Rockwood Kenneth, Black Sandra E, Song Xiaowei, Hogan David B, Gauthier Serge, MacKnight Chris, Vandorpe Robert, Guzman Antonio, Montgomery Patrick, Kertesz Andrew, Bouchard Remi W, Feldman Howard
Dalhousie University, Canada.
J Neurol Sci. 2006 Jan 15;240(1-2):7-14. doi: 10.1016/j.jns.2005.08.010. Epub 2005 Oct 5.
There is a need for empirical studies to define criteria for vascular cognitive impairment (VCI) subtypes. In this paper, we report the predictive validity of a subtype classification scheme based on clinical and radiographic features.
Nine Canadian memory clinics participated in the Consortium to Investigate Vascular Impairment of Cognition. This cohort consisted of 1347 patients, of whom 324 had VCI, and was followed for up to 30 months.
Clinical and neuroimaging features defined three subtypes: vascular cognitive impairment, no dementia, (n=97), vascular dementia (n=101) and mixed neurodegenerative/vascular dementia (n=126). Any ischemic lesion on neuroimaging increased the odds (odds ratio=9.31; 95% confidence interval 6.46, 13.39) of a VCI diagnosis. No VCI subtype, however, was associated with a specific neuroimaging abnormality. Compared to those with no cognitive impairment, patients with each VCI subtype had higher rates of death and institutionalization (hazard ratio for combined adverse events=6.08, p<0.001).
Both clinical features and radiographic features help establish a diagnosis of VCI. The outcomes of VCI subtypes, however, are more strongly associated with clinical features than with radiographic ones.
需要进行实证研究来确定血管性认知障碍（VCI）亚型的标准。在本文中，我们报告了一种基于临床和影像学特征的亚型分类方案的预测效度。
九家加拿大记忆诊所参与了血管性认知障碍调查联盟。该队列由1347名患者组成，其中324名患有VCI，并随访了长达30个月。
临床和神经影像学特征定义了三种亚型：无痴呆的血管性认知障碍（n = 97）、血管性痴呆（n = 101）和混合性神经退行性/血管性痴呆（n = 126）。神经影像学上的任何缺血性病变都会增加VCI诊断的几率（优势比 = 9.31；95%置信区间6.46，13.39）。然而，没有一种VCI亚型与特定的神经影像学异常相关。与无认知障碍的患者相比，每种VCI亚型的患者死亡和住院率更高（合并不良事件的风险比 = 6.08，p < 0.001）。
临床特征和影像学特征都有助于VCI的诊断。然而，VCI亚型的预后与临床特征的相关性比与影像学特征的相关性更强。
