Sachdev P S, Brodaty H, Valenzuela M J, Lorentz L, Looi J C L, Wen W, Zagami A S
Schools of Psychiatry and Medicine, University of New South Wales, Australia.
Neurology. 2004 Mar 23;62(6):912-9. doi: 10.1212/01.wnl.0000115108.65264.4b.
To characterize the neuropsychological profile of vascular cognitive impairment (VCI) and vascular dementia (VaD).
The authors examined 170 patients with stroke or TIA at 3 to 6 months after the vascular event, and 96 age-matched healthy controls, with detailed neuropsychological and medical-psychiatric assessments, with a majority (66.7%) undergoing MRI brain scans. The subjects were diagnosed as having VaD, VCI, or no cognitive impairment by consensus. The neuropsychological tests were classified into cognitive domains, and composite z-scores adjusted for age and education.
VaD subjects had disturbance in all cognitive domains, with verbal memory, especially retention, being less affected. VCI subjects had similar but less severe disturbance. The domains that best discriminated cognitively impaired from unimpaired patients were abstraction, mental flexibility, information processing speed, and working memory. Cognitive impairment had a significant correlation with deep white matter hyperintensities, but not with volume and number of infarctions, even though the VaD subjects had larger infarct volumes than VCI subjects. The MRI variables did not provide additional discrimination between subgroups.
The cognitive deficits in VaD and VCI are characterized by disturbance of frontal functions, with less verbal memory impairment. VaD and VCI differ in severity but not pattern of disturbance. The brain lesions that best account for these deficits are noninfarct subcortical white matter and gray matter changes due to ischemia. The picture of VaD/VCI presented shows subcortical deficits embellished by cognitive deficits from cortical infarctions.
描述血管性认知障碍（VCI）和血管性痴呆（VaD）的神经心理学特征。
作者在血管事件发生后3至6个月对170例中风或短暂性脑缺血发作（TIA）患者以及96例年龄匹配的健康对照者进行了详细的神经心理学和医学 - 精神病学评估，其中大多数（66.7%）接受了脑部MRI扫描。通过共识将受试者诊断为患有VaD、VCI或无认知障碍。神经心理学测试被分为认知领域，并根据年龄和教育程度调整了复合z分数。
VaD受试者在所有认知领域均有障碍，言语记忆尤其是记忆保持受影响较小。VCI受试者有类似但程度较轻的障碍。最能区分认知受损和未受损患者的领域是抽象、心理灵活性、信息处理速度和工作记忆。认知障碍与深部白质高信号有显著相关性，但与梗死灶的体积和数量无关，尽管VaD受试者的梗死灶体积比VCI受试者大。MRI变量未在亚组之间提供额外的区分。
VaD和VCI的认知缺陷以额叶功能障碍为特征，言语记忆损害较轻。VaD和VCI在严重程度上不同，但在障碍模式上相同。最能解释这些缺陷的脑病变是非梗死性皮质下白质和缺血引起的灰质变化。所呈现的VaD/VCI情况显示皮质梗死导致的认知缺陷加重了皮质下缺陷。
