Cerebrovascular disease and dementia
Cerebrovascular disease and dementia
复制标题
DOI：
10.1259/bjr/75681080
复制
发表时间：
2007-01-01
影响因子：
2.6
通讯作者：
Knopman, D. S.
中科院分区：
文献类型：
--
作者：
Knopman, D. S.
脑血管疾病是晚年痴呆症的主要诱因，占痴呆症病例的20%。动脉粥样硬化和动脉粥样硬化机制是疾病负担的主要原因。脑血管病有几种表现形式。以大血管和大小动脉梗死为形式的大血管疾病可产生广泛的临床综合征。单战略性脑梗死、多发双侧脑梗死和多发腔隙性脑梗死可导致认知功能障碍，其严重程度和类型都有很大的不同。微血管疾病几乎肯定在痴呆的发病机制中起作用。小血管疾病通常与大血管疾病和阿尔茨海默病共存，影像学上不明显。淀粉样血管病与老年人认知障碍有关，可引起微出血和大出血。其他不太常见的病因包括血管增生和CADASIL（大脑常染色体显性动脉病变伴皮层下梗死和脑白质病）。神经影像学在血管性痴呆的诊断中起着至关重要的作用。目前还没有一个框架来评估脑血管病理的程度，以防止认知障碍的增加。尽管影像学的进步提高了我们对老年人脑血管疾病的认识，但在临床实践中血管性痴呆仍未得到充分的认识。
Cerebrovascular disease is a major contributor to later-life dementia, accounting for up to 20% of cases of dementia. Atherosclerotic and arteriolosclerotic mechanisms account for most of the burden of disease. Cerebrovascular disease may take several forms. Macrovascular disease in the form of large vessel and larger arteriole infarcts produce a wide spectrum of clinical syndromes. Single strategic infarctions, multiple bilateral infarctions and multiple lacunar infarctions can lead to cognitive dysfunction that spans a large range of both severity and type of cognitive deficits. Microvascular disease almost certainly plays a role in the pathogenesis of dementia. Small vessel disease, which is not evident radiographically, often coexists with macrovascular disease and also with Alzheimer's disease. Amyloid angiopathy is relevant in cognitive disorders in the elderly and causes microhaemorrhages and large haemorrhages. Other much less common aetiologies include vasculitides and CADASIL (cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy). Neuroimaging plays a critical role in the diagnosis of vascular dementia. There is no framework for rating the extent of cerebrovascular pathology that is validated against increasing cognitive impairment. Although advances in imaging have increased our recognition of cerebrovascular disease in the elderly, vascular dementia is still inadequately recognized in clinical practice.