de Leeuw F E, van Gijn J
Universitair Medisch Centrum St Radboud, afd. Neurologie, Postbus 9101, 6500 HB Nijmegen.
Ned Tijdschr Geneeskd. 2004 Jun 12;148(24):1181-6.
Vascular dementia is one of the most frequently occurring dementia syndromes. Its prevalence is about 5% among subjects above 85 years of age. Elevated blood pressure and atherosclerosis are the most important risk factors. According to international criteria, vascular dementia usually occurs within three months after having a stroke. However, the diagnosis can be difficult as some strokes are clinically 'silent' and may go unnoticed. Other factors may also contribute to the dementia syndrome, and concomitant depression may mask its clinical picture. In population studies, treatment of vascular risk factors is associated with a relatively low incidence of vascular dementia, but this effect has not been investigated in a randomized clinical trial. The value of acetylsalicylic acid in attenuating cognitive deterioration in patients with vascular dementia is uncertain. Acetylcholinesterase inhibitors may slow down cognitive decline not only in some patients with Alzheimer's disease but also in patients with vascular dementia.
血管性痴呆是最常见的痴呆综合征之一。在85岁以上的人群中,其患病率约为5%。血压升高和动脉粥样硬化是最重要的危险因素。根据国际标准,血管性痴呆通常在中风后三个月内发生。然而,诊断可能会很困难,因为有些中风在临床上是“无症状的”,可能未被注意到。其他因素也可能导致痴呆综合征,同时存在的抑郁症可能会掩盖其临床表现。在人群研究中,治疗血管危险因素与血管性痴呆的发病率相对较低有关,但这一效果尚未在随机临床试验中得到研究。乙酰水杨酸在减轻血管性痴呆患者认知衰退方面的价值尚不确定。乙酰胆碱酯酶抑制剂不仅可能减缓一些阿尔茨海默病患者的认知衰退,也可能减缓血管性痴呆患者的认知衰退。