Institute for Ageing and Health, Newcastle University Campus for Ageing and VitalityNewcastle upon Tyne, UK.
Panminerva Med. 2012 Sep;54(3):139-48.
Considerable evidence indicates that systemic vascular diseases are associated with neurodegenerative processes preceding cognitive decline and dementia. Conditions such as hypertension, diabetes, atrial fibrillation, ischemic heart disease, dyslipidaemia and obesity have propensity to induce strokes, which increase risk of dementia up to five-fold in the elderly. The link between vascular diseases and clinical Alzheimer's disease (AD) also exists but pathological confirmation has often been lacking. However, more than 30% of stroke survivors will develop dementia within two years. Transient ischaemic attacks and silent infarcts may unmask neurodegenerative processes characterized by primary pathologies such as those found in AD. Cerebral infarction and neurodegenerative pathologies are additive and accelerate dementia. Medial temporal atrophy is a strong predictor of dementia and also appears a feature in demented stroke survivors with minimal AD pathology. The atrophy is attributed to selective smaller cell volumes in the hippocampus and likely frontal lobe that may reflect loss of neuronal arborization and connectivity. Therapeutic strategies that maintain or restore functional morphology in surviving neurons could prevent further cognitive decline in post stroke and ageing related dementias.
大量证据表明，全身性血管疾病与认知能力下降和痴呆症之前的神经退行性过程有关。高血压、糖尿病、心房颤动、缺血性心脏病、血脂异常和肥胖症等疾病容易导致中风，使老年人患痴呆症的风险增加五倍。血管疾病与临床阿尔茨海默病（AD）之间也存在联系，但往往缺乏病理证实。然而，超过 30%的中风幸存者在两年内会发展为痴呆症。短暂性脑缺血发作和无症状性梗死可能揭示以 AD 等主要病变为特征的神经退行性过程。脑梗死和神经退行性病变是累加的，并加速痴呆症的发生。海马体的内侧颞叶萎缩是痴呆症的一个强有力的预测指标，在痴呆症中风幸存者中也表现出轻度 AD 病理的特征。这种萎缩归因于海马体和可能的额叶中选择性较小的细胞体积，这可能反映了神经元分支和连接的丧失。维持或恢复存活神经元功能形态的治疗策略可以防止中风后和与年龄相关的痴呆症的进一步认知能力下降。
