Criteria for the diagnosis of vascular dementia (VaD) that are reliable, valid, and readily applicable in a variety of settings are urgently needed for both clinical and research purposes. To address this need, the Neuroepidemiology Branch of the National Institute of Neurological Disorders and Stroke (NINDS) convened an International Workshop with support from the Association Internationale pour la Recherche et l'Enseignement en Neurosciences (AIREN), resulting in research criteria for the diagnosis of VaD. Compared with other current criteria, these guidelines emphasize (1) the heterogeneity of vascular dementia syndromes and pathologic subtypes including ischemic and hemorrhagic strokes, cerebral hypoxic-ischemic events, and senile leukoencephalopathic lesions; (2) the variability in clinical course, which may be static, remitting, or progressive; (3) specific clinical findings early in the course (eg, gait disorder, incontinence, or mood and personality changes) that support a vascular rather than a degenerative cause; (4) the need to establish a temporal relationship between stroke and dementia onset for a secure diagnosis; (5) the importance of brain imaging to support clinical findings; (6) the value of neuropsychological testing to document impairments in multiple cognitive domains; and (7) a protocol for neuropathologic evaluations and correlative studies of clinical, radiologic, and neuropsychological features. These criteria are intended as a guide for case definition in neuroepidemiologic studies, stratified by levels of certainty (definite, probable, and possible). They await testing and validation and will be revised as more information becomes available.

Our purpose was to verify some basic aspects of validation of the Unified Parkinson's Disease Rating Scale (UPDRS). One hundred and sixty-seven Parkinson's disease (PD) patients were included. Group A (n = 40) was simultaneously assessed by five raters who applied the UPDRS and other PD rating scales (PDRS). A set of timed tests, the Mini-Mental State Examination (MMSE), and the Hamilton Scale for Depression (HSD) were administered by an independent examiner. Group B (n = 127) was individually assessed through the UPDRS and the other PDRSs by one neurologist in four different hospitals. The UPDRS was administered in 16.95 +/- 7.98 min. The internal consistency was high (Cronbach's alpha = 0.96). Nevertheless, the items related to depression, motivation/initiative, and tremor were scarcely consistent. The Interrater reliability was satisfactory (all the items had k > 0.40). There was a high correlation of the UPDRS with the Hoehn and Yahr staging (rs = 0.71; p < 0.001) and some timed tests (finger tapping; arising from chair), but also with the MMSE and HSD (rs = 0.53; rs = 0.64; p < 0.001). The convergent validity with the other PDRS (Intermediate Scale and Schwab and England Scale) was very high (rs = 0.76-0.96; p < 0.001). The factor analysis identified six factors that explained 59.6% of the variance. The dimension "tremor" showed a remarkable independence. The UPDRS is a multidimensional, reliable, and valid scale, with some inconveniences derived from its internal consistency, discriminant validity, and pragmatic application.

There is limited information about long-term prognosis of ischemic stroke in young adults. Giving the potentially negative impact in physical, social, and emotional aspects of an ischemic stroke in young people, providing early accurate long-term prognostic information is very important in this clinical setting. Moreover, detection of factors associated with bad outcomes (death, recurrence, moderate-to-severe disability) help physicians in optimizing secondary prevention strategies. The present paper reviews the most relevant published information concerning long-term prognosis and predictors of unfavorable outcomes of ischemic stroke affecting young adults. As a summary, we can conclude that, in the long term, stroke in the young adult increases slightly the risk of mortality, implies higher risk of future cardiovascular events, and determines functional limitations in a significant percentage of patients. Nevertheless, in every individual case the prognosis has to be considered depending on several factors (stroke subtype, initial severity, cardiovascular risk factors) that determine the long-term outcomes.

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Participation rates were good in both phases of the NEDICES baseline study, and this was influenced by age, sex and setting of the participants. Educational attainment, occupation and health status data are analogous to other Spanish studies performed in the elderly. As the study population was large and good participation rates were achieved, precise analysis of morbidity of the neurological disorders investigated will be possible.