Department of Neurology Ocshner/LSU Health Sciences Center-Sheveport, Shreveport, LA, USA.
Department of Radiology, Ocshner/LSU Health Sciences Center-Sheveport, Shreveport, LA, USA.
J Stroke Cerebrovasc Dis. 2021 Aug;30(8):105864. doi: 10.1016/j.jstrokecerebrovasdis.2021.105864. Epub 2021 May 29.
Vascular dementia (VaD) is the second most common cause of dementia and a major health concern worldwide. A comprehensive review on VaD is warranted for better understanding and guidance for the practitioner. We provide an updated overview of the epidemiology, pathophysiological mechanisms, neuroimaging patterns as well as current diagnostic and therapeutic approaches.
A narrative review of current literature in VaD was performed based on publications from the database of PubMed, Scopus and Google Scholar up to January, 2021.
VaD can be the result of ischemic or hemorrhagic tissue injury in a particular region of the brain which translates into clinically significant cognitive impairment. For example, a cerebral infarct in the speech area of the dominant hemisphere would translate into clinically significant impairment as would involvement of projection pathways such as the arcuate fasciculus. Specific involvement of the angular gyrus of the dominant hemisphere, with resultant Gerstman's syndrome, could have a pronounced effect on functional ability despite being termed a "minor stroke". Small vessel cerebrovascular disease can have a cumulate effect on cognitive function over time. It is unfortunately well recognized that "good" functional recovery in acute ischemic or haemorrhagic stroke, including subarachnoid haemorrhage, does not necessarily translate into good cognitive recovery. The victim may often be left unable to have gainful employment, drive a car safely or handle their affairs independently.
This review should serve as a compendium of updated information on VaD and provide guidance in terms of newer diagnostic and potential therapeutic approaches.
血管性痴呆（VaD）是痴呆的第二大常见病因，也是全球范围内的一个主要健康关注点。为了更好地理解 VaD 并为临床医生提供指导，有必要对其进行全面综述。我们提供了 VaD 的流行病学、病理生理机制、神经影像学模式以及当前诊断和治疗方法的最新概述。
根据 PubMed、Scopus 和 Google Scholar 数据库截至 2021 年 1 月的出版物，对 VaD 的当前文献进行了叙述性综述。
VaD 可能是大脑特定区域的缺血性或出血性组织损伤的结果，导致临床上显著的认知障碍。例如，优势半球言语区的脑梗死会导致临床上显著的损害，而投射通路的受累，如弓状束，也会导致损害。优势半球角回的特定受累，导致格斯特曼综合征，尽管被称为“小中风”，但可能对功能能力产生明显影响。小血管脑血管病随着时间的推移会对认知功能产生累积影响。不幸的是，人们已经认识到急性缺血性或出血性中风（包括蛛网膜下腔出血）的“良好”功能恢复并不一定转化为良好的认知恢复。患者可能经常无法从事有收益的工作、安全驾驶或独立处理事务。
本综述应作为 VaD 最新信息的纲要，并为新的诊断和潜在治疗方法提供指导。
