with leukoaraiosis. Demented patients had lower total cholesterol (TC) and high density lipoprotein-C (HDL-C) levels than controls. No differences in serum lipids emerged between the 3 demented groups. Median Lp(a) was higher in VD, as compared to SDAT and controls, and in patients with lacunar infarctions. Lp(a) higher than 30 mg/dl was more frequent in VD than in SDAT and controls. Apo(a) S1 isoforms were significantly more frequent in VD than in SDAT + HD; isoforms heavier than S4 were more frequent in HD than in VD and SDAT. The Hachinski ischemic score (HIS) was positively correlated with Lp(a) levels (Spearman Rho = 0.23, p

Meta-analysis of the Hachinski Ischemic Score in pathologically verified dementias.

Our objectives were to investigate the utility of the Hachinski Ischemic Score (HIS) in differentiating patients with pathologically verified Alzheimer's disease (AD), multi-infarct dementia (MID), and "mixed" (AD plus cerebrovascular disease) dementia, and to identify the specific items of the HIS that best discriminate those dementia subtypes. Investigators from six sites participated in a meta-analysis by contributing original clinical data, HIS, and pathologic diagnoses on 312 patients with dementia (AD, 191; MID, 80; and mixed, 41). Sensitivity and specificity of the HIS were calculated based on varied cutoffs using receiver-operator characteristic curves. Logistic regression analyses were performed to compare each pair of diagnostic groups to obtain the odds ratio (OR) for each HIS item. The mean HIS (+/- SD) was 5.4 +/- 4.5 and differed significantly among the groups (AD, 3.1 +/- 2.5; MID, 10.5 +/- 4.1; mixed, 7.7 +/- 4.3). Receiver-operator characteristic curves showed that the best cutoff was < or = 4 for AD and > or = 7 for MID, as originally proposed, with a sensitivity of 89.0% and a specificity of 89.3%. For the comparison of MID versus mixed the sensitivity was 93.1% and the specificity was 17.2%, whereas for AD versus mixed the sensitivity was 83.8% and the specificity was 29.4%. HIS items distinguishing MID from AD were stepwise deterioration (OR, 6.06), fluctuating course (OR, 7.60), hypertension (OR, 4.30), history of stroke (OR, 4.30), and focal neurologic symptoms (OR, 4.40). Only stepwise deterioration (OR, 3.97) and emotional incontinence (OR, 3.39) distinguished MID from mixed, and only fluctuating course (OR, 0.20) and history of stroke (OR, 0.08) distinguished AD from mixed. Our findings suggest that the HIS performed well in the differentiation between AD and MID, the purpose for which it was originally designed, but that the clinical diagnosis of mixed dementia remains difficult. Further prospective studies of the HIS should include additional clinical and neuroimaging variables to permit objective refinement of the scale and improve its ability to identify patients with mixed dementia.

Sensitivity and specificity of newly proposed clinical criteria for possible vascular dementia.

The objective of this study was to determine the sensitivity and specificity of clinical criteria for possible vascular dementia (VaD) recently developed independently by two groups: the State of California Alzheimer's Disease Diagnostic and Treatment Centers (ADDTC) and the National Institute for Neurological Disorders and Stroke with the Association Internationale pour la Recherche et l'Enseignement en Neurosciences (NINDS-AIREN). We also wished to compare the performance of the new criteria to that of the Hachinski Ischemic Score (HIS). The study was comprised of a retrospective chart review and clinicopathologic correlation, and took place in 304-bed acute-care geriatric hospital. The subjects were 113 autopsied elderly patients with dementia, who were assessed to determine sensitivity and specificity of the ADDTC and NINDS-AIREN criteria for possible VaD. Sensitivity and specificity were calculated using the neuropathologic diagnosis as a gold standard. Sensitivity was 0.63, and specificity was 0.64 for the ADDTC, 0.58 sensitivity and 0.80 specificity for the NINDS, and 0.43 sensitivity and 0.88 specificity for the HIS. Test combinations did not lead to substantial gains in sensitivity or specificity. The majority of patients with Alzheimer's disease were successfully excluded by the ADDTC (87%), the NINDS-AIREN (91%), and the HIS (97%). The proportion of mixed dementia cases clinically misclassified as VaD was 54% for the ADDTC, 29% for the NINDS-AIREN, and 18% for the HIS. Low sensitivity is the main weakness of the above clinical criteria for possible VaD. Mixed dementia is better excluded by the NINDS-AIREN than the ADDTC. Data from this validation study should provide valuable information to clinicians and researchers who wish to apply these criteria to the diagnosis of VaD.

Misclassification of dementia subtype using the Hachinski Ischemic Score: results of a meta-analysis of patients with pathologically verified dementias.

Misclassification of dementia subtype using the Hachinski Ischemic Score: results of a meta-analysis of patients with pathologically verified dementias.

Utility of ischemic scores in the differential diagnosis of Alzheimer's disease and ischemic vascular dementia.

Despite new developments in the concept of vascular dementia, the Hachinski Ischemic Score (HIS) and its modified versions continue to be widely used in the clinical differentiation of Alzheimer's disease (AD) and ischemic vascular dementia (IVD). The sensitivity of the HIS and two modified versions in the diagnosis of AD, IVD, and single infarcts in a large, geriatric population with mild cognitive impairment (N = 100) was evaluated. Sensitivity for identification of AD was greater than 90% but was less than 70% for IVD. Over one third of patients with one or more infarcts on computed tomographic brain scans and 63% of mixed cases were classified as having probable AD. It is concluded that ischemic scores may be useful at predicting prevalence rates if individual case accuracy is ignored. Despite being sensitive to identifying AD, ischemic scores are insensitive to both cerebral infarction and IVD and cannot reliably exclude IVD. Finally, patients with mixed dementia should not be expected to have intermediate scores.