Vascular contributions to cognitive impairment and dementia: a statement for healthcare professionals from the american heart association/american stroke association.
Vascular contributions to cognitive impairment and dementia: a statement for healthcare professionals from the american heart association/american stroke association.
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DOI：
10.1161/str.0b013e3182299496
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发表时间：
2011-09
期刊：
影响因子：
8.3
通讯作者：
American Heart Association Stroke Council, Council on Epidemiology and Prevention, Council on Cardiovascular Nursing, Council on Cardiovascular Radiology and Intervention, and Council on Cardiovascular Surgery and Anesthesia
中科院分区：
文献类型：
--
作者：
Gorelick PB;Scuteri A;Black SE;Decarli C;Greenberg SM;Iadecola C;Launer LJ;Laurent S;Lopez OL;Nyenhuis D;Petersen RC;Schneider JA;Tzourio C;Arnett DK;Bennett DA;Chui HC;Higashida RT;Lindquist R;Nilsson PM;Roman GC;Sellke FW;Seshadri S;American Heart Association Stroke Council, Council on Epidemiology and Prevention, Council on Cardiovascular Nursing, Council on Cardiovascular Radiology and Intervention, and Council on Cardiovascular Surgery and Anesthesia
该科学声明概述了血管对认知障碍和痴呆的影响的证据。血管对晚年认知障碍和痴呆的影响很常见。回顾了血管性认知障碍（VCI）的定义、神经病理学、基础科学和病理生理学方面、神经影像学和血管及其他相关危险因素的作用以及潜在的预防和治疗机会。本声明可作为从业者更好地了解 VCI 和痴呆症、预防和治疗的总体指南。写作组成员由写作组联合主席根据其之前在相关主题领域的工作提名，并得到美国心脏协会中风理事会科学声明监督委员会、流行病学和预防委员会以及手稿监督委员会的批准。写作小组使用系统文献综述（主要涵盖1990年至2010年5月1日期间的出版物）、先前发表的指南、个人档案和专家意见来总结现有证据，指出当前知识的差距，并在适当时使用美国心脏协会标准制定建议。写作小组的所有成员都有机会对建议发表评论并批准本文件的最终版本。经过美国心脏协会的同行评审，以及中风委员会领导层、流行病学和预防委员会以及科学声明监督委员会的审查，该声明得到了美国心脏协会科学咨询和协调委员会的批准。 VCI 的构建已被引入，以捕获与所有形式的脑血管脑损伤（不仅仅是中风）相关的整个认知障碍，范围从轻度认知障碍到完全发展的痴呆。神经血管单元的功能障碍和脑血流调节机制可能是 VCI 病理生理过程的重要组成部分。脑淀粉样血管病正在成为阿尔茨海默病、微梗塞、大脑微出血和大出血以及 VCI 风险的重要标志。晚年认知障碍的神经病理学通常是阿尔茨海默病和微血管脑损伤的混合体，它们可能重叠和协同作用，从而增加认知障碍的风险。在这方面，磁共振成像和其他神经影像技术在 VCI 的定义和检测中发挥着重要作用，并提供证据表明，伴有白质高信号和小深度梗塞的皮质下形式的 VCI 很常见。在许多情况下，VCI 的风险标志与传统的中风风险因素相同。这些风险可能包括但不限于心房颤动、高血压、糖尿病和高胆固醇血症。此外，这些相同的血管危险因素可能是阿尔茨海默病的危险标志。颈动脉内膜中层厚度和动脉僵硬度正在成为动脉老化的标志，并可能作为 VCI 的风险标志。目前，美国食品和药物管理局尚未批准 VCI 的具体治疗方法。然而，检测和控制中风和心血管疾病的传统危险因素可能有效预防 VCI，即使对于老年人也是如此。血管对认知障碍和痴呆的影响很重要。近年来，基于临床前、神经病理学、神经影像学、生理学和流行病学研究，对 VCI 的理解有了很大的发展。建议采用跨学科、转化和交互的方法来进一步了解这个实体，并更好地表征其神经心理学特征。需要进行前瞻性、定量的临床病理神经影像研究，以提高对神经影像变化的病理基础以及临床 VCI 和阿尔茨海默病演变中血管和阿尔茨海默病病理之间复杂相互作用的认识。可能需要从中年开始进行长期血管风险标志物介入研究，以预防或推迟 VCI 和阿尔茨海默病的发作。强化减少高危人群血管危险因素的研究是另一个重要的研究途径。
This scientific statement provides an overview of the evidence on vascular contributions to cognitive impairment and dementia. Vascular contributions to cognitive impairment and dementia of later life are common. Definitions of vascular cognitive impairment (VCI), neuropathology, basic science and pathophysiological aspects, role of neuroimaging and vascular and other associated risk factors, and potential opportunities for prevention and treatment are reviewed. This statement serves as an overall guide for practitioners to gain a better understanding of VCI and dementia, prevention, and treatment. Writing group members were nominated by the writing group co-chairs on the basis of their previous work in relevant topic areas and were approved by the American Heart Association Stroke Council Scientific Statement Oversight Committee, the Council on Epidemiology and Prevention, and the Manuscript Oversight Committee. The writing group used systematic literature reviews (primarily covering publications from 1990 to May 1, 2010), previously published guidelines, personal files, and expert opinion to summarize existing evidence, indicate gaps in current knowledge, and, when appropriate, formulate recommendations using standard American Heart Association criteria. All members of the writing group had the opportunity to comment on the recommendations and approved the final version of this document. After peer review by the American Heart Association, as well as review by the Stroke Council leadership, Council on Epidemiology and Prevention Council, and Scientific Statements Oversight Committee, the statement was approved by the American Heart Association Science Advisory and Coordinating Committee. The construct of VCI has been introduced to capture the entire spectrum of cognitive disorders associated with all forms of cerebral vascular brain injury—not solely stroke—ranging from mild cognitive impairment through fully developed dementia. Dysfunction of the neurovascular unit and mechanisms regulating cerebral blood flow are likely to be important components of the pathophysiological processes underlying VCI. Cerebral amyloid angiopathy is emerging as an important marker of risk for Alzheimer disease, microinfarction, microhemorrhage and macrohemorrhage of the brain, and VCI. The neuropathology of cognitive impairment in later life is often a mixture of Alzheimer disease and microvascular brain damage, which may overlap and synergize to heighten the risk of cognitive impairment. In this regard, magnetic resonance imaging and other neuroimaging techniques play an important role in the definition and detection of VCI and provide evidence that subcortical forms of VCI with white matter hyperintensities and small deep infarcts are common. In many cases, risk markers for VCI are the same as traditional risk factors for stroke. These risks may include but are not limited to atrial fibrillation, hypertension, diabetes mellitus, and hypercholesterolemia. Furthermore, these same vascular risk factors may be risk markers for Alzheimer disease. Carotid intimal-medial thickness and arterial stiffness are emerging as markers of arterial aging and may serve as risk markers for VCI. Currently, no specific treatments for VCI have been approved by the US Food and Drug Administration. However, detection and control of the traditional risk factors for stroke and cardiovascular disease may be effective in the prevention of VCI, even in older people. Vascular contributions to cognitive impairment and dementia are important. Understanding of VCI has evolved substantially in recent years, based on preclinical, neuropathologic, neuroimaging, physiological, and epidemiological studies. Transdisciplinary, translational, and transactional approaches are recommended to further our understanding of this entity and to better characterize its neuropsychological profile. There is a need for prospective, quantitative, clinical-pathological-neuroimaging studies to improve knowledge of the pathological basis of neuroimaging change and the complex interplay between vascular and Alzheimer disease pathologies in the evolution of clinical VCI and Alzheimer disease. Long-term vascular risk marker interventional studies beginning as early as midlife may be required to prevent or postpone the onset of VCI and Alzheimer disease. Studies of intensive reduction of vascular risk factors in high-risk groups are another important avenue of research.