Reliability study of white matter rating scale for the Dementia and Disability in Thai Elderly Project

Abstract

Objective: To study the reliability of white matter rating scale on magnetic resonance imaging (MRI) of elderly patients in the urban community of Bangkok. Material and Method: One hundred elderly with clinical diagnosis of cognitive impairment in the urban community around Siriraj Hospital underwent cranial MRI according to the Dementia and Disability in Thai Elderly Project. The axial T1wi, T2wi, and fluid attenuated inversion recovery (FLAIR) were separately assessed by two neuroradiologists. The assessment included white matter change by using Scheltens' rating scale, atrophy, and evidence of infarction. The inter-rater agreements were analyzed. Results: The inter-rater agreement of periventricular hyperintensities, white matter, basal ganglion and infratentorial foci of hyperintensities were very good (ICC = 0.89-0.98).The agreement was good for central atrophy (Kw = 0.66) and moderate for cortical atrophy (Kw = 0.49). The silent infarction was found in the study population and divided into cortical (15%), subcortical (26%), brainstem (3%), and infratentorial infarction (8%). Conclusion: White matter hyperintensities was an important radiological criteria for diagnosis of vascular dementia. Appropriate rating scale is necessary especially in research study. The authors found that Scheltens' rating scale needed some training and slightly time consuming at the beginning but was a good reliable tool.