Román G C, Tatemichi T K, Erkinjuntti T, Cummings J L, Masdeu J C, Garcia J H, Amaducci L, Orgogozo J M, Brun A, Hofman A
Neuroepidemiology Branch, NINDS, NIH, Bethesda, MD 20892.
Neurology. 1993 Feb;43(2):250-60. doi: 10.1212/wnl.43.2.250.
Criteria for the diagnosis of vascular dementia (VaD) that are reliable, valid, and readily applicable in a variety of settings are urgently needed for both clinical and research purposes. To address this need, the Neuroepidemiology Branch of the National Institute of Neurological Disorders and Stroke (NINDS) convened an International Workshop with support from the Association Internationale pour la Recherche et l'Enseignement en Neurosciences (AIREN), resulting in research criteria for the diagnosis of VaD. Compared with other current criteria, these guidelines emphasize (1) the heterogeneity of vascular dementia syndromes and pathologic subtypes including ischemic and hemorrhagic strokes, cerebral hypoxic-ischemic events, and senile leukoencephalopathic lesions; (2) the variability in clinical course, which may be static, remitting, or progressive; (3) specific clinical findings early in the course (eg, gait disorder, incontinence, or mood and personality changes) that support a vascular rather than a degenerative cause; (4) the need to establish a temporal relationship between stroke and dementia onset for a secure diagnosis; (5) the importance of brain imaging to support clinical findings; (6) the value of neuropsychological testing to document impairments in multiple cognitive domains; and (7) a protocol for neuropathologic evaluations and correlative studies of clinical, radiologic, and neuropsychological features. These criteria are intended as a guide for case definition in neuroepidemiologic studies, stratified by levels of certainty (definite, probable, and possible). They await testing and validation and will be revised as more information becomes available.
出于临床和研究目的，迫切需要可靠、有效且能在各种环境中轻松应用的血管性痴呆（VaD）诊断标准。为满足这一需求，美国国立神经疾病与中风研究所（NINDS）神经流行病学分支在国际神经科学研究与教学协会（AIREN）的支持下召开了一次国际研讨会，制定了VaD诊断的研究标准。与其他现行标准相比，这些指南强调：（1）血管性痴呆综合征和病理亚型的异质性，包括缺血性和出血性中风、脑缺氧缺血事件以及老年白质脑病病变；（2）临床病程的变异性，可能是静止性、缓解性或进行性的；（3）病程早期的特定临床发现（如步态障碍、失禁或情绪及人格改变），这些发现支持血管性而非退行性病因；（4）为明确诊断，需要确定中风与痴呆发病之间的时间关系；（5）脑成像对支持临床发现的重要性；（6）神经心理学测试对记录多个认知领域损害的价值；（7）神经病理学评估以及临床、放射学和神经心理学特征相关性研究的方案。这些标准旨在作为神经流行病学研究中病例定义的指南，按确定性水平（明确、很可能和可能）分层。它们有待测试和验证，并将随着更多信息的获取而修订。
