Zekry Dina
Front Neurol Neurosci. 2009;24:95-106. doi: 10.1159/000197888. Epub 2009 Jan 26.
Randomized controlled trials of primary and secondary prevention of vascular dementia demonstrate real effects on the cause or progression of disease (disease-modifying treatment). These strategies lead to a reduction in all cerebrovascular risk factors, in particular hypertension. Such treatment may prevent dementia by reducing stroke and possibly by other mechanisms that remain undetermined,such as those involved in neurodegeneration and cell death. Curative treatment of vascular dementia, particularly given recent studies on cholinesterase inhibitors (rivastigmine, donepezil and galantamine) and memantine, is still ineffective. There is insufficient evidence to support widespread use of these drugs in vascular dementia. Particular considerations should be taken into account in clinical trials. Vascular dementia is a heterogeneous disease with different subtypes and mechanisms.Therefore, well-designed, adequately powered trials accounting for this heterogeneity, with better clinical definitions and an assessment and detection of cognitive and global changes specific to vascular dementia, are needed.
血管性痴呆一级和二级预防的随机对照试验证明了对疾病病因或进展有实际效果（疾病修饰治疗）。这些策略可降低所有脑血管危险因素，尤其是高血压。此类治疗可能通过减少中风以及可能通过其他尚未确定的机制（如涉及神经退行性变和细胞死亡的机制）来预防痴呆。血管性痴呆的治愈性治疗仍然无效，特别是考虑到最近关于胆碱酯酶抑制剂（卡巴拉汀、多奈哌齐和加兰他敏）和美金刚的研究。没有足够的证据支持在血管性痴呆中广泛使用这些药物。临床试验中应考虑特殊因素。血管性痴呆是一种具有不同亚型和机制的异质性疾病。因此，需要设计良好、有足够效力的试验来考虑这种异质性，具备更好的临床定义以及对血管性痴呆特有的认知和整体变化进行评估和检测。
