Hachinski Ischaemic Score
Differentiates vascular dementia from Alzheimer-type dementia (Hachinski 1975). Sums 13 weighted clinical features. Score ≥7 = vascular dementia; ≤4 = Alzheimer's; 5–6 = mixed.
Score interpretation
→ Investigate Alzheimer's: MRI / FDG-PET / CSF biomarkers / amyloid PET as available. Cholinesterase inhibitor (donepezil, rivastigmine, galantamine) per NICE TA217. Memantine for moderate-severe disease.
→ Investigate both pathologies. Vascular risk-factor optimisation (BP, lipids, antiplatelet). Cholinesterase inhibitor trial reasonable. MRI pattern (medial temporal vs subcortical lacunes/leukoaraiosis) helps.
→ MRI brain to characterise small-vessel disease / strategic infarcts. Aggressive vascular prevention (target BP <130/80, statin, antiplatelet if no AF, clopidogrel preferred per CAPRIE in stroke). Memantine off-label only; cholinesterase inhibitors not recommended in pure vascular dementia.
Interpretation bands for the Hachinski. Apply clinical judgement and local guidance.
References
Related
Curated clinical cross-links plus same-class fallbacks.
- Aspirin (Loading Dose) · Antiplatelet — ACS / Ischaemic Stroke
- Alteplase (tPA) · Thrombolytic — Ischaemic Stroke / Massive PE
- Donepezil · Acetylcholinesterase inhibitor (AChEI) — dementia
- Memantine · NMDA receptor antagonist — dementia
- Rivastigmine · Dual AChEI and BuChEI inhibitor — dementia
- Quetiapine (Elderly — Dementia Caution) · Atypical Antipsychotic
- Acute Stroke / TIA Assessment · NICE NG128; RCP Stroke Guidelines 2023
- Status Epilepticus (Adults) · NICE CG137; ESEM guidelines; RCP Neurology Guidelines
- Suspected Subarachnoid Haemorrhage · NICE NG228; RCEM 2023; AHA/ASA 2023
- Adult Head Injury · NICE NG232 (2023)
- Bell's Palsy / Facial Nerve Palsy · ENT UK 2017; AAN
- Vertigo Workup · ENT UK; NICE CKS
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.