Stroke. 2010 Mar;41(3):554-6. doi: 10.1161/STROKEAHA.109.571281. Epub 2010 Jan 7.
White matter lesions (WMLs) and cerebral infarcts are common findings in Alzheimer disease and may contribute to dementia severity. WMLs and lacunar infarcts may provide a potential target for intervention strategies. This study assessed whether multicomponent vascular care in patients with Alzheimer disease with cerebrovascular lesions slows progression of WMLs and prevents occurrence of new infarcts.
A randomized controlled clinical trial, including 123 subjects, compared vascular care with standard care in patients with Alzheimer disease with cerebrovascular lesions on MRI. Progression of WMLs, lacunes, medial temporal lobe atrophy, and global cortical atrophy were semiquantitatively scored after 2-year follow-up.
Sixty-five subjects (36 vascular care, 29 standard care) had a baseline and a follow-up MRI and in 58 subjects, a follow-up scan could not be obtained due to advanced dementia or death. Subjects in the vascular care group had less progression of WMLs as measured with the WML change score (1.4 versus 2.3, P=0.03). There was no difference in the number of new lacunes or change in global cortical atrophy or medial temporal lobe atrophy between the 2 groups.
Vascular care in patients with Alzheimer disease with cerebrovascular lesions slows progression of WMLs. Treatment aimed at vascular risk factors in patients with early Alzheimer disease may be beneficial, possibly in an even earlier stage of the disease.
脑白质病变（WMLs）和脑梗死是阿尔茨海默病的常见表现，可能导致痴呆严重程度的增加。WMLs 和腔隙性梗死可能为干预策略提供潜在靶点。本研究评估了针对伴有脑血管病变的阿尔茨海默病患者的多组分血管护理是否能减缓 WML 进展并预防新梗死的发生。
一项随机对照临床试验纳入了 123 例患者，比较了 MRI 显示有脑血管病变的阿尔茨海默病患者接受血管护理与标准护理的效果。在 2 年随访后，对 WML、腔隙、海马体萎缩和全脑皮质萎缩的进展进行半定量评分。
65 例患者（血管护理组 36 例，标准护理组 29 例）有基线和随访 MRI，58 例患者由于痴呆进展或死亡而无法获得随访扫描。血管护理组的 WML 变化评分较低（1.4 对 2.3，P=0.03），表明 WML 进展较慢。两组间新腔隙的数量、全脑皮质萎缩或海马体萎缩的变化均无差异。
针对伴有脑血管病变的阿尔茨海默病患者的血管护理可减缓 WML 的进展。针对早期阿尔茨海默病患者的血管危险因素进行治疗可能有益，甚至可能在疾病的更早阶段有益。
