Derouesné Christian
Université Paris VI, Faculté de médecine Pitié-Salpêtrière, Paris.
Psychol Neuropsychiatr Vieil. 2005 Jun;3(2):89-96.
Vascular dementia is not a disease or even a clearly defined disorder. It is a construct, which brings together very heterogeneous disturbances at the clinical, pathological and etiological levels. Due to the absence of neuropathologic diagnostic criteria, the frequency of associated degenerative pathology (mainly of Alzheimer type), and the heterogeneity of the construct, its clinical diagnosis remains questionable using various diagnostic criteria. The concept of vascular cognitive impairment (VCI) has been proposed as a substitute for vascular dementia to provide some clarification about the relationship between ischemic brain lesions and cognitive dysfunction. Its main interest is to allow diagnosis and treatment of minor cognitive deficits associated with ischemic brain lesions before the occurrence of dementia. Clinical and neuropsychological manifestations of VCI are of fronto-subcortical type, quite distinct from those of Alzheimer's disease. From a practical point of view, the main point is to find out and to treat the vascular risk factors which cause cognitive deficits by themselves or increase those associated with Alzheimer's disease.
血管性痴呆并非一种疾病，甚至也不是一种定义明确的病症。它是一种概念，将临床、病理和病因学层面非常异质性的障碍汇集在一起。由于缺乏神经病理学诊断标准、相关退行性病变（主要是阿尔茨海默病类型）的发生率以及该概念的异质性，使用各种诊断标准时其临床诊断仍存在疑问。血管性认知障碍（VCI）的概念已被提出作为血管性痴呆的替代，以对缺血性脑病变与认知功能障碍之间的关系提供一些阐释。其主要意义在于能够在痴呆发生之前对与缺血性脑病变相关的轻度认知缺陷进行诊断和治疗。VCI的临床和神经心理学表现为额颞叶皮质下类型，与阿尔茨海默病的表现截然不同。从实际角度来看，关键在于找出并治疗那些自身导致认知缺陷或增加与阿尔茨海默病相关认知缺陷的血管危险因素。
