Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA.
J Alzheimers Dis. 2010;20(3):699-709. doi: 10.3233/JAD-2010-091555.
Cerebrovascular disease plays an important role in cognitive disorders in the elderly. Cerebrovascular disease and Alzheimer's disease interact on several levels, with one important level being the overlap in risk factors. The major vascular risk factors such as diabetes and impaired glycemic control, hypertension, obesity, and hyper- or dyslipidemia have been associated both with Alzheimer's disease and vascular dementia. The purpose of this review is to consider the context in which vascular dementia is diagnosed, place the pathophysiological consequences of cerebrovascular disease on cognition in the context of clinical and pathological Alzheimer's disease, and then to consider the evidence for the role of major vascular risk factors in late-life cognitive impairment, changes in brain imaging and neuropathological changes. Midlife diabetes mellitus, hypertension, and obesity are established risk factors for clinically defined Alzheimer's disease as well as vascular dementia. The basis for these relationships could either be that the risk factors lead to microvascular brain disease, promote Alzheimer pathology or both. The associations of late-life onset diabetes mellitus, hypertension, and obesity with cognitive impairment are either attenuated or reversed. The role of vascular risk factors in midlife should be the focus of public health efforts to reduce the burden of late-life cognitive impairment.
脑血管疾病在老年人认知障碍中起着重要作用。脑血管疾病和阿尔茨海默病在几个层面上相互作用，一个重要层面是风险因素的重叠。主要的血管危险因素，如糖尿病和血糖控制受损、高血压、肥胖以及高或血脂异常，既与阿尔茨海默病又与血管性痴呆相关。本综述的目的是考虑诊断血管性痴呆的背景，将脑血管疾病对认知的病理生理学后果置于临床和病理阿尔茨海默病的背景下，然后考虑主要血管危险因素在晚年认知障碍、脑成像和神经病理学变化中的作用的证据。中年糖尿病、高血压和肥胖是临床定义的阿尔茨海默病以及血管性痴呆的既定危险因素。这些关系的基础可能是这些危险因素导致微血管脑疾病，促进阿尔茨海默病病理，或者两者兼而有之。晚年发病的糖尿病、高血压和肥胖与认知障碍的关联要么减弱，要么逆转。血管危险因素在中年的作用应成为公共卫生努力的重点，以减轻晚年认知障碍的负担。
