Cherubini Antonio, Lowenthal David T, Paran Esther, Mecocci Patrizia, Williams Leonard S, Senin Umberto
Gerontology and Geriatrics, University of Perugia, Perugia, Italy.
Am J Ther. 2007 Nov-Dec;14(6):533-54. doi: 10.1097/MJT.0b013e3180ed6b8f.
Alzheimer's disease is the most prevalent and common form of cognitive impairment, ie, dementia, in the elderly followed in second place by vascular dementia due to the microangiopathy associated with poorly-controlled hypertension. Besides blood pressure elevation, advancing age is the strongest risk factor for dementia. Deterioration of intellectual function and cognitive skills that leads to the elderly patient becoming more and more dependent in his, her, activities of daily living, ie, bathing, dressing, feeding self, locomotion, and personal hygiene. It has been known and demonstrated for many years that lowering of blood pressure from a previous hypertensive point can result in stroke prevention yet lowering of blood pressure does not prevent the microangiopathy that leads to white matter demyelinization which when combined with the clinical cognitive deterioration is compatible with a diagnosis of vascular dementia. It is known from many large studies, ie, SHEP, SCOPE, and HOPE, that lowering of blood pressure gradually will not and should not worsen the cognitive impairment. However, if the pressure is uncontrolled a stroke which might consequently occur would further worsen their cognitive derangement. So an attempt at slow reduction of blood pressure since cerebral autoregulation is slower as age increases is in the patient's best interest. It is also important to stress that control of blood glucose can also be seen as an attempt to prevent vascular dementia from uncontrolled hyperglycemia. Vascular dementia is not considered one of the reversible causes of dementia. Reversible causes of cognitive impairment are over medication with centrally acting drugs such as sedatives, hypnotics, antidepressants, and antipsychotics, electrolyte imbalance such as hyponatremia, azotemia, chronic liver disease, and poor controlled chronic congestive heart failure. Criteria for the clinical diagnosis of vascular dementia include cognitive decline in regards to preceding functionally higher level characterized by alterations in memory and in two or more superior cortical functions that include orientation, attention, verbal linguistic capacities, visual spacial skills, calculation, executive functioning, motor control, abstraction and judgment. Patients with disturbances of consciousness, delirium (acute confusional states), psychosis, serious aphasia, or sensory-motor alterations that preclude proper execution of neuro-psychological testing are also considered to have probably vascular dementia. Furthermore, these are ten of the other essential cerebral or systematic pathologies present that would be able to produce a dementia syndrome.
阿尔茨海默病是老年人中最常见的认知障碍形式，即痴呆症，其次是由于与控制不佳的高血压相关的微血管病变导致的血管性痴呆。除了血压升高外，年龄增长是痴呆症最强的风险因素。智力功能和认知技能的衰退导致老年患者在日常生活活动（如洗澡、穿衣、自我进食、移动和个人卫生）中越来越依赖他人。多年来已知并已证实，从先前的高血压水平降低血压可预防中风，但降低血压并不能预防导致白质脱髓鞘的微血管病变，而白质脱髓鞘与临床认知衰退相结合则符合血管性痴呆的诊断。从许多大型研究（如SHEP、SCOPE和HOPE）中可知，逐渐降低血压不会也不应使认知障碍恶化。然而，如果血压不受控制，随后可能发生的中风会进一步加重他们的认知紊乱。因此，鉴于随着年龄增长大脑自动调节功能会变慢，缓慢降低血压符合患者的最大利益。同样重要的是要强调，控制血糖也可视为预防因血糖控制不佳导致血管性痴呆的一种尝试。血管性痴呆不被认为是痴呆症的可逆病因之一。认知障碍的可逆病因包括过度使用中枢作用药物（如镇静剂、催眠药、抗抑郁药和抗精神病药）、电解质失衡（如低钠血症）、氮质血症、慢性肝病以及控制不佳的慢性充血性心力衰竭。血管性痴呆的临床诊断标准包括相对于先前功能较高水平的认知衰退，其特征是记忆力改变以及两个或更多高级皮质功能改变，这些功能包括定向、注意力、语言能力、视觉空间技能、计算、执行功能、运动控制、抽象和判断。意识障碍、谵妄（急性意识模糊状态）、精神病、严重失语或感觉运动改变而无法正确进行神经心理学测试的患者也被认为可能患有血管性痴呆。此外，还有其他十种重要的脑部或系统性疾病也可能导致痴呆综合征。
