Vascular Cognitive Impairment and Dementia.
Vascular Cognitive Impairment and Dementia.
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DOI：
10.1212/con.0000000000001124
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发表时间：
2022-06-01
期刊：
影响因子：
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通讯作者：
Chang Chui, Helena
中科院分区：
文献类型：
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作者：
Chang Wong, Ellen;Chang Chui, Helena
本文对血管性认知障碍和痴呆进行了广泛的概述，包括流行病学、病理生理学、临床方法和治疗。重点是了解脑血管疾病的常见潜在类型（包括动脉粥样硬化、动脉粥样硬化和脑淀粉样血管病）以及对罕见遗传性脑血管疾病的认识。血管性认知障碍和痴呆的病理生理学具有异质性，最新的血管性认知障碍和痴呆诊断标准将大血管性痴呆的诊断分为四种表型类别，包括皮质下缺血性血管性痴呆、中风后痴呆、多发梗塞性痴呆和混合性痴呆。控制心血管危险因素，包括管理中年血压、胆固醇和血糖，仍然是预防血管性认知障碍和痴呆的主要措施。鉴于自发性脑出血的风险增加，在危险因素管理方面，脑淀粉样血管病需要特别考虑。最近的试验表明，通过有针对性的认知康复，血管性认知障碍和痴呆患者的整体认知功能得到了一定程度的改善。彻底的临床评估和神经影像学构成诊断的基础。由于血管性认知障碍和痴呆是痴呆的主要原因，因此识别危险因素并优化其管理至关重要。一旦发生血管性脑损伤，应进行对症治疗并进行二级预防。
This article gives a broad overview of vascular cognitive impairment and dementia, including epidemiology, pathophysiology, clinical approach, and management. Emphasis is placed on understanding the common underlying types of cerebrovascular disease (including atherosclerosis, arteriolosclerosis, and cerebral amyloid angiopathy) and awareness of rare inherited cerebrovascular disorders. The pathophysiology of vascular cognitive impairment and dementia is heterogeneous, and the most recent diagnostic criteria for vascular cognitive impairment and dementia break down the diagnosis of major vascular dementia into four phenotypic categories, including subcortical ischemic vascular dementia, poststroke dementia, multi-infarct dementia, and mixed dementia. Control of cardiovascular risk factors, including management of midlife blood pressure, cholesterol, and blood sugars, remains the mainstay of prevention for vascular cognitive impairment and dementia. Cerebral amyloid angiopathy requires special consideration when it comes to risk factor management given the increased risk of spontaneous intracerebral hemorrhage. Recent trials suggest some improvement in global cognitive function in patients with vascular cognitive impairment and dementia with targeted cognitive rehabilitation. Thorough clinical evaluation and neuroimaging form the basis for diagnosis. As vascular cognitive impairment and dementia is the leading nondegenerative cause of dementia, identifying risk factors and optimizing their management is paramount. Once vascular brain injury has occurred, symptomatic management should be offered and secondary prevention pursued.