Division of Special Neurology, Department of Neurology, Medical University of Graz, Graz, Austria.
Neurodegener Dis. 2010;7(1-3):122-6. doi: 10.1159/000285521. Epub 2010 Feb 18.
Diagnostic criteria separating vascular dementia from other dementias, particularly Alzheimer's disease (AD) neglect the real world in which most AD cases present with at least some vascular brain lesions. Most importantly, vascular lesions, even if subtle, exert significant effects on the patients' cognitive functioning if they coexist with AD pathology.
To emphasize the need for an integrative dementia concept in which the vascular component represents an important end point in trial planning and a possibility for disease modification along the whole spectrum of combined vascular and primary degenerative pathology.
Review of the literature on possible surrogate markers to study the contribution of vascular brain damage in dementia.
The longitudinal change in volume of white matter lesions is the best elaborated putative surrogate marker for the study of the vascular component in dementia. Validation of the role of lacunes and microbleeds as surrogate end points is poor. Loss of brain volume is an important adjunct outcome measure even though the vascular origin of atrophy remains uncertain.
A focus on pure vascular dementia distracts from the importance of vascular factors in dementia. Consideration of the vascular component in future clinical trials will improve our pathophysiological understanding and provide options for treatment.
将血管性痴呆与其他类型痴呆（尤其是阿尔茨海默病，AD）区分开来的诊断标准忽略了大多数 AD 患者至少存在一些血管性脑损伤的现实世界。最重要的是，如果血管性病变与 AD 病理学共存，即使是轻微的病变也会对患者的认知功能产生重大影响。
强调需要一种综合的痴呆概念，其中血管成分代表了试验计划中的一个重要终点，并且有可能沿着血管性和原发性退行性病变的整个谱系进行疾病修饰。
对可能的替代标志物进行文献回顾，以研究血管性脑损伤在痴呆中的作用。
脑白质病变体积的纵向变化是研究痴呆中血管成分的最佳替代标志物。腔隙和微出血作为替代终点的验证效果较差。脑容量的丧失是一个重要的附加结果测量指标，尽管脑萎缩的血管起源仍不确定。
关注单纯的血管性痴呆会忽略血管因素在痴呆中的重要性。在未来的临床试验中考虑血管成分将提高我们的病理生理学理解，并提供治疗选择。
