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首页> 外文期刊>The Canadian Journal of Neurological Sciences: le Journal Canadien des Sciences Neurologiques >Therapeutic issues in vascular dementia: studies, designs and approaches.
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Therapeutic issues in vascular dementia: studies, designs and approaches.

机译：血管性痴呆的治疗问题：研究，设计和方法。

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Vascular dementia (VaD) is a heterogeneous disorder resulting from various cerebrovascular diseases (CVD) causing cognitive impairment that reflects severity and location of damage. Epidemiological studies suggest VaD is the second commonest cause of dementia, but autopsy series report that pure VaD is infrequent, while combined CVD and Alzheimer's Disease(AD) is likely the commonest pathological-dementia correlate. Both diseases share vascular risk factors and benefit from their treatment. The most widely used diagnostic criteria for VaD are highly specific but not sensitive. Vascular Cognitive Impairment (VCI) is a dynamic, evolving concept that embraces VaD, Vascular Cognitive Impairment No Dementia (VCIND) and mixed AD and CVD. Clinical trials to date have focused on probable and possible VaD with beneficial effects evident for different drug classes, including cholinergic agents and NMDA agonists. Limitations have included use of cognitive tools suitable for AD that are insensitive to executive dysfunction. Disease heterogeneity has not been adequately controlled and subtypes require further study. Diagnostic VaD criteria now 13 years old need updating. More homogeneous subgroups need to be defined and therapeutically targeted to improve cognitive-behavioural outcomes including optimal control of vascular risk factors. More sensitive testing of executive function outlined in recent VCI Harmonization criteria and longer trial duration are needed to discern meaningful effects. Imaging criteria must be well-defined, with centralized review and standardized protocols. Serial scanning with quantification of tissue atrophy and lesion burden is becoming feasible, and cognitive interventions, including rehabilitation pharmacotherapy, with drugs strategically coupled to cognitive -behavioural treatments, hold promise and need further development.
机译：血管性痴呆（VaD）是一种由多种脑血管疾病（CVD）引起的异质性疾病，引起认知障碍，反映了损伤的严重程度和位置。流行病学研究表明，VaD是痴呆症的第二大常见病因，但尸检系列报告显示，纯VaD很少见，而CVD和阿尔茨海默氏病（AD）合并可能是最常见的病理性痴呆症相关因素。两种疾病均具有血管危险因素，并从其治疗中受益。 VaD最广泛使用的诊断标准是高度特异性的，但不敏感。血管性认知障碍（VCI）是一个动态，不断发展的概念，涵盖了VaD，无痴呆的血管性认知障碍（VCIND）以及混合AD和CVD。迄今为止的临床试验都集中在可能的和可能的VaD上，其对不同药物类别（包括胆碱能药和NMDA激动剂）的有益作用明显。局限性包括对行政功能障碍不敏感的适用于AD的认知工具的使用。疾病异质性尚未得到充分控制，亚型需要进一步研究。现年13岁的诊断VaD标准需要更新。需要定义和治疗更均一的亚组，以改善认知行为结果，包括对血管危险因素的最佳控制。最近的VCI协调标准中概述了对执行功能进行更敏感的测试，并且需要更长的试用期才能发现有意义的效果。成像标准必须明确定义，并具有集中审查和标准化协议。定量扫描组织萎缩和病变负荷的连续扫描变得可行，并且包括干预性药物疗法在内的认知干预，以及策略性地与认知行为治疗相结合的药物，有望实现并且需要进一步发展。

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