Neuropsychology and Behavioural Neurology Unit, Division of Molecular and Cognitive Neuroscience, University of Basel, Basel, Switzerland.
Department of Neurology, University Clinic of Basel, Basel, Switzerland.
Neurol Neurochir Pol. 2021;55(4):333-345. doi: 10.5603/PJNNS.a2021.0035. Epub 2021 Jun 7.
With newer research-based classification systems, the term Vascular Cognitive Impairment (VCI) is now preferred to vascular dementia. VCI is an umbrella term that includes all forms of cognitive deficits ranging from mild cognitive impairment of vascular origin (VaMCI) to vascular dementia (VaD). The new VCI construct takes into account the fact that in addition to single strategic infarcts, multiple infarcts, and leukoaraiosis, there are other mechanisms of cerebrovascular disease such as chronic hypoperfusion that might account for the pattern of cognitive deficits associated with vascular dementia. The key to defining the spectrum of VCI is neuropsychological testing, bedside or office-based clinical examination, and neuroimaging. The lack of specific cognitive tools that are sufficiently sensitive to detect subtle deficits makes the assessment of cognitive impairment difficult. Prospective cross-sectional and longitudinal studies of VCI from different settings are therefore required. Although there have been few published reports, behavioural and psychological symptoms (BPS) are inherently present in VCI from the onset and during the course of the disease. Besides the type of population (i.e. clinical, community or nursing-home settings), the definition of VCI/VaD and the instruments used, and differences in the prevalence and pattern of BPS between various studies, could be due to other, often unconsidered, factors such as gender, age, education, use of medication and VCI/VaD severity.
随着新的基于研究的分类系统的出现，现在更倾向于使用“血管性认知障碍”（Vascular Cognitive Impairment，VCI）这一术语来替代血管性痴呆。VCI 是一个总称，包括从血管性轻度认知障碍（VaMCI）到血管性痴呆（VaD）等各种认知缺陷。新的 VCI 概念考虑到了这样一个事实，即除了单一的战略梗死、多发性梗死和白质疏松症外，还有其他脑血管疾病的机制，如慢性低灌注，这些机制可能导致与血管性痴呆相关的认知缺陷模式。定义 VCI 谱的关键是神经心理学测试、床边或办公室临床检查和神经影像学。缺乏足够敏感的特定认知工具来检测细微缺陷，使得认知障碍的评估变得困难。因此，需要对不同环境下的 VCI 进行前瞻性横断面和纵向研究。尽管发表的报告很少，但从疾病的一开始到整个过程中，血管性认知障碍就存在行为和心理症状（Behavioural and Psychological Symptoms，BPS）。除了人群类型（即临床、社区或疗养院环境）、VCI/VaD 的定义以及使用的工具以及不同研究之间 BPS 的患病率和模式差异之外，其他通常未被考虑的因素，如性别、年龄、教育程度、用药情况和 VCI/VaD 的严重程度，也可能是导致这些差异的原因。
