Department of Neurology, Mayo Clinic Florida, Jacksonville, Florida.
Department of Neurology, Baptist Health, Jacksonville, Florida.
Semin Neurol. 2021 Feb;41(1):75-84. doi: 10.1055/s-0040-1722217. Epub 2021 Jan 8.
Despite substantial advances in stroke care, vascular cognitive impairment remains a prominent source of disability. Unlike sensorimotor impairments, cognition often continues to decline after stroke. An aging population will increase the prevalence of vascular cognitive impairment, with stroke playing an important role. Ten percent of patients presenting with stroke have pre-stroke dementia; an additional 10% will develop incident dementia with a first stroke, and 30% with a recurrent stroke. While stroke increases the risk of cognitive impairment, the presence of cognitive impairment also impacts acute stroke treatment and increases risk of poor outcome by nearly twofold. There is substantial overlap in the clinical and pathological aspects of vascular and degenerative dementias in many patients. How they relate to one another is controversial. The treatment of vascular cognitive impairment remains supportive, focusing on treating vascular risk factors. Cognitive rehabilitation after stroke is an area of active research, and existing pharmacologic treatments have limited benefit. Heightened awareness of cognitive impairment in the setting of stroke is imperative for prognostication and management, impetus for research and, ultimately, the discovery of efficacious treatments.
尽管在中风治疗方面取得了重大进展，但血管性认知障碍仍然是残疾的主要原因。与感觉运动障碍不同，中风后认知功能往往会继续下降。人口老龄化将增加血管性认知障碍的患病率，中风在此过程中起着重要作用。10%的中风患者有卒中前痴呆；另外 10%的患者在首次中风后会出现新发痴呆，30%的患者在再次中风后会出现痴呆。虽然中风会增加认知障碍的风险，但认知障碍的存在也会影响急性中风的治疗，并使不良预后的风险增加近两倍。在许多患者中，血管性和退行性痴呆在临床和病理方面有很大的重叠。它们之间的关系存在争议。血管性认知障碍的治疗仍然是支持性的，重点是治疗血管危险因素。中风后认知康复是一个活跃的研究领域，现有的药物治疗获益有限。在中风的背景下提高对认知障碍的认识对于预后和管理至关重要，这是推动研究并最终发现有效治疗方法的动力。
