From the Department of Clinical Neurological Sciences, Western University, London, Ontario, Canada.
Neurology. 2021 Aug 10;97(6):273-279. doi: 10.1212/WNL.0000000000012103. Epub 2021 Apr 21.
There is no health without brain health, which is threatened by rising curves of stroke, ischemic heart disease, and dementia (the triple threat). The fastest growing and intractable threat has been dementia. Focusing on finding a drug to stop Alzheimer disease has yielded growing knowledge but no treatments, partly because in the elderly, cognitive impairment results from multiple interactive pathologies aggravated by fragility and tempered by resilience on the advancing background of aging. The concept of vascular cognitive impairment (VCI) cuts pragmatically through this complexity. VCI is any cognitive impairment caused by or associated with vascular factors. It spans the spectrum of undetected cognitive impairment to full-blown dementia. The vascular component represents the only major current, treatable, and preventable contributor to dementia and offers the possibility of delaying, mitigating, or preventing more dementias in the near future. The triple threat conditions share the same protective and treatable risk factors and can be prevented together. The approach needs to be comprehensive, identifying all relevant environmental, socioeconomic, health care, and individual factors; targeted, as risks and protective factors differ among populations and individuals; and and investment valued, yielding worthwhile returns in terms of money, effort, or time. The World Stroke Organization's proclamation calling for the joint prevention of stroke and potentially preventable dementias has been endorsed by 23 international, regional, and national brain and heart organizations, including the American Academy of Neurology. We need to develop joint prevention programs to curb the triple threat. Millions of brains depend on it.
没有大脑健康就没有健康，而中风、缺血性心脏病和痴呆症（三重威胁）的发病率不断上升正威胁着大脑健康。增长最快且最难应对的威胁一直是痴呆症。专注于寻找一种能够阻止阿尔茨海默病的药物已经产生了越来越多的知识，但没有治疗方法，部分原因是在老年人中，认知障碍是由多种相互作用的病理引起的，这些病理因脆弱性而加重，因衰老背景下的韧性而减轻。血管性认知障碍（VCI）的概念在很大程度上解决了这种复杂性。VCI 是指任何由血管因素引起或与之相关的认知障碍。它涵盖了从无症状认知障碍到完全痴呆的认知障碍谱。血管成分是痴呆症当前唯一主要的、可治疗的和可预防的因素，为未来延缓、减轻或预防更多痴呆症提供了可能。三重威胁的情况具有相同的保护和治疗风险因素，可以共同预防。这种方法需要全面，识别所有相关的环境、社会经济、医疗保健和个人因素；有针对性，因为风险和保护因素在不同人群和个体中存在差异；并且有价值的投资，在金钱、努力或时间方面都能获得有价值的回报。世界中风组织呼吁联合预防中风和潜在可预防的痴呆症的宣言已经得到 23 个国际、地区和国家的大脑和心脏组织的认可，包括美国神经病学学会。我们需要制定联合预防计划来遏制这三重威胁。数以百万计的大脑依赖于此。
