Seaman Family MR Center, Foothills Medical Centre, Calgary, AB, Canada.
Hotchkiss Brain Institute, Foothills Medical Center, Room 1A10 Health Research Innovation Center, Calgary, AB, Canada.
J Neurochem. 2018 Mar;144(5):565-581. doi: 10.1111/jnc.14132. Epub 2017 Sep 6.
The incidence of dementia is expected to double in the next 20 years and will contribute to heavy social and economic burden. Dementia is caused by neuronal loss that leads to brain atrophy years before symptoms manifest. Currently, no cure exists and extensive efforts are being made to mitigate cognitive impairment in late life in order to reduce the burden on patients, caregivers, and society. The most common type of dementia, Alzheimer's disease (AD), and vascular dementia (VaD) often co-exists in the brain and shares common, modifiable risk factors, which are targeted in numerous secondary prevention trials. There is a growing need for non-pharmacological interventions and infrastructural support from governments to encourage psychosocial and behavioral interventions. Secondary prevention trials need to be redesigned based on the risk profile of individual subjects, which require the use of validated and standardized clinical, biological, and neuroimaging biomarkers. Multi-domain approaches have been proposed in high-risk populations that target optimal treatment; clinical trials need to recruit individuals at the highest risk of dementia before symptoms develop, thereby identifying an enriched disease group to test preventative and disease modifying strategies. The underlying aim should be to reduce microscopic brain tissue loss by modifying vascular and lifestyle risk factors over a relatively short period of time, thus optimizing the opportunity for preventing dementia in the future. Collaboration between international research groups is of key importance to the optimal use and allocation of existing resources, and the development of new techniques in preventing dementia. This article is part of the Special Issue "Vascular Dementia".
痴呆症的发病率预计在未来 20 年内将翻一番，并将导致沉重的社会和经济负担。痴呆症是由神经元丧失引起的，这种丧失会导致大脑萎缩，早在症状出现之前数年就会发生。目前，尚无治愈方法，正在进行广泛的努力以减轻晚年认知障碍，从而减轻患者、护理人员和社会的负担。最常见的痴呆类型，阿尔茨海默病（AD）和血管性痴呆（VaD），通常在大脑中共存，并具有共同的、可改变的危险因素，这些危险因素是许多二级预防试验的目标。人们越来越需要政府提供非药物干预和基础设施支持，以鼓励社会心理和行为干预。二级预防试验需要根据个体受试者的风险状况进行重新设计，这需要使用经过验证和标准化的临床、生物学和神经影像学生物标志物。在高风险人群中提出了多领域方法，以针对最佳治疗方法；临床试验需要在症状出现之前招募痴呆症风险最高的个体，从而确定一个丰富的疾病群体，以测试预防和疾病修饰策略。其根本目的应该是通过在相对较短的时间内改变血管和生活方式危险因素来减少脑组织的微观损失，从而为未来预防痴呆症提供最佳机会。国际研究小组之间的合作对于最佳利用和分配现有资源以及开发预防痴呆症的新技术至关重要。本文是“血管性痴呆”特刊的一部分。
