Paul Robert H, Cohen Ronald A, Moser David J, Ott Brian R, Sethi Manish, Sweet Lawrence, Browndyke Jeff, Malloy Paul, Garrett Kelly
Brown Medical School, Providence, Rhode Island 20903, USA.
Cogn Behav Neurol. 2003 Mar;16(1):40-6. doi: 10.1097/00146965-200303000-00005.
To determine whether demographic data, dementia severity, functional status, whole brain volume (WBV), or subcortical hyperintensity volume (SH) predict subsequent cognitive decline in vascular dementia (VaD).
The identification of variables that accurately predict progressive cognitive decline in dementia has important clinical implications.
A cohort of 30 patients with VaD completed neurologic and neuropsychologic examinations and magnetic resonance imaging of the brain at baseline and again after 12 months. All participants met clinical and research criteria for VaD according to standard guidelines. Change scores were computed for measures of verbal fluency, verbal learning, and visual learning. Potential correlates of cognitive change included age, education, score on the Hachinski scale, WBV, SH, and functional ability.
As a group, lower WBV and lower Hachinski score correlated with decline in verbal fluency and visual learning, whereas lower Hachinski score correlated with decline in verbal learning. However, when subdivided by disease type, this pattern held only for individuals with evidence of a cortical stroke at baseline. No clinical variables correlated with cognitive decline among individuals without a cortical infarction.
Assessment of cognitive decline in VaD should be guided by dementia subtype, with particular attention directed at severity of cerebral atrophy rather than classic symptoms of infarction.
确定人口统计学数据、痴呆严重程度、功能状态、全脑体积（WBV）或皮质下高信号体积（SH）是否能预测血管性痴呆（VaD）患者随后的认知衰退。
识别能准确预测痴呆患者进行性认知衰退的变量具有重要的临床意义。
30例VaD患者组成的队列在基线时及12个月后完成了神经学和神经心理学检查以及脑部磁共振成像。所有参与者均根据标准指南符合VaD的临床和研究标准。计算言语流畅性、言语学习和视觉学习测量指标的变化分数。认知变化的潜在相关因素包括年龄、教育程度、哈金斯基量表得分、WBV、SH和功能能力。
总体而言，较低的WBV和较低的哈金斯基得分与言语流畅性和视觉学习能力下降相关，而较低的哈金斯基得分与言语学习能力下降相关。然而，按疾病类型细分时，这种模式仅适用于基线时有皮质卒中证据的个体。在无皮质梗死的个体中，没有临床变量与认知衰退相关。
VaD认知衰退的评估应以痴呆亚型为指导，尤其要关注脑萎缩的严重程度而非梗死的典型症状。
