This calculator is for general information and education. It is not medical advice and does not replace the judgment of a doctor, nurse or pharmacist who knows the full clinical picture.
Vascular or degenerative dementia?
Dementia has many causes. The most common is Alzheimer’s disease, a degenerative condition that progresses slowly. The second is vascular dementia, caused by strokes or by disease of the small vessels of the brain. In 1975, Vladimir Hachinski and colleagues proposed a score based on features of the history and examination that are typical of a vascular cause.
The 13 items
2 points each:
- Abrupt onset
- Fluctuating course
- History of strokes
- Focal neurological symptoms (for example sudden weakness or loss of speech)
- Focal neurological signs on examination
1 point each:
- Stepwise deterioration
- Nocturnal confusion
- Relative preservation of personality
- Depression
- Somatic complaints
- Emotional incontinence
- History of hypertension
- Evidence of associated atherosclerosis
The maximum is 18.
Example
An 80-year-old with slowly progressive memory loss has a history of hypertension and known atherosclerosis but no strokes or focal signs:
- Score: 2, suggesting a degenerative dementia such as Alzheimer’s disease
Another patient whose problems began abruptly after a stroke, progressed in steps, with hypertension and a weak arm on examination, scores 2 + 1 + 1 + 2 + 2 = 8, suggesting vascular dementia.
Interpretation
- 4 or less: degenerative dementia more likely
- 5 to 6: indeterminate, often mixed
- 7 or more: vascular dementia more likely
Studies comparing the score with autopsy findings showed good separation between pure Alzheimer’s disease and multi-infarct dementia, but much less accuracy for mixed dementia, which is common in older people.
In practice
The score remains a useful structured summary of the history. Today, brain MRI or CT is essential to show strokes, white matter lesions and other causes, and a full assessment includes cognitive tests, blood tests and often a specialist memory clinic. Controlling blood pressure, diabetes, cholesterol and smoking helps prevent further vascular damage whatever the score.