Department of Psychology, Rowan University, Glassboro, NJ, USA.
Department of Behavioral Sciences and the Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA.
J Alzheimers Dis. 2020;73(1):63-71. doi: 10.3233/JAD-190654.
Alzheimer's disease (AD) and vascular dementia (VaD) are the two most common types of dementia. Although the combination of these disorders, called 'mixed' dementia, is recognized, the prevailing clinical and research perspective continues to consider AD and VaD as independent disorders. A review of recent neuropathological and neuropsychological literature reveals that these two disorders frequently co-occur and so-called 'pure' AD or VaD is comparatively rare. In addition, recent research shows that vascular dysfunction not only potentiates AD pathology, but that pathological changes in AD may subsequently induce vascular disorders. On the basis of these data, we propose that the neurobiological underpinnings underlying AD/VaD dementia and their neuropsychological phenotypes are best understood as existing along a clinical/pathological continuum or spectrum. We further propose that in conjunction with current diagnostic criteria, statistical modeling techniques using neuropsychological test performance should be leveraged to construct a system to classify AD/VaD spectrum dementia in order to test hypotheses regarding how mechanisms related to AD and VaD pathology interact and influence each other.
阿尔茨海默病（AD）和血管性痴呆（VaD）是两种最常见的痴呆症。尽管这些疾病的组合，称为“混合”痴呆症，已被认识到，但占主导地位的临床和研究观点仍然认为 AD 和 VaD 是独立的疾病。对最近神经病理学和神经心理学文献的回顾表明，这两种疾病经常同时发生，因此所谓的“单纯”AD 或 VaD 相对较少见。此外，最近的研究表明，血管功能障碍不仅增强了 AD 病理学，而且 AD 的病理变化随后可能诱导血管紊乱。基于这些数据，我们提出 AD/VaD 痴呆症的神经生物学基础及其神经心理学表型最好被理解为沿着临床/病理连续体或谱存在。我们进一步提出，结合当前的诊断标准，应该利用使用神经心理学测试表现的统计建模技术来构建一个系统，以对 AD/VaD 谱痴呆进行分类，以检验与 AD 和 VaD 病理相关的机制如何相互作用和影响的假设。
