Farlow Martin R
Department of Neurology, Indiana University School of Medicine, CL 299, 541 Clinical Dr, Indianapolis, IN 46202, USA.
Mayo Clin Proc. 2006 Oct;81(10):1350-8. doi: 10.4065/81.10.1350.
Vascular dementia (VaD) is the second leading cause of dementia and is often underdiagnosed. Stroke is the leading cause of VaD, although it may also develop secondary to a variety of other cerebrovascular or cardiovascular conditions. Currently, no drugs are approved for the treatment of VaD. However, because cholinergic deficits have been found in patients with VaD, similar to those found in patients with Alzheimer disease (AD), it is believed that cholinesterase inhibitors, which are indicated for the treatment of mild to moderate AD, may also provide benefit for patients with VaD. Clinical trials of donepezil, galantamine, and rivastigmine have supported this idea, although as yet, large-scale, prospective studies in VaD have only been reported for donepezil. Donepezil was shown to provide benefits in cognition, global function, and activities of daily living compared with placebo. The N-methyl-D-aspartate receptor antagonist memantine may also provide some cognitive benefit in VaD, particularly in patients with more advanced disease. These data suggest that antidementia drugs currently used for treatment of AD should be considered for treatment of VaD as well.
血管性痴呆（VaD）是痴呆的第二大常见病因，且常常未被充分诊断。中风是VaD的主要病因，不过它也可能继发于多种其他脑血管或心血管疾病。目前，尚无药物被批准用于治疗VaD。然而，由于在VaD患者中发现了胆碱能缺陷，这与阿尔茨海默病（AD）患者中发现的情况类似，因此人们认为，用于治疗轻至中度AD的胆碱酯酶抑制剂可能也会使VaD患者受益。多奈哌齐、加兰他敏和卡巴拉汀的临床试验支持了这一观点，尽管到目前为止，仅报道了多奈哌齐在VaD方面的大规模前瞻性研究。与安慰剂相比，多奈哌齐在认知、整体功能和日常生活活动方面显示出益处。N-甲基-D-天冬氨酸受体拮抗剂美金刚在VaD中可能也会带来一些认知益处，尤其是在病情更严重的患者中。这些数据表明，目前用于治疗AD的抗痴呆药物也应考虑用于治疗VaD。
