Special topic section: linkages among cerebrovascular, cardiovascular, and cognitive disorders: Preventing dementia by preventing stroke: The Berlin Manifesto
Special topic section: linkages among cerebrovascular, cardiovascular, and cognitive disorders: Preventing dementia by preventing stroke: The Berlin Manifesto
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DOI：
10.1177/1747493019871915
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发表时间：
2019-09-22
影响因子：
6.7
通讯作者：
Khachaturian, Zaven S.
中科院分区：
文献类型：
--
作者：
Hachinski, Vladimir;Einhaeupl, Karl;Khachaturian, Zaven S.
中风和痴呆症的发病率在世界各地存在差异，低收入和中等收入国家的发病率上升，而高收入国家的发病率下降。这表明，无论是什么因素导致了这些趋势，都是可以改变的。在人群水平上，神经系统疾病作为一个群体占全球残疾调整生命年的最大比例（10%）。在神经系统疾病中，中风（42%）和痴呆（10%）占主导地位。中风和痴呆症彼此有风险，并且有一些相同的，在很大程度上可以改变的风险和保护因素。原则上，90%的中风和35%的痴呆症估计是可以预防的。由于中风使患痴呆症的机会增加一倍，而且中风比痴呆症更常见，因此超过三分之一的痴呆症可以通过预防中风来预防。病理学、病理生理学和临床水平的发展也指出了新的方向。对脑病理生理学的日益了解揭示了脑血管疾病和神经变性的相互作用，确定了新的治疗靶点，包括保护内皮细胞、血脑屏障和神经血管单元的其他组分。此外，针对淀粉样血管病方面的炎症和遗传操作有新的可测试的承诺。与此同时，越来越多的证据表明，整个人群的教育水平提高，血管风险因素降低（例如，吸烟率降低）和包括中风在内的血管疾病患者的认知功能更好，痴呆率更低。在个人层面，试验表明，房颤抗凝治疗可以将痴呆症的风险降低48%，收缩压低于140 mmHg可能对大脑更好。基于这些考虑，世界中风组织发布了一项公告，得到了所有关注全球脑和心血管健康的主要国际组织的认可，呼吁联合预防中风和痴呆症。这篇文章总结了转化为行动的证据。(c)2019年，阿尔茨海默病协会和世界中风组织。爱思唯尔公司出版All rights reserved.
The incidence of stroke and dementia are diverging across the world, rising for those in low-and middle-income countries and falling in those in high-income countries. This suggests that whatever factors cause these trends are potentially modifiable. At the population level, neurological disorders as a group account for the largest proportion of disability-adjusted life years globally (10%). Among neurological disorders, stroke (42%) and dementia (10%) dominate. Stroke and dementia confer risks for each other and share some of the same, largely modifiable, risk and protective factors. In principle, 90% of strokes and 35% of dementias have been estimated to be preventable. Because a stroke doubles the chance of developing dementia and stroke is more common than dementia, more than a third of dementias could be prevented by preventing stroke. Developments at the pathological, pathophysiological, and clinical level also point to new directions. Growing understanding of brain pathophysiology has unveiled the reciprocal interaction of cerebrovascular disease and neurodegeneration identifying new therapeutic targets to include protection of the endothelium, the blood-brain barrier, and other components of the neurovascular unit. In addition, targeting amyloid angiopathy aspects of inflammation and genetic manipulation hold new testable promise. In the meantime, accumulating evidence suggests that whole populations experiencing improved education, and lower vascular risk factor profiles (e.g., reduced prevalence of smoking) and vascular disease, including stroke, have better cognitive function and lower dementia rates. At the individual levels, trials have demonstrated that anticoagulation of atrial fibrillation can reduce the risk of dementia by 48% and that systolic blood pressure lower than 140 mmHg may be better for the brain. Based on these considerations, the World Stroke Organization has issued a proclamation, endorsed by all the major international organizations focused on global brain and cardiovascular health, calling for the joint prevention of stroke and dementia. This article summarizes the evidence for translation into action. (c) 2019 the Alzheimer's Association and the World Stroke Organisation. Published by Elsevier Inc. All rights reserved.