The featured paper is ‘Comparability of the Clinical Diagnostic Criteria for Vascular Dementia: A Critical Review Part 1’ by Wiederkehr and colleagues.
This is a clever approach to a review with clinically relevant results. This isn’t a systematic review but I would class it as a semi-structured review. The reason for this is that there are no stated criteria for selecting the papers or criteria for review or indeed for identifying the criteria in the first instance. However the authors have selected eight criteria that are used for the diagnosis of vascular dementia and then appraised each of these (although the methodology is not formally stated). A table comparing the criteria is included. By adopting this approach, it is easy for the reader to see the strengths and weaknesses of the different criteria and how new criteria could be constructed utilising the lessons learnt from the above. The authors state that there is not supporting longitudinal data for the various criteria and compare this with the criteria for Alzheimer’s Disease. Indeed one of the difficulties with the vascular dementia construct is that there is heterogeneity in the syndromes, aetiologies and lesions. Moving towards a homogenous grouping which the authors suggest at the end – with primary lesions for example, may still lead to the creation of artificial boundaries which could result in grouping dissimilar conditions. A dimensional approach might well be a solution for the vascular dementias, with different dimensions corresponding with neuropsychological deficits, established vascular lesions, aetiological factors and so on.
The authors conclude by stating that:-
‘There is now a vital need for an international agreement on clinical criteria for the diagnosis of vascular dementia as well as subtypes of vascular dementia that would take into consideration the heterogenous nature of the vascular mechanisms‘
Steps to Treatment = 5 (Refinement of current criteria, testing of new criteria, inclusion in policy, use in practice leading to diagnosis, treatment following diagnosis)
Wiederkehr S, Simard M, Fortin C and van Reekum R, Comparability of the Clinical Diagnostic Criteria for Vascular Dementia: A Critical Review. Part 1. The Journal of Neuropsychiatry and Clinical Neurosciences.
Steps To Treatment (STT)
STT = Steps To Treatment. An estimate of the number of steps between the results and translation into practice i.e. treatment. This is an opinion.
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