首页|期刊导航|中华医学杂志（英文版）|A new diagnostic algorithm for vascular cognitive impairment: the proposed criteria and evaluation of its reliability and validity
中华医学杂志（英文版）2010，Vol.123Issue(3)：311-319,9.DOI:10.3760/cma.j.issn.0366-6999.2010.03.011
A new diagnostic algorithm for vascular cognitive impairment: the proposed criteria and evaluation of its reliability and validity
A new diagnostic algorithm for vascular cognitive impairment: the proposed criteria and evaluation of its reliability and validity
摘要
Abstract
Background Vascular cognitive impairment (VCI) is considered to be the most common pattern of cognitive impairment. We aimed to devise a diagnostic algorithm for VCI, and evaluate the reliability and validity of our proposed criteria.Methods We based our new algorithm on previous literature, a Delphi consensus method, and preliminary testing. First, successive 100 patients with cerebrovascular disease (CVD) in hospital underwent a structured medical examination. Twenty-five case vignettes fulfilled the proposed criteria of diagnosis for probable or possible VCI were divided into three subtype categories: vascular cognitive impairment, no dementia (VCIND), vascular dementia (VaD) or mixed VCI/Alzheimer's disease (AD). Inter-raters reliability was assessed using a Fleiss kappa analysis. Convergent validity was also evaluated by correlation coefficients (r) between the proposed key points for each subtype and the currently accepted criteria. Forty-five patients with probable VCI were examined to determine the accuracy of identification for each subtype.Results The proposed criteria showed clinical diagnostic validity for VCI, and were able to define probable, possible and definite VCI, three VCI subtypes, and vascular causes. There was good consensus between experts (Cronbach's α=0.96 for both rounds). Significant moderate to good items-total correlations were found for two questionnaires (50-r range, 0.40-0.97 and 0.41-0.99, respectively). Significant slight and moderate inter-raters reliability were obtained for VCI (k=0.13) and three VCI subtypes (k=0.45). Furthermore, good convergent validity was observed in a comparison of significant correlations between criteria: good (4-r range, 0.75-0.92) to perfect (3-r=1.00) validity for the VCIND subtype, and moderate to good validity for the VaD subtype (1-r=0.46; 5-r range, 0.76-0.92) and for the mixed VCI/AD subtype (r=0.92 and 1.00; 4-r range, 0.47-0.70). Importantly, the area under receiver operating characteristic (ROC) curves for the subtypes of VCIND, VaD and mixed VCI/AD were 0.85, 0.67 and 0.93, respectively.Conclusion Our results suggest that the new VCI diagnostic algorithm might be a suitable clinical approach for assessing stroke patients.关键词
criteria/vascular cognitive impairment/subtype/cerebrovascular disease/validityKey words
criteria/vascular cognitive impairment/subtype/cerebrovascular disease/validity引用本文复制引用
ZHAO Qian-lu,ZHOU Yong,WANG Yi-long,DONG Ke-hui,WANG Yong-jun..A new diagnostic algorithm for vascular cognitive impairment: the proposed criteria and evaluation of its reliability and validity[J].中华医学杂志（英文版）,2010,123(3):311-319,9.基金项目
This study was supported by a grant from the National Science and Technology Programme in the 11th Five-year Plan (No. 2006BA101A11). （No. 2006BA101A11）
