Vascular dementia: a construct in evolution.

D W Desmond
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Abstract

Since the late 1800s, when Alzheimer and Binswanger proposed the concept of "arteriosclerotic brain degeneration," there has been an evolution in thinking regarding cerebrovascular disease (CVD) as a basis for dementia. While later work recognized the importance of specific infarct characteristics including volume, multiplicity, and location, recent studies have found that many factors may work in combination with those characteristics to produce dementia, including white matter disease; vascular risk factors such as diabetes; comorbid illnesses, particularly those that might produce cerebral ischemia or hypoxia; genetic factors; and host characteristics such as older age and fewer years of education. Studies of the prevalence of vascular dementia (VaD) have suggested that CVD is second only to Alzheimer's disease as a basis for dementia in Western countries and the most common basis in certain Asian countries, but those studies may have underestimated the frequency of dementia associated with CVD due to a failure to perform brain imaging and decreased survival among patients with CVD. Few studies of the incidence of VaD have been performed, but they have also consistently demonstrated an elevated risk associated with CVD. While certain methodologic issues have contributed to the debate regarding the importance of CVD as a basis for dementia, including variability in the techniques that have been used to characterize brain lesions, assess cognitive function, and diagnose dementia; difficulties inherent in the determination of a causal role for CVD in dementia; and the potential confounding effects of aphasia and depression in patients with stroke, it is clear that VaD remains an important public health problem.

血管性痴呆:进化中的构造。
自19世纪末阿尔茨海默和宾斯旺格提出“动脉硬化性脑变性”的概念以来,人们对脑血管疾病(CVD)作为痴呆症的基础的看法发生了演变。虽然后来的研究认识到特定梗死特征的重要性,包括体积、多样性和位置,但最近的研究发现,许多因素可能与这些特征相结合,产生痴呆,包括白质疾病;糖尿病等血管危险因素;合并症,特别是那些可能导致脑缺血或缺氧的疾病;遗传因素;而房主的特点是年龄较大,受教育年限较短。血管性痴呆(VaD)患病率的研究表明,在西方国家,CVD是仅次于阿尔茨海默病的痴呆症的基础,在某些亚洲国家也是最常见的基础,但这些研究可能低估了与CVD相关的痴呆的频率,因为CVD患者未能进行脑成像和生存率降低。很少有关于VaD发病率的研究,但它们也一致表明与CVD相关的风险升高。虽然某些方法学问题导致了关于心血管疾病作为痴呆基础的重要性的争论,包括用于表征脑病变、评估认知功能和诊断痴呆的技术的可变性;确定心血管疾病在痴呆中的因果作用所固有的困难;以及脑卒中患者失语和抑郁的潜在混杂效应,很明显VaD仍然是一个重要的公共卫生问题。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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