de Haan Edward H, Nys Gudrun M, Van Zandvoort Martine J
Experimental Psychology, Helmholtz Institute, Utrecht University and Department of Neurology, University Medical Centre, Utrecht, The Netherlands.
Curr Opin Neurol. 2006 Dec;19(6):559-64. doi: 10.1097/01.wco.0000247612.21235.d9.
This review of the cognitive status following stroke and vascular cognitive impairment starts by questioning the concept of vascular dementia and related concepts. Our position is that in many cases these labels promote a superficial conceptualization of an inherently complex and heterogeneous phenomenon hampering a more detailed understanding.
After stroke or disease of the cerebral vasculature, the cognitive and emotional outcome is dependent on a combination of three factors with the relative importance differing between causes. First, focal damage may lead to selective impairments that are dependent on the localization of the (grey matter) lesion. Second, diffuse neuronal dysfunction produces a more uniform profile of a decrease in mental speed, memory problems, and reduced executive functioning. Third, cognitive outcome is further modulated - notably in terms of severity - by patient variables such as age, sex, premorbid level of functioning, and comorbidity (e.g. hypertension).
The complex character of the cognitive repercussions of stroke can be better harnessed by employing modern neuropsychological assessment procedures. This allows both a detailed categorization of the patients for the selection and effectiveness of therapeutic intervention, as well as the construction of reliable prognostic models.
本综述对中风后认知状态及血管性认知障碍展开探讨，开篇便对血管性痴呆的概念及相关概念提出质疑。我们的观点是，在许多情况下，这些标签促成了对一种本质上复杂且异质性现象的表面概念化，从而妨碍了更深入的理解。
在发生中风或脑血管疾病后，认知和情感结果取决于三个因素的综合作用，不同病因中各因素的相对重要性有所不同。其一，局灶性损伤可能导致取决于（灰质）病变定位的选择性损伤。其二，弥漫性神经元功能障碍会产生更一致的表现，即思维速度下降、记忆问题以及执行功能减退。其三，认知结果会受到患者变量（如年龄、性别、病前功能水平和合并症（如高血压））的进一步调节，尤其是在严重程度方面。
运用现代神经心理学评估程序能够更好地把握中风认知影响的复杂特性。这既有助于对患者进行详细分类，以选择合适的治疗干预措施并评估其有效性，也有助于构建可靠的预后模型。
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