Hurła Mikołaj, Banaszek Natalia, Kozubski Wojciech, Dorszewska Jolanta
Laboratory of Neurobiology, Department of Neurology.
Chair and Department of Neurology, Poznan University of Medical Sciences, Poznan, Poland.
Curr Alzheimer Res. 2024 Jul 29. doi: 10.2174/0115672050319219240711103459.
Alzheimer's disease (AD) and vascular dementia (VD) are the leading causes of dementia, presenting a significant challenge in differential diagnosis. While their clinical presentations can overlap, their underlying pathologies are distinct. AD is characterized by the accumulation of amyloid plaques and neurofibrillary tangles, leading to progressive neurodegeneration. VD, on the other hand, arises from cerebrovascular insults that disrupt blood flow to the brain, causing neuronal injury and cognitive decline. Despite distinct etiologies, AD and VD share common risk factors such as hypertension, diabetes, and hyperlipidemia. Recent research suggests a potential role for oral microbiota in both diseases, warranting further investigation. The diagnostic dilemma lies in the significant overlap of symptoms including memory loss, executive dysfunction, and personality changes. The absence of definitive biomarkers and limitations of current neuroimaging techniques necessitate a multi-modal approach integrating clinical history, cognitive assessment, and neuroimaging findings. Promising avenues for improved diagnosis include the exploration of novel biomarkers like inflammatory markers, MMPs, and circulating microRNAs. Additionally, advanced neuroimaging techniques hold promise in differentiating AD and VD by revealing characteristic cerebrovascular disease patterns and brain atrophy specific to each condition. By elucidating the complexities underlying AD and VD, we can refine diagnostic accuracy and optimize treatment strategies for this ever-growing patient population. Future research efforts should focus on identifying disease-specific biomarkers and developing more effective neuroimaging methods to achieve a definitive diagnosis and guide the development of targeted therapies.
阿尔茨海默病（AD）和血管性痴呆（VD）是痴呆的主要病因，在鉴别诊断方面构成重大挑战。虽然它们的临床表现可能重叠，但其潜在病理却截然不同。AD的特征是淀粉样斑块和神经原纤维缠结的积累，导致进行性神经退行性变。另一方面，VD源于脑血管损伤，这种损伤会破坏大脑的血液流动，导致神经元损伤和认知能力下降。尽管病因不同，但AD和VD有共同的风险因素，如高血压、糖尿病和高脂血症。最近的研究表明口腔微生物群在这两种疾病中可能发挥作用，值得进一步研究。诊断难题在于症状存在显著重叠，包括记忆力丧失、执行功能障碍和性格改变。缺乏明确的生物标志物以及当前神经成像技术的局限性，需要采用一种综合临床病史、认知评估和神经成像结果的多模式方法。改善诊断的有前景途径包括探索新型生物标志物，如炎症标志物、基质金属蛋白酶和循环微小RNA。此外，先进的神经成像技术有望通过揭示每种疾病特有的脑血管疾病模式和脑萎缩来区分AD和VD。通过阐明AD和VD背后的复杂性，我们可以提高诊断准确性，并为这一不断增长的患者群体优化治疗策略。未来的研究工作应专注于识别疾病特异性生物标志物和开发更有效的神经成像方法，以实现明确诊断并指导靶向治疗的开发。
