阿尔茨海默病与血管性痴呆的非认知功能损害

目的　观察阿尔茨海默病与血管性痴呆的患者除认知功能异常外 ,是否存在非认知功能的异常。方法　根据DSM -Ⅳ阿尔茨海默病及血管性痴呆的诊断标准以及CDR的临床痴呆分级标准 ,对神经内科老年记忆障碍专科病房的 2 1例轻中度阿尔茨海默病及 2 5例血管性痴呆患者的非认知功能损害的临床表现进行了观察 ,包括情感反应、行为异常、人格变化及知觉异常。结果　阿尔茨海默病患者的非认知功能损害在情感障碍 (16例 ,76 % )、人格异常 (10例 ,48% )及知觉异常 (6例 ,2 9% )方面 ,明显多于血管性痴呆组 (分别为 10例 ,40 % ;1例 ,4% ;1例 ,4% )。结论　痴呆患者不仅有认知功能的损害 ,还有非认知功能的损害。阿尔茨海默病的非认知功能损害重于血管性痴呆 ,可能与两种痴呆的发病机制不同有关。     

不同脑部位单灶卒中后执行功能损害的研究

<正>血管性认知功能损害(vascular cognitive impair-ment,VCI)是指所有由血管性因素导致的从轻度认知障碍到痴呆的一大类综合征。Wentzel提出标准诊断血管性痴呆(vascular dementia,VaD)和血管性无痴呆型认知损害(cognitive impairment no dementia,CIND)。按病灶部位分类可分为皮层型、皮层下型和多发梗死型,其中皮层下型又可以分为皮层下关键部位梗死型、皮层下小血管型。皮层下关键部位主要为丘脑     

血管性认知损害的研究进展

血管性认知损害（VCI）指血管或与血管相关因素引起的认知功能障碍,其范围囊括了痴呆及非痴呆等各种类型的认知功能障碍,危险因素主要是血管性危险因素和基因遗传因素,病理生理改变是皮质下白质缺血及梗死,尼莫地平、美金刚、丙戊茶碱治疗VCI可能有一定疗效,防治其危险因素是预防VCI的首要原则。     

血管性痴呆的病因研究

目前多数研究认为血管性痴呆的发生与卒中有直接联系，卒中后认知力损害有其独特表现形式，在血管性痴呆的相关危险因素上尚无统一意见，一些血管性，基因性以及人口统计学因素被认为和血管性痴呆相关。     

血管性认知损害的筛查工具与早期诊断

血管性认知损害(vascular cognitive impairment,VCI)是由脑血管病危险因素(如高血压、心脏病、糖尿病和高血脂等)、明显(如脑梗死和脑出血等)或不明显的脑血管病(如白质疏松和慢性脑缺血等)引起的从轻度认知障碍到痴呆的综合征[1,2].目前较为统一的意见是VCI包括3个内容[3～6]:非痴呆型血管性认知损害 (vascular cognitive impairment,no dementia,VCIND)、血管性痴呆(vascular dementia,VD )、AD伴血管病变(即混合性痴呆,mixed AD/VD).与血管性痴呆相比,其内涵有了扩展,认知障碍不强调记忆力损害,只要有某些认知领域的功能下降,即使没有记忆力减退,仍然可定性为认知障碍;同时,"血管性"不特指脑出血或梗死,还包括各种可能影响脑功能的心脑血管病变.     

老年血管性认知功能损害及其预防

1 概述与概念 世界各地流行病学资料显示,65岁以上者老年痴呆患病率约为8%.根据现行诊断标准和分类方法,阿尔茨海默病(Alzheimer's disease,AD)是最常见的痴呆类型,占所有病例的1/2～2/3,其次为血管性痴呆(vascular dementia,VaD),约占总痴呆病例的30%,VaD旧称"脑动脉硬化性痴呆"或"多发脑梗死性痴呆",诊断VaD的现行标准要求患者有记忆力下降和其他认知功能损害,其严重程度足以符合痴呆的标准,同时有脑血管疾病的临床或颅脑影像学证据,并且脑血管疾病可能是认知功能损害的原因.     

血管性认知损害之我见

人们对血管病变影响认知功能的认识已逾一个世纪,并随研究的不断深化而先后萌生出动脉硬化性痴呆、多发梗死性痴呆和血管性痴呆(VaD)的概念.20世纪90年代血管性认知损害(VCI)概念的问世,为进一步研究创建了崭新的平台,但也衍生出不少新问题有待解决.     

脑小血管病与认知功能障碍

随着人口老龄化的加剧,各种原因所致的痴呆患者人数逐年增加,而血管性痴呆作为继阿尔茨海默病的第2常见痴呆类型逐渐受到人们的重视。流行病学调查发现,血管性痴呆在65岁以上的人群中占10%~15%,其患病率每增长5.3岁即增加1倍,是血管性认知功能损害最严重的形式[1]。脑小血管病相关认知功能障碍是血管性认知功能障碍的重要亚型,约50%的血管性认知功能障碍因小血管病所致[2],是其首要病因,多项研究表明脑小血管     

血管性认知损害的危险因素

血管性认知损害(vascular cognitive impairment,VCI)是指由各种血管性因素引起的不同程度的认知功能损害综合征,其发病率日益增高,但其危险因素尚不明确.注重VCI的早期预防可有效减少血管性痴呆的发生.文章对VCI的危险因素进行了综述.     

神经影像学检查对血管性痴呆46例的临床评价

血管性痴呆(VD)是脑血管病变引起脑损害所致的痴呆,它是仅次于阿尔茨海默病(AD)之后的第二常见痴呆[1,2],其主要表现为认知功能障碍及相关脑血管病的神经功能障碍和神经影像学征象.神经影像是明确痴呆病因的重要手段之一,本文试图通过对VD患者的头部CT或MRI表现进行分析,来探讨神经影像学检查对VD临床评价中的价值,从而对VD患者的防治和判断预后起重要作用.     

Cognitive dysfunction in patients with type 2 diabetes

People with diabetes mellitus are at increased risk of cognitive dysfunction and dementia. This review explores the nature and severity of cognitive changes in patients with type 2 diabetes. Possible risk factors such as hypo‐ and hyperglycemia, vascular risk factors, micro‐ and macrovascular complications, depression and genetic factors will be examined, as well as findings from brain imaging and autopsy studies. We will show that type 2 diabetes is associated with modest cognitive decrements in non‐demented patients that evolve only slowly over time, but also with an increased risk of more severe cognitive deficits and dementia. There is a dissociation between these two ‘types’ of cognitive dysfunction with regard to affected age groups and course of development. Therefore, we hypothesize that the mild and severe cognitive deficits observed in patients with type 2 diabetes reflect separate processes, possibly with different risk factors and aetiologies. Copyright © 2010 John Wiley & Sons, Ltd.     

Association between mild vascular cognitive impairment and impaired activities of daily living in older stroke survivors without dementia

OBJECTIVES: To determine the relationship between mild vascular cognitive impairment (mVCI) and functional disability in older stroke survivors without dementia. DESIGN: Cohort study. SETTING: Stroke patients from representative hospital-based stroke registers. PARTICIPANTS: Three hundred thirty-nine stroke survivors without dementia, aged 75 and older. MEASUREMENTS: Neuropsychological assessments were completed 3 months poststroke. Activities of daily living (ADLs) were evaluated using the Bristol scale. Operationalized criteria, including cognitive impairment no dementia (CIND), were applied for mVCI. RESULTS: Significant impairments of ADLs were evident in mVCI (CIND vs no CIND; basic care: z=3.2; P=.001, intermediate care: z=3.6; P<.001, complex management: z=4.5; P<.001) but varied according to the profile of cognitive impairments. Patients with attentional or global impairments had more severe functional disability than patients with isolated memory deficits, with an intermediate level of dysfunction in patients with executive impairments. CONCLUSION: The findings emphasize the importance of identifying early cognitive impairments to optimize rehabilitation, care planning, and secondary prevention of dementia in stroke patients.     

脑小血管病变

脑白质和中央灰质的小血管病变(SVD)是血管性痴呆的重要亚型,小血管病变痴呆的特点是认知障碍的功能障碍型,神经功能缺损包括失衡、失禁和情绪障碍。SVD在健康成人和轻度认知障碍患者中也比较常见,很容易被影像技术所显现,但难以与混合性SVD/AD相鉴别。文章就SVD的研究进展和有待解决的问题进行综述。     

Cognitive deficits 3 to 6 years before dementia onset in a population sample: the Honolulu-Asia aging study

OBJECTIVE: To determine the type of cognitive deficits occurring 3 to 6 years before onset of dementia in a population sample. DESIGN: A prospective study in which cognitive deficits in participants who had incident dementia at the 6-year follow-up were examined at baseline and 3 years. SETTING: Honolulu, Hawaii. PARTICIPANTS: Three thousand seven hundred thirty-four Japanese-American men aged 71 to 93 at baseline. At the 6-year follow-up, there were 52 incident cases of dementia, and 1,559 controls. MEASUREMENTS: The Cognitive Abilities Screening Instrument (CASI) and a questionnaire on subjective memory problems were administered at baseline. Dementia was assessed at baseline and at 3-year and 6-year follow-ups. RESULTS: Subjects who had incident dementia at 6-year follow-up, had showed deficits 3 to 6 years earlier in the CASI domain of episodic memory and in the questionnaire covering subjective memory problems. Up to 3 years before onset, there was worsening of the episodic memory deficit from baseline and new deficits in language, verbal fluency, and orientation. CONCLUSION: Cognitive deficits and awareness of memory problems are frequently present several years before dementia onset. The predictive value of these deficits is not large enough to allow earlier diagnosis of dementia, but information about such deficits may be useful as criteria for mild cognitive impairment.     

Nicardipine: A Hypotensive Dihydropyridine-Type Calcium Antagonist with a Peculiar Cerebrovascular Profile

Control of blood pressure protects against the development of cerebrovascular lesions, stroke, and vascular dementia (VaD). Cerebrovascular disease is increasingly recognized as a cause of cognitive impairment and dementia primarily in the elderly. Nicardipine is a dihydropyridine-type calcium channel blocker (CCB) with a peculiar cerebrovascular profile developed approximately 30 years ago. This study has reviewed the main controlled clinical studies investigating the use of nicardipine in pathologies associated with cerebrovascular injury, such as subarachnoid haemorrhage (SAH), acute stroke, and VaD. SAH is a main cerebrovascular indication of CCBs. In this indication, CCBs prevent vasospasm and improve clinical outcomes. Nimodipine represents the CCB more investigated in this indication. Former studies did not demonstrate a clear advantage of nicardipine versus nimodipine in SAH. A more recent approach using implants of nicardipine prolonged-release showed a decreased incidence of vasospasm, delayed ischemic deficits, and improved clinical outcome after severe SAH. Controlled trials have shown the effectiveness of the drug in preventing stroke. Increasing evidence suggests some benefit of some CCBs in VaD or mixed degenerative and vascular dementia. In this setting, nicardipine has been investigated in approximately 6,000 patients, with an improvement of cognitive deterioration in more than 60% of patients treated. The pronounced anti-hypertensive activity of nicardipine and its safety and effectiveness in cognitive domain suggest its reconsideration in the treatment of cognitive impairment of vascular origin as well as for reducing the risk of recurrent stroke in patients at high risk of it.     

The association between demographic factors, disease severity and the duration of symptoms at clinical presentation in elderly people with dementia.

OBJECTIVE: To determine the association between factors unrelated to the disease process, the duration of symptoms and the degree of cognitive or functional impairment in elderly patients presenting with dementia. METHOD: The living situation, educational level, age, gender and diagnosis based on standardized criteria were recorded for 209 elderly patients presenting to a memory clinic with dementia. Cognitive and functional deficits were measured with the cognitive section of the Cambridge Mental Disorders of the Elderly Examination combined with the Mini-Mental State Examination and the abbreviated version of the Blessed dementia scale, respectively. RESULTS: 129 patients had a diagnosis of probable Alzheimer's disease, 19 had probable ischaemic vascular dementia and 61 had mixed dementia. There was no effect of diagnosis on duration of symptoms or dementia severity at the time of presentation. Patients living with a son or daughter were more functionally impaired than those living alone or with a spouse. Males had higher cognitive scores but did not have milder functional deficits. Patients with only a primary-school education had a trend towards lower cognitive scores at presentation but did not have more functional deficits. CONCLUSIONS: The gender of the patient and the relationship to the carer are associated with cognitive and functional scores at the time of presentation in patients with dementia.     

Predictors of dementia amongst newly diagnosed non-valvular atrial fibrillation patients

Atrial fibrillation (AF) confers a 2-to-3-fold increased risk of developing cognitive dysfunction and dementia, independent of age and past stroke. The purpose of study was to identify risk factors for developing dementia amongst AF patients in India. This was a single-centre, prospective, observational study wherein recently diagnosed, treatment naïve, persistent non-valvular AF patients were enrolled. All patients were screened for dementia using the Mini-Mental state exam. Amongst a total of 108 patients enrolled, 40 (37%) had dementia. The most common cognitive deficits were in attention and calculation followed by memory deficits. Factors independently contributing to dementia were advanced age, female sex, presence of diabetes, elevated pulmonary artery pressures and a lower serum albumin.     

H型高血压与血管性痴呆

脑血管病是我国首位死亡原因。我国脑卒中年死亡人数200多万,在导致脑卒中发生的可控因素中,高血压和同型半胱氨酸升高位居前列,二者在导致脑卒中的发生上具有协同作用,而缺血性脑卒中是导致血管性痴呆的重要病因。我国学者将伴有同型半胱氨酸升高的高血压定义为＂H型高血压＂。我国原发性高血压患者中约有75%为H型高血压。血管性痴呆是指由各类脑血管病所致的痴呆综合征,是继阿尔茨海默病之后第二常见的痴呆。高血压和高同型半胱氨酸血症可引起认知功能障碍,进而导致血管性痴呆的发生,且待患者达血管性痴呆的诊断标准时,常已错过重要的早期干预治疗阶段,故在认知功能明显损害之前就发现并进行干预是非常重要的。现对H型高血压和血管性痴呆的关系做一综述。     

血管性痴呆与血管性认知障碍

由于传统痴呆定义的束缚,目前的血管性痴呆诊断标准不能发现非痴呆的认知障碍,也难以与混合性痴呆相区别,更不能促进血管性痴呆的防治。用血管性认知障碍的概念则可以涵盖所有与血管危险因素和脑血管病变有关的各种程度的认知障碍,促进早期识别和早期干预。     

Pre‐clinical Dementia: Does it Exist?

Abstract . Identification of syndromes that will progress to dementia carries immense importance for the management of these diseases when therapies are available and for future research into effective early prevention. Evidence supporting the presence of a preclinical phase for dementia has arisen from a range of different areas. Clinical and epidemiological studies have identified both cognitive and neurological abnormalities which predict the future development of dementia. Similarly, various neuroimaging techniques have identified abnormalities in asymptomatic subjects with significant risk for developing Alzheimer's disease and subjects who show mild cognitive deficits. Neuropathological series are hampered by non‐representative study populations and poor antemortem data but in studies where informants have been utilised to provide details of subjects' antemortem cognitive function, evidence indicates that the presence of brain pathology is associated with cognitive deficits. This paper reviews the current literature exploring the presence of a pre‐clinical phase for dementia, identifies the weaknesses in this research and provides suggestions for future research.