Smith Eric E, Barber Philip, Field Thalia S, Ganesh Aravind, Hachinski Vladimir, Hogan David B, Lanctôt Krista L, Lindsay M Patrice, Sharma Mukul, Swartz Richard H, Ismail Zahinoor, Gauthier Serge, Black Sandra E
Department of Clinical Neurosciences and Hotchkiss Brain Institute University of Calgary Calgary Alberta Canada.
Vancouver Stroke Program Djavad Mowafaghian Centre for Brain Health, Division of Neurology University of British Columbia Vancouver British Columbia Canada.
Alzheimers Dement (N Y). 2020 Nov 11;6(1):e12056. doi: 10.1002/trc2.12056. eCollection 2020.
Vascular disease is a common cause of dementia, and often coexists with other brain pathologies such as Alzheimer's disease to cause mixed dementia. Many of the risk factors for vascular disease are treatable. Our objective was to review evidence for diagnosis and treatment of vascular cognitive impairment (VCI) to issue recommendations to clinicians.
A subcommittee of the Canadian Consensus Conference on Diagnosis and Treatment of Dementia (CCCDTD) reviewed areas of emerging evidence. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system was used to assign the quality of the evidence and strength of the recommendations.
Using standardized diagnostic criteria, managing hypertension to conventional blood pressure targets, and reducing risk for stroke are strongly recommended. Intensive blood pressure lowering in middle-aged adults with vascular risk factors, using acetylsalicylic acid in persons with VCI and covert brain infarctions but not if only white matter lesions are present, and using cholinesterase inhibitors are weakly recommended.
The CCCDTD has provided evidence-based recommendations for diagnosis and management of VCI for use nationally in Canada, that may also be of use worldwide.
血管疾病是痴呆症的常见病因，且常与其他脑部病变（如阿尔茨海默病）共存，从而导致混合性痴呆。血管疾病的许多危险因素是可以治疗的。我们的目的是回顾血管性认知障碍（VCI）诊断和治疗的证据，以便向临床医生提出建议。
痴呆症诊断与治疗加拿大共识会议（CCCDTD）的一个小组委员会对新出现证据的领域进行了审查。采用推荐分级评估、制定与评价（GRADE）系统来确定证据质量和推荐强度。
强烈建议使用标准化诊断标准、将高血压控制到常规血压目标以及降低中风风险。对于有血管危险因素的中年成年人强化降压、对患有VCI和隐匿性脑梗死的患者使用乙酰水杨酸（但仅存在白质病变时不建议使用）以及使用胆碱酯酶抑制剂的建议力度较弱。
CCCDTD为VCI的诊断和管理提供了基于证据的建议，供加拿大全国使用，这些建议在全球可能也有用。
