Department of Clinical Neurological Sciences, Western University, London, Ontario, Canada; Department of Neurology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran; Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada.
Department of Neurology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran; Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands.
Alzheimers Dement. 2018 Feb;14(2):148-156. doi: 10.1016/j.jalz.2017.07.755. Epub 2017 Sep 30.
The relative contributions of vascular and degenerative pathology to dementia are unknown. We aim to quantify the proportion of dementia explained by potentially preventable vascular lesions.
We systematically searched for population-based cohorts before February 2017 reporting clinicopathological data for individuals with and without dementia. We calculated the summary proportion and absolute risk of dementia comparing subjects with and without the pathology.
We identified 10 studies comprising 2856 subjects. Vascular-type pathology and mixed pathology are respectively two and three times more likely in demented patients. The summary proportion of dementia is 77%-86% in subjects with mixed degenerative and vascular pathology and 45% in subjects with pure Alzheimer-type pathology.
Patients with mixed pathologies have nearly twice the incremental risk of dementia compared with patients with only Alzheimer-type lesions. Consequently, many cases of dementia could be prevented or delayed by targeting the vascular component.
血管性和退行性病变对痴呆的相对贡献尚不清楚。我们旨在量化潜在可预防血管病变导致的痴呆比例。
我们系统地检索了截至 2017 年 2 月的人群队列研究，这些研究报告了有和无痴呆的个体的临床病理数据。我们比较了有和无病理学表现的受试者，计算了痴呆的汇总比例和绝对风险。
我们确定了 10 项研究，共纳入 2856 名受试者。血管性病变和混合性病变在痴呆患者中分别更常见两倍和三倍。在有混合退行性和血管性病变的受试者中，痴呆的汇总比例为 77%-86%，而在仅有阿尔茨海默病样病变的受试者中为 45%。
与仅有阿尔茨海默病样病变的患者相比，混合病变患者的痴呆增量风险几乎增加了一倍。因此，通过针对血管成分，可以预防或延迟许多痴呆病例。
