Román Gustavo C, Kalaria Raj N
University of Texas Health Science Center, 7703 Floyd Curl Drive, San Antonio, TX 78229-3900, USA.
Neurobiol Aging. 2006 Dec;27(12):1769-85. doi: 10.1016/j.neurobiolaging.2005.10.004. Epub 2005 Nov 21.
Alzheimer's disease (AD) and vascular dementia (VaD) are widely accepted as the most common forms of dementia. Cerebrovascular lesions frequently coexist with AD, creating an overlap in the clinical and pathological features of VaD and AD. This review assembles evidence for a role for cholinergic mechanisms in the pathogenesis of VaD, as has been established for AD. We first consider the anatomy and vascularization of the basal forebrain cholinergic neuronal system, emphasizing its susceptibility to the effects of arterial hypertension, sustained hypoperfusion, and ischemic cerebrovascular disease. The impact of aging and consequences of disruption of the cholinergic system in cognition and in control of cerebral blood flow are further discussed. We also summarize preclinical and clinical evidence supporting cholinergic deficits and the use of cholinesterase inhibitors in patients with VaD. We postulate that vascular pathology likely plays a common role in initiating cholinergic neuronal abnormalities in VaD and AD.
阿尔茨海默病（AD）和血管性痴呆（VaD）被广泛认为是最常见的痴呆形式。脑血管病变常与AD共存，导致VaD和AD在临床和病理特征上出现重叠。本综述收集了胆碱能机制在VaD发病机制中作用的证据，就像其在AD发病机制中的作用已得到证实一样。我们首先考虑基底前脑胆碱能神经元系统的解剖结构和血管分布，强调其对动脉高血压、持续性灌注不足和缺血性脑血管疾病影响的易感性。进一步讨论衰老的影响以及胆碱能系统破坏对认知和脑血流控制的后果。我们还总结了支持VaD患者胆碱能缺陷及使用胆碱酯酶抑制剂的临床前和临床证据。我们推测血管病理可能在引发VaD和AD胆碱能神经元异常方面发挥共同作用。
