Konno S, Meyer J S, Terayama Y, Margishvili G M, Mortel K F
Department of Neurology, Baylor College of Medicine, Houston, Texas, USA.
Drugs Aging. 1997 Nov;11(5):361-73. doi: 10.2165/00002512-199711050-00004.
Vascular dementia (VAD) is considered to be the second most common cause of dementia in Europe and the US. In Asia and many developing countries, it is more common than dementia of the Alzheimer's type (DAT). VAD is the most preventable form of dementia associated with later life. The pathogenesis of VAD is multifactorial, and it represents a heterogeneous, not a homogeneous, clinical entity. Classification of VAD by pathogenesis is important for its prevention and treatment. Control of the risk factors for VAD reduces its incidence and stabilises or improves cognitive performance following stroke. Proper diagnostic evaluation of VAD requires: (i) a well defined quantitative assessment of the cognitive deficits present; (ii) assessment of risk factors for stroke; (iii) identification of cerebral vascular lesions by history, neurological examination and neuroimaging; (iv) exclusion of other causes of dementia; (v) establishment of a positive diagnosis of possible, probable or definite VAD versus DAT or mixed VAD/DAT; and (vi) identification of the temporal relationship between cognitive deficits and cerebral vascular lesions. VAD can be subdivided into 8 major types, as follows: (i) multi-infarct dementia secondary to large cerebral emboli [type 1]; (ii) strategically placed infarctions causing dementia [type 2]; (iii) multiple subcortical lacunar lesions secondary to atherosclerosis or degenerative arteriolar changes [type 3]; (iv) Binswanger's disease (arteriosclerotic subcortical leukoencephalopathy) [type 4]; (v) mixtures of types 1, 2 and 3 [type 5]; (vi) haemorrhagic lesions causing dementia [type 6]; (vii) subcortical dementia secondary to hereditary factors (type 7); and (viii) mixtures of DAT and VAD (type 8). Treatment is dictated by the pathogenetic subtype of VAD that is present.
血管性痴呆（VAD）被认为是欧美地区第二常见的痴呆病因。在亚洲和许多发展中国家，它比阿尔茨海默病型痴呆（DAT）更为常见。VAD是与老年期相关的最可预防的痴呆形式。VAD的发病机制是多因素的，它代表的是一种异质性而非同质性的临床实体。按发病机制对VAD进行分类对其预防和治疗很重要。控制VAD的危险因素可降低其发病率，并在中风后稳定或改善认知功能。对VAD进行恰当的诊断评估需要：（i）对存在的认知缺陷进行明确的定量评估；（ii）评估中风的危险因素；（iii）通过病史、神经系统检查和神经影像学识别脑血管病变；（iv）排除其他痴呆病因；（v）确立可能、很可能或肯定的VAD与DAT或混合型VAD/DAT的阳性诊断；以及（vi）确定认知缺陷与脑血管病变之间的时间关系。VAD可细分为8种主要类型，如下：（i）继发于大脑大栓子的多梗死性痴呆[1型]；（ii）导致痴呆的关键部位梗死[2型]；（iii）继发于动脉粥样硬化或小动脉退行性改变的多发性皮质下腔隙性病变[3型]；（iv）宾斯旺格病（动脉硬化性皮质下白质脑病）[4型]；（v）1、2和3型的混合[5型]；（vi）导致痴呆的出血性病变[6型]；（vii）继发于遗传因素的皮质下痴呆（7型）；以及（viii）DAT和VAD的混合（8型）。治疗取决于所存在的VAD致病亚型。
