Vladimir Hachinski is a Canadian clinical neuroscientist and researcher based at the Schulich School of Medicine and Dentistry at Western University. He is also a Senior Scientist at London's Lawson Health Research Institute. His research pertains in the greatest part to stroke and dementia, and the interactions between them. He helped to establish the world's first successful stroke unit at Sunnybrook Hospital in Toronto, and, by extension, helped cement stroke units as the standard of care for stroke patients. He also helped discover that the insula mediates the cardiac complications of stroke, and elucidated its importance in the mechanism of sudden death following stroke.
Hachinski has held many prominent positions in the global neurology community, including editor-in-chief of the journal Stroke and president of the World Federation of Neurology. He is a Fellow of the Royal Society of Canada (FRSC)and the Canadian Academy of Health Sciences (FCAHS), a Member of the Orders of Canada and Ontario, and the recipient of several national and international awards and recognitions for his research and advocacy.
Early life, education, and early career
Hachinski was born in Zhytomyr, Ukraine, the eldest of three children. He moved with his family to Caripito, Venezuela as a child. The family moved to Port Perry, Ontario, Canada soon after. When he arrived in Canada, he knew only a little English, but he learned quickly, graduating from Port Perry High School a year later at the top of his class and with top marks in English.
Hachinski received his MD in 1966 from the University of Toronto, and completed his residency in internal medicine and neurology at centres in Toronto and Montreal, followed by a neurophysiology fellowship in Toronto. He received his formal accreditation in neurology as a Fellow of the Royal College of Physicians and Surgeons of Canada (FRCPC) in 1972. From 1973-74, a research fellowship with the Ontario Department of Health brought him to a cerebrovascular laboratory at the National Hospital for Nervous Diseases in London, England, and then to the Department of Clinical Physiology at Bispebjerg Hospital in Copenhagen, Denmark.
Following this, he returned to Toronto to take a staff position in the Department of Neurosciences at Sunnybrook Medical Centre, where he and Dr. John W. Norris established the MacLachlan Stroke Unit, Canada’s first acute stroke unit. Hachinski remained at Sunnybrook until 1980, when he moved to London, Ontario to act as a neurology consultant for its major health centres: University Hospital, Victoria Hospital, St. Joseph's Hospital, and the London Psychiatric Hospital. He was hired concurrently as a professor at Western University (then called the University of Western Ontario). During this time (and until 1990), he also acted as Director of the Investigative Stroke Unit at London’s University Hospital.
In 1987, he earned a Master of Science degree from McMaster University in Hamilton, Ontario, studying in the Department of Epidemiology and Biostatistics with a focus on design, measurement, and evaluation. The University of London’s highest earned degree, Doctor of Science (in Hachinski's case, in medicine), was conferred upon him in 1988 for his “contributions to migraine, stroke, and dementia.”
Vascular cognitive impairment
At the beginning of Hachinski’s career, the prevailing view was that most dementias were caused by hardened brain arteries (mental deterioration via cerebral atherosclerosis). Still a junior neurologist at the time, Hachinski showed in 1974 that, in fact, only a small minority of dementias were so-caused, and that most were “multi-infarct dementias” — dementias caused by multiple, small, often imperceptible strokes. The terms “vascular dementia” and “vascular cognitive impairment” would later be widely adopted to describe all cognitive impairments in order to distinguish them from primary degenerative dementia (i.e., Alzheimer disease and senile dementia) and to emphasize that they are preventable and treatable, insofar as their vascular causes (i.e., atherosclerosis, stroke, etc.) are treatable as well.
In the same year, on the heels of that revelation and the corresponding lingual retooling, Hachinski and colleagues submitted for publication an ischemic score (later eponymously called the Hachinski Ischemic Scale) for use in diagnosing multi-infarct and primary degenerative dementias. Successfully distinguishing between the two is tremendously important for patient prognosis, as treating the vascular causes of dementias can mitigate their effects. The scale is a prolifically cited tool, and has since been validated and optimized for use outside of clinical research settings.
In 1986, the journal, Archives of Neurology published a series of papers by Hachinski, Harold Merskey and colleagues on the rarefaction of white matter in the brains of elderly people. These papers were among the first to recognize the importance of white matter lesions as risks for stroke and dementia. Rarefaction of white matter in the brain had already been shown to be correlated with a wide variety of health problems, but these papers were groundbreaking for two reasons especially: First, they introduced the term, “leukoaraiosis,” a word derived by Hachinski, Paul Potter and Harold Merskey to etymologically and Hippocratically describe the rarefaction; and second, they specifically highlighted a previously underappreciated relationship between vascular risk factors for cognitive impairment (i.e., treatable and preventable risk factors for both stroke and multi-infarct dementia) and leukoaraiosis. By coining “leukoaraiosis,” Hachinski drew medical practitioners’ attention to these white matter hypodensities in the brains of patients affected by small strokes.
Hachinski continued to develop and promote his novel approach to dementia — viewing it as a product of preventable and treatable vascular problems, thus itself also amenable to prevention, delay, and mitigation — eventually coining it as the “vascular cognitive impairment approach” to dementias in 1994. This proactive and preventative, rather than solely retroactive and treatment-based approach included other novel coinages, such as “brain at risk,” describing patients without cognitive impairment but with risk factors for it.
Even with these developments, available diagnostic criteria for dementias continued to present a challenge, as they were not able to capture the complex, interactive, and adaptive nature of brain pathologies leading to dementia. For this reason, in 2006, Hachinski decided to lead (with Gabrielle LeBlanc) the development of minimal common standards to describe the clinical, neuropsychological, imaging, genetic, and neuropathological features of cognitive impairment. This standardization has allowed for ongoing improvement of the diagnostic criteria with new knowledge, comparison of results from different studies, and analysis & meta-analysis using “big data” techniques.
The MacLachlan Stroke Unit at Sunnybrook, Canada’s first stroke unit (est. 1975), was almost 20 years ahead of its time; stroke units have been considered the most effective treatment for stroke patients of all ages, severities, and types only since the 1990s. Hachinski and Norris' early work with that unit and others helped to cement the importance of dedicated wards for stroke patient monitoring and treatment, but his research over the next 17 years also shaped how those treatments and monitoring methods are executed.
In 1986, while he was Director of the Investigative Stroke Unit at University Hospital in London, he developed (with Robert Coté), the Canadian Neurological Scale – a simple but systematic tool, usable by non-physicians for evaluating and monitoring the neurological status of patients with acute stroke. Later, in 1992, he (with collaborators David Cechetto and Stephen Oppenheimer) began work to explore possible mechanisms for observed increases in catecholamines, cardiac enzymes, arrhythmias, and sudden death following acute stroke. This would eventually lead to the discovery that the insula of the brain is the mediator of these various cardiac complications.
In addition to his interest in the mechanisms of stroke and best practices for treatment, Hachinski also has a keen research interest in stroke prevention. He acted as the principal neurological investigator on several seminal, multicentre studies, beginning with the Canadian-American Ticlopidine study (1983–88) and the Extracranial/Intracranial Arterial Bypass Surgery trial (1983–87). The former showed a preventative advantage to the drug Ticlopidine over commonly-prescribed Aspirin, while the latter showed that the increasingly popular and very expensive EC/IC arterial bypass procedure did not significantly reduce the risk of ischemic stroke.
In 2003, alongside several other researchers, Hachinski began a proof of principle study through the Canadian Stroke Network on secondary stroke prevention. The study aimed to explore the efficacy of stroke risk-factor counselling and monitoring in effecting lifestyle changes and prescription adherence in patients, as well as exploring barriers and testing possible solutions to effective stroke risk-factor management. The preliminary results were extremely promising, showing that the addition of a lay-person to usual stroke care results in far better outcomes and reduced risk-factors. That initial study led to the creation of a multi-centre study in 2009 under the direction of Richard Chan.
Hachinski's home province of Ontario, Canada introduced a formal Provincial Stroke System in 2000. At the time, Hachinski hypothesized that this increased attention to stroke care would result not only in decreased incidence of stroke, but also in some dementias, since they share most of the same treatable risk factors. The prediction was correct, and he is therefore advocating a strategy of preventing some dementias through the prevention of stroke. With Luciano Sposato, Moira Kapral and others, he showed, for the first time, a concomitant decrease in the incidence of stroke and dementia at a whole-population level.
Key administrative positions and advocacy
Hachinski has held numerous high-level administrative positions in the medical community during his career.
- 2011–present : Founding chair, World Brain Alliance: a collection of the most important international organizations promoting brain/mental health and reducing brain/mental health disorders, founded on three premises:
- There is no health without brain health
- Brain health begins with the mother's and the child's education
- Our brains are our future
- 2010-13 : President, World Federation of Neurology (WFN; international body representing world neurology); first Canadian in its six decades history
- 2006-10: Vice President (North America), WFN
- 2000-10: Editor-in-Chief, Stroke
- 2008-12 : Vice President, World Stroke Organization
- 2004-06: Led working group to develop World Stroke Agenda (2004, Vancouver) and World Stroke Day Proclamation (2006, Capetown), observed every October 29.
Hachinski's primary popular medicine contributions have been publications in cooperation with his son, Vladimir, and daughter, Larissa. With Vladimir, he published an article in the Journal of the Canadian Medical Association called, "Music and the Brain" in August 1994. With Larissa, he published the book, Stroke: A Comprehensive Guide to Brain Attack in 2003. Coining and employing the term “brain attack,” the book was written to increase public awareness of the importance of adequate stroke care and early intervention.
An interest in the history of medicine has led Hachinski to publish several articles on the subject over the course of his career:
- “Stalin’s last years: delusions or dementia?” European Journal of Neurology. 6:129-132, 1999.
- “Kos (A poem about Hippocrates).” The Lancet. 349:1561, 1997.
- “On the names of Babinski.” Canadian Journal of Neurological Sciences. 23:76-79, 1996.
- “Neurology in Islamic Spain: a call for further research.” Journal of the History of the Neurosciences. 2:45-51, 1993.
- “Cajal: crossroads to greatness.” Annals of the Royal College of Physicians and Surgeons of Canada. 25:290-292, 1992.
- “H.J.M Barnett: a biographical sketch.” (a) Surgical Neurology. 26:529-531; 1986. (b) “Modern Neurosurgical Giants” Ed: Bucy PC. Elsevier, New York, pp. 35-38, 1986.
- “Transient cerebral ischemia: a historical sketch.” In: Historical Aspects of the Neurosciences. (Eds) Rose FC, Bynum WF. Raven Press, New York, pp. 185–193, 1982.
Arts and humanities
In addition to his medical research, Hachinski is also respectably accomplished in poetry, music, and history (including history of medicine). He possesses an honours degree in history from the University of London, UK, is a Corresponding Member of the North American Academy of the Spanish Language (a corresponding academy of the Royal Spanish Academy) and has published a poetry anthology, Resonancias, under the pen name Alejandro Aranda. Finally, "Dream Waltz," composed by Hachinski and orchestrated by Jason Stanford (Professor of Theory and Composition at Western University), premiered at the Musikverein in Vienna, Austria by the Brno Philharmoniker on September 24, 2013.
Honours and recognition
Over the course of his career, Hachinski has been the recipient of many awards and recognitions in his field. The most notable and significant are outlined below.
- 2015: Scientist Career Award, Lawson Health Research Institute
- 2014: Fellowship in the Royal Society of Canada
- 2014: Karolinska Stroke Award for Excellence in Stroke Research
- 2013: Chancellor's Award Lecture in Neuroscience and Neurology, University of Louisiana
- 2013: Queen Elizabeth II Diamond Jubilee Medal
- 2012: Order of Ontario
- 2010: Ontario Premier’s Discovery Award in life sciences and medicine
- 2010: Biomedical Science Ambassador Award, Partners In Research
- 2010: International Bial Merit Award in Medical Sciences
- 2010: Leadership in Stroke Medicine Award, World Stroke Organization
- 2008: Member of the Order of Canada
- 2006: Distinguished University Professor, Western University
- 2005: Fellowship in the Canadian Academy of Health Sciences
- 2005: Thomas Willis Award, American Stroke Association
- 2000: Mihara Award in research on cerebrovascular disorders
- 1990: Ontario Trillium Clinical Scientist Award
- 1989: Featured in Canadian Who’s Who
Hachinski holds four honorary doctorates. The first, Doctor of Medicine honoris causa from the University of Salamanca, Spain, was awarded in 2000. This was followed by Doctor of the University honoris causa from the University of Buenos Aires, Argentina (2005), Doctor of Medicine honoris causa from the University of Cordoba, Argentina (2007), and Doctor honoris causa from the Russian Academy of Medical Sciences (2012).
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- "A stroke of genius" (PDF). Dementia Action Alliance. researchmedia.eu. Retrieved 2016-06-13.
- Donnan, Geoffrey A; Fisher, Marc; Macleod, Malcolm; Davis, Stephen M (2008-05-10). "Stroke". The Lancet. 371 (9624). doi:10.1016/S0140-6736(08)60694-7. ISSN 0140-6736.
- Stroke Unit Trialists' Collaboration (2013-09-11). Organised inpatient (stroke unit) care for stroke. John Wiley & Sons, Ltd. doi:10.1002/14651858.cd000197.pub3/abstract;jsessionid=4452e271158ef2632e87e53d93112529.f02t03.
- Cechetto D, Yingcheng Yu, Hachinski V. Cardiovascular Consequences (CVC) of Insular Cortex Lesion Compared to Rat Stroke Model. 18th International Joint Conference on Stroke and Cerebral Circulation February 11–13, 1993
- Arculus, Paul. "Former PPHS graduate now heads World Federation of Neurology". Port Perry and Scugog Township Heritage Gallery (scugogheritage.com). Retrieved 2016-05-31.
- Canadian who's who. Volume XXIV, 1989, Simpson, Kieran (ed.); University of Toronto Press, 1988
- "Dr. Vladimir Hachinski, CM, MD, FRCPC, DSc". Canadians for Health Research (chrcrm.org). Retrieved 2016-05-31.
- Hachinski, V.C.; Lassen, N.A.; Marshall, J. (1974-07-27). "Multi-Infarct Dementia: a cause of mental deterioration in the elderly". The Lancet. 304 (7874). doi:10.1016/S0140-6736(74)91496-2. ISSN 0140-6736.
- Alagiakrishnan, Kannayiram; Memon, Mohammed A. "Vascular Dementia". MedScape. "Background". Retrieved 2016-05-31.
- Hachinski, VC; Iliff, LD; Zilhka, E; et al. (1975-09-01). "Cerebral blood flow in dementia". Archives of Neurology. 32 (9): 632–637. doi:10.1001/archneur.1975.00490510088009. ISSN 0003-9942.
- Hachinski, V; Oveisgharan, S; Romney, A; Shankle, WR (2012-02-01). "Optimizing the hachinski ischemic scale". Archives of Neurology. 69 (2): 169–175. doi:10.1001/archneurol.2011.1698. ISSN 0003-9942.
- Steingart, A; Hachinski, VC; Lau, C; et al. (1987-01-01). "Cognitive and neurologic findings in subjects with diffuse white matter lucencies on computed tomographic scan (leuko-araiosis)". Archives of Neurology. 44 (1): 32–35. doi:10.1001/archneur.1987.00520130024012. ISSN 0003-9942.
- Aminoff, Michael Jeffrey (2008-01-01). Neurology and General Medicine. Elsevier Health Sciences. p. 128. ISBN 0443067074.
- Hachinski, VC; Potter, P; Merskey, H (1987-01-01). "Leuko-araiosis". Archives of Neurology. 44 (1): 21–23. doi:10.1001/archneur.1987.00520130013009. ISSN 0003-9942.
- Hachinski, Vladimir (1994-08-01). "Vascular dementia: a radical redefinition". Dementia (Basel, Switzerland). 5 (3-4): 130–132. doi:10.1159/000106709. ISSN 1013-7424. PMID 8087166 – via PubMed/NCBI.
- Bowler, J. V.; Hachinski, V. (1995-08-01). "Vascular cognitive impairment: a new approach to vascular dementia". Baillière's Clinical Neurology. 4 (2): 357–376. ISSN 0961-0421. PMID 7496625.
- Cappa, S. F. (2008). Cognitive Neurology: A Clinical Textbook. Oxford University Press. p. 258. ISBN 9780198569275.
- Hachinski, Vladimir (1992-09-12). "Preventable senility: a call for action against the vascular dementias". The Lancet. 340 (originally published as Volume 2) (8820): 645–648. doi:10.1016/0140-6736(92)92177-H.
- Hachinski, V. C.; Bowler, J. V. (1993-10-01). "Vascular dementia". Neurology. 43 (10): 2159–2160; author reply 2160–2161. ISSN 0028-3878. PMID 8414002.
- Hachinski, Vladimir; Iadecola, Costantino; Petersen, Ron C.; Breteler, Monique M.; Nyenhuis, David L.; Black, Sandra E.; Powers, William J.; DeCarli, Charles; Merino, Jose G. (2006-09-01). "National Institute of Neurological Disorders and Stroke – Canadian Stroke Network Vascular Cognitive Impairment Harmonization Standards". Stroke. 37 (9): 2220–2241. doi:10.1161/01.STR.0000237236.88823.47. ISSN 0039-2499. PMID 16917086.
- Langhorne, P.; Williams, B.O.; Gilchrist, W.; Howie, K. (1993-08-14). "Do stroke units save lives?". The Lancet. 342 (8868): 395–398. doi:10.1016/0140-6736(93)92813-9. ISSN 0140-6736.
- Sinha, S.; Warburton, E. A. (2000-09-01). "The evolution of stroke units—towards a more intensive approach?". QJM. 93 (9): 633–638. doi:10.1093/qjmed/93.9.633. ISSN 1460-2725. PMID 10984558.
- Côté, R.; Hachinski, V. C.; Shurvell, B. L.; Norris, J. W.; Wolfson, C. (1986-07-01). "The Canadian Neurological Scale: a preliminary study in acute stroke.". Stroke. 17 (4): 731–737. doi:10.1161/01.STR.17.4.731. ISSN 0039-2499. PMID 3738958.
- Oppenheimer, S. M.; Hachinski, V. C. (1992-02-01). "The cardiac consequences of stroke". Neurologic Clinics. 10 (1): 167–176. ISSN 0733-8619. PMID 1557001.
- Oppenheimer, SM; Cechetto, DF; Hachinski, VC (1990-05-01). "Cerebrogenic cardiac arrhythmias: Cerebral electrocardiographic influences and their role in sudden death". Archives of Neurology. 47 (5): 513–519. doi:10.1001/archneur.1990.00530050029008. ISSN 0003-9942.
- Oppenheimer, S. M.; Gelb, A.; Girvin, J. P.; Hachinski, V. C. (1992-09-01). "Cardiovascular effects of human insular cortex stimulation". Neurology. 42 (9): 1727–1732. doi:10.1212/wnl.42.9.1727. ISSN 0028-3878. PMID 1513461.
- "A stroke of genius" (PDF). Understanding vascular mechanisms > Stroke Related Research > par. 3. Retrieved 2016-05-31.
- Gent, M.; Blakely, J. A.; Easton, J. D.; Ellis, D. J.; Hachinski, V. C.; Harbison, J. W.; Panak, E.; Roberts, R. S.; Sicurella, J. (1988-10-01). "The Canadian American Ticlopidine Study (CATS) in thromboembolic stroke. Design, organization, and baseline results.". Stroke. 19 (10): 1203–1210. doi:10.1161/01.STR.19.10.1203. ISSN 0039-2499. PMID 3051529.
- Gent, M.; Blakely, J. A.; Easton, J. D.; Ellis, D. J.; Hachinski, V. C.; Harbison, J. W.; Panak, E.; Roberts, R. S.; Sicurella, J. (1989-06-03). "The Canadian American Ticlopidine Study (CATS) in thromboembolic stroke". Lancet (London, England). 1 (8649): 1215–1220. ISSN 0140-6736. PMID 2566778.
- The EC/IC Bypass Study Group (1985-11-07). "Failure of Extracranial–Intracranial Arterial Bypass to Reduce the Risk of Ischemic Stroke". New England Journal of Medicine. 313 (19): 1191–1200. doi:10.1056/NEJM198511073131904. ISSN 0028-4793. PMID 2865674.
- "Canadian Stroke Network Annual Report 2002-2003" (PDF). p. 7. Retrieved 2016-05-31.
- Chan, Richard. "Promoting Adherence to a Regimen of risk factor modification by Trained Non-medical personnel Evaluated against Regular practice Study". International Standard Randomised Controlled Trial Number (ISRCTN) Registry. doi:10.1186/isrctn07607027.
- "Ontario Stroke System Overview" (PDF). Ontario College of Family Physicians (ocfp.on.ca). 2011-04-18. Retrieved 2016-05-31.
- "Advocating for global stroke and dementia strategy". London Health Sciences Centre. 2016-02-22. Retrieved 2016-06-01.
- Sposato LA; Kapral MK; Fang J; et al. (2015-12-01). "Declining incidence of stroke and dementia: Coincidence or prevention opportunity?". JAMA Neurology. 72 (12): 1529–1531. doi:10.1001/jamaneurol.2015.2816. ISSN 2168-6149.
- Neuropenews. "Interview with Vladimir Hachinski". eanpages - News Blog of the European Academy of Neurology. Retrieved 2016-06-06.
- "World Brain Alliance". www.wfneurology.org. Retrieved 2016-06-06.
- Hachinski, Vladimir (2013-06-11). "Neurology in a globalizing world: World Congress of Neurology, Vienna, 2013". Neurology. 80 (24): 2248–2249. doi:10.1212/WNL.0b013e318296ea48. ISSN 0028-3878. PMID 23751918.
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- Aarli, Johan A. (2014-05-08). The History of the World Federation of Neurology: The First 50 Years. OUP Oxford. p. 99. ISBN 9780191022111.
- "World Stroke Organization - Elections Results - WSO Board of Directors". www.world-stroke.org. Retrieved 2016-06-06.
- Hachinski, Vladimir (2008-09-01). "World Stroke Day Proclamation". Stroke. 39 (9): 2409–2420. doi:10.1161/STROKEAHA.107.000009. ISSN 0039-2499.
- Hachinski, Vladimir (2008-09-01). "World Stroke Day 2008 "Little Strokes, Big Trouble"". Stroke. 39 (9): 2407–2408. doi:10.1161/STROKEAHA.108.531681. ISSN 0039-2499. PMID 18723419.
- CMAJ. 151(3):293–296, 1994 Aug 1: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1336919/
- Hachinski, Vladimir; Hachinski, Larissa (2003-01-01). Stroke: A Comprehensive Guide to "brain Attacks" : Everything You Need to Know. Firefly Books. p. ix. ISBN 9781552096420.
- "Académicos correspondientes — ANLE". Academia Norteamericana de la Lengua Española (ANLE) (in Español). Retrieved 2016-06-08.
- Aranda, Alejandro (1990). Resonancias. Madrid: Editorial Pliegos. ISBN 9788486214647.
- Wallace, Janice (2013-06-20). "Western News - Partnership captures a beautiful 'Dream' for professors". Western News. Retrieved 2016-06-08.
- Hachinski, Vladimir (2016). "Undreamt dreams can happen". Hektoen International. 8 (2). ISSN 2155-3017. Retrieved 2016-06-08.
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- "Search Fellows | The Royal Society of Canada". www.rsc-src.ca. Retrieved 2016-06-14.
- "Two researchers share the Karolinska Stroke Award". Karolinska Institutet. Retrieved 2016-06-13.
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- "Biomedical Science Ambassador Award - Partners In Research". Partners In Research. Retrieved 2016-06-13.
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