Sachdev P, Brodaty H
School of Psychiatry, University of New South Wales, Australia.
Alzheimer Dis Assoc Disord. 1999 Oct-Dec;13 Suppl 3:S206-12. doi: 10.1097/00002093-199912003-00029.
We performed a review of the published literature on dementia, stroke, and vascular dementia (VaD) emanating from Australia and sought the opinions of senior clinicians and investigators in the field of dementia. We conclude from these sources that the public health importance of cognitive impairment and dementia secondary to cerebrovascular disease is recognized in Australia as is the potential to alter the public health burden significantly by preventative strategies. VaD is considered to be a heterogenous group of syndromes, and there is a lack of consensus on the appropriate diagnostic criteria. The concept is considered to be in evolution and empirical support is needed for its definition, subtyping, and the understanding of the pathophysiological mechanisms. An alternative term--vascular cognitive disorder--is suggested to overcome some of the difficulties inherent in the concept of "dementia" as used currently. The importance of noncognitive disorders of vascular origin is highlighted. No treatment is recognized to be specifically effective in VaD. Australian clinicians and researchers are beginning to grapple with the many difficulties entailed in our understanding of the cognitive and noncognitive consequences of cerebrovascular disease. There is a need for an international consensus on diagnostic criteria, particularly for drug development and research.
我们对澳大利亚发表的有关痴呆症、中风和血管性痴呆（VaD）的文献进行了综述，并征求了痴呆症领域资深临床医生和研究人员的意见。我们从这些资料中得出结论，在澳大利亚，人们认识到脑血管疾病继发的认知障碍和痴呆症对公共卫生的重要性，以及通过预防策略显著改变公共卫生负担的可能性。VaD被认为是一组异质性综合征，对于合适的诊断标准缺乏共识。该概念被认为仍在演变，其定义、亚型划分以及病理生理机制的理解都需要实证支持。有人建议使用另一个术语——血管性认知障碍，以克服当前使用的“痴呆症”概念所固有的一些困难。强调了血管源性非认知障碍的重要性。目前尚未公认有哪种治疗方法对VaD特别有效。澳大利亚的临床医生和研究人员开始应对我们在理解脑血管疾病的认知和非认知后果方面所面临的诸多困难。需要就诊断标准达成国际共识，特别是对于药物开发和研究而言。
