血管性痴呆和血管性认知障碍的临床研究进展

Diagnosis and Management of Vascular Cognitive Impairment and Dementia

血管性认知障碍和痴呆是认知障碍和痴呆领域以及脑血管病领域研究方面的交叉点。本文综述了血管性痴呆和认知障碍的定义、诊断标准和药物治疗进展。在诊断方面重点介绍了血管性痴呆各个亚型的临床特点。在治疗方面重点介绍了血管性痴呆和认知障碍的胆碱能递质代谢障碍以及胆碱酯酶抑制剂治疗的进展。

Vascular dementias(VaDs)are the second most common cause of dementia.Vascular cognitive impairment(VCI)and dementias extend beyond the traditional multi-infarct dementia.Variation in defining the cognitive syndrome,in vascular etiologies,and allowable brain changes in current criteria have resulted in variable estimates of prevalence,of groups of subjects,and of the types and distribution of putative causal brain lesions.Ideally in constructing new criteria the diagnostic elements should be tested with prospective studies with clinical-pathological correlation.Meanwhile focus on more homogenous subtypes of VaD,and on imaging criteria could be a solution.Subcortical ischemic vascular dementia(SIVD)incorporates small vessel disease as the chief vascular etiology,lacunar infarct and ischaemic white matter lesions as primary type of brain lesions.In addition to simple co-existence,VaD and AD have closer interaction.Vascular cognitive impairment(VCI)is a spectrum that includes subtle cognitive deficits of vascular origin,post-stroke dementia,and the complex group of the vascular dementias.Recently symptomatic cholinergic treatment has shown promise in AD with VaD,as well as probable VaD.Future focus should be directed to the distinct etiological and pathological factors.