Lo Coco Daniele, Lopez Gianluca, Corrao Salvatore
Neurology and Stroke Unit, National Relevance and High Specialization Hospital Trust ARNAS Civico, Di Cristina, Benfratelli, Palermo, Italy.
Department of Internal Medicine, National Relevance and High Specialization Hospital Trust ARNAS Civico, Di Cristina, Benfratelli, Palermo, Italy; Centre of Research for Effectiveness and Appropriateness in Medicine (C.R.E.A.M.), Di.Bi.M.I.S., University of Palermo, Palermo, Italy.
Vasc Health Risk Manag. 2016 Mar 24;12:105-16. doi: 10.2147/VHRM.S75306. eCollection 2016.
We reviewed current knowledge about the interaction between stroke and vascular risk factors and the development of cognitive impairment and dementia. Stroke is increasingly recognized as an important cause of cognitive problems and has been implicated in the development of both Alzheimer's disease and vascular dementia. The prevalence of cognitive impairment after stroke is high, and their combined effects significantly increase the cost of care and health resource utilization, with reflections on hospital readmissions and increased mortality rates. There is also substantial evidence that vascular risk factors (such as hypertension, diabetes, obesity, dyslipidemia, and tobacco smoking) are independently associated with an increased risk of cognitive decline and dementia. Thus, a successful management of these factors, as well as optimal acute stroke management, might have a great impact on the development of cognitive impairment. Notwithstanding, the pathological link between cognitive impairment, stroke, and vascular risk factors is complex and still partially unclear so that further studies are needed to better elucidate the boundaries of this relationship. Many specific pharmacological treatments, including anticholinergic drugs and antihypertensive medications, and nonpharmacological approaches, such as diet, cognitive rehabilitation, and physical activity, have been studied for patients with vascular cognitive impairment, but the optimal care is still far away. Meanwhile, according to the most recent knowledge, optimal stroke care should also include cognitive assessment in the short and long term, and great efforts should be oriented toward a multidisciplinary approach, including quality-of-life assessment and support of caregivers.
我们回顾了关于中风与血管危险因素之间的相互作用以及认知障碍和痴呆症发展的现有知识。中风越来越被认为是认知问题的一个重要原因，并且与阿尔茨海默病和血管性痴呆的发展都有关联。中风后认知障碍的患病率很高，它们的综合影响显著增加了护理成本和卫生资源的利用，这体现在医院再入院率和死亡率的上升上。也有大量证据表明，血管危险因素（如高血压、糖尿病、肥胖、血脂异常和吸烟）与认知能力下降和痴呆症风险增加独立相关。因此，成功管理这些因素以及优化急性中风管理，可能会对认知障碍的发展产生重大影响。尽管如此，认知障碍、中风和血管危险因素之间的病理联系很复杂，仍部分不清楚，因此需要进一步研究以更好地阐明这种关系的界限。对于血管性认知障碍患者，已经研究了许多具体的药物治疗方法，包括抗胆碱能药物和抗高血压药物，以及非药物方法，如饮食、认知康复和体育活动，但最佳护理仍任重道远。同时，根据最新知识，最佳中风护理还应包括短期和长期的认知评估，并且应大力采用多学科方法，包括生活质量评估和对护理人员的支持。
