Bendigo Hospital, Monash University School of Rural Health, Bendigo, Vic., Australia.
Department of Medicine, Bendigo Hospital, Bendigo, Vic., Australia.
Eur J Neurol. 2022 Apr;29(4):1254-1265. doi: 10.1111/ene.15211. Epub 2022 Jan 20.
Lewy body dementia (LBD), including dementia with Lewy bodies (DLB) and Parkinson's disease dementia, is a common form of neurodegenerative dementia. The frequency and influence of comorbid cerebrovascular disease is not understood but has potentially important clinical management implications.
A systematic literature search was conducted (MEDLINE and Embase) for studies including participants with DLB and/or Parkinson's disease dementia assessing cerebrovascular lesions (imaging and pathological studies). They included white matter changes, cerebral amyloid angiopathy, cerebral microbleeds (CMB), macroscopic infarcts, microinfarcts and intracerebral haemorrhage.
Of 4411 articles, 63 studies were included. Cerebrovascular lesions commonly studied included white matter changes (41 studies) and CMB (18 studies). There was an increased severity of white matter changes on magnetic resonance imaging (visualized as white matter hyperintensities), but not neuropathology, in LBD compared to Parkinson's disease without dementia and age-matched controls. CMB prevalence in DLB was highly variable but broadly similar to Alzheimer's disease (0%-48%), with a lobar predominance. No relationship was found between large cortical or small subcortical infarcts or intracerebral haemorrhage and the presence of LBD.
The underlying mechanisms of white matter hyperintensities in LBD require further exploration, as their increased severity in LBD was not supported by neuropathological examination of white matter. CMB in LBD had a similar prevalence to Alzheimer's disease. There is a need for larger studies assessing the influence of cerebrovascular lesions on clinical symptoms, disease progression and outcomes.
路易体痴呆（LBD）包括路易体痴呆（DLB）和帕金森病痴呆，是一种常见的神经退行性痴呆形式。合并脑血管病的频率和影响尚不清楚，但具有重要的临床管理意义。
系统检索 MEDLINE 和 Embase 中的文献，纳入评估脑血管病变（影像学和病理学研究）的 DLB 和/或帕金森病痴呆患者的研究。包括脑白质改变、脑淀粉样血管病、脑微出血（CMB）、大梗死、微梗死和脑出血。
在 4411 篇文章中，有 63 项研究入选。研究中常见的脑血管病变包括脑白质改变（41 项研究）和 CMB（18 项研究）。与帕金森病无痴呆和年龄匹配的对照组相比，LBD 患者的磁共振成像上（表现为脑白质高信号）脑白质改变更严重，但神经病理学无差异。DLB 患者 CMB 的患病率差异很大，但与阿尔茨海默病相似（0%-48%），以脑叶为主。在 LBD 患者中，未发现大皮质或小皮质下梗死或脑出血与 LBD 的存在之间存在相关性。
LBD 患者脑白质高信号的潜在机制需要进一步探索，因为其严重程度在 LBD 中未得到白质病理学检查的支持。LBD 中的 CMB 与阿尔茨海默病相似。需要更大规模的研究来评估脑血管病变对临床症状、疾病进展和结局的影响。
