Staekenborg Salka S, van der Flier Wiesje M, van Straaten Elisabeth C W, Lane Roger, Barkhof Frederik, Scheltens Philip
Department of Neurology and Alzheimer Centre, Vrije University Medical Centre, Amsterdam, The Netherlands.
Stroke. 2008 Feb;39(2):317-22. doi: 10.1161/STROKEAHA.107.493353. Epub 2007 Dec 20.
The aim of this study was to describe the prevalence of a number of neurological signs in a large population of patients with vascular dementia (VaD) and to compare the relative frequency of specific neurological signs dependent on type of cerebrovascular disease.
Seven hundred six patients with VaD (NINDS-AIREN) were included from a large multicenter clinical trial (registration number NCT00099216). At baseline neurological examination, the presence of 16 neurological signs was assessed. Based on MRI, patients were classified as having large vessel VaD (18%; large territorial or strategical infarcts on MRI), small vessel VaD (74%; white matter hyperintensities [WMH], multiple lacunes, bilateral thalamic lesions on MRI), or a combination of both (8%).
A median number of 4.5 signs per patient was presented (maximum 16). Reflex asymmetry was the most prevalent symptom (49%), hemianopia was most seldom presented (10%). Measures of small vessel disease were associated with an increased prevalence of dysarthria, dysphagia, parkinsonian gait disorder, rigidity, and hypokinesia and as well to hemimotor dysfunction. By contrast, in the presence of a cerebral infarct, aphasia, hemianopia, hemimotor dysfunction, hemisensory dysfunction, reflex asymmetry, and hemiplegic gait disorder were more often observed.
The specific neurological signs demonstrated by patients with VaD differ according to type of imaged cerebrovascular disease. Even in people who meet restrictive VaD criteria, small vessel disease is often seen with more subtle signs, including extrapyramidal signs, whereas large vessel disease is more often related to lateralized sensorimotor changes and aphasia.
本研究旨在描述大量血管性痴呆（VaD）患者中多种神经体征的患病率，并比较取决于脑血管疾病类型的特定神经体征的相对频率。
从一项大型多中心临床试验（注册号NCT00099216）中纳入了706例VaD患者（NINDS-AIREN）。在基线神经学检查时，评估了16种神经体征的存在情况。根据磁共振成像（MRI），患者被分类为患有大血管VaD（18%；MRI上有大面积脑区或关键部位梗死）、小血管VaD（74%；MRI上有白质高信号[WMH]、多发腔隙性梗死、双侧丘脑病变）或两者皆有（8%）。
每位患者出现的体征中位数为4.5个（最多16个）。反射不对称是最常见的症状（49%），偏盲最不常见（10%）。小血管疾病的指标与构音障碍、吞咽困难、帕金森步态障碍、僵硬和运动迟缓以及半身运动功能障碍的患病率增加有关。相比之下，在存在脑梗死的情况下，失语、偏盲、半身运动功能障碍、半身感觉功能障碍、反射不对称和偏瘫步态障碍更常被观察到。
VaD患者所表现出的特定神经体征因成像脑血管疾病的类型而异。即使在符合严格VaD标准的人群中，小血管疾病也常伴有更细微的体征，包括锥体外系体征，而大血管疾病更常与偏侧感觉运动变化和失语有关。
