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首页> 外文期刊>Journal of stroke and cerebrovascular diseases: The official journal of National Stroke Association >Vasodilator Responses to Acetazolamide Tested in Subtypes of Vascular Dementia
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Vasodilator Responses to Acetazolamide Tested in Subtypes of Vascular Dementia

机译：血管性痴呆亚型中对乙酰唑胺的血管舒张反应

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Objectives: Thirty seven vascular dementia (VAD) patients were categorized into eight subtypes based on clinical, radiological, and pathogenetic features. Cerebral vasodilator responses to acetazolamide were then compared with age-matched normal controls and stroke patients without dementia. Methods: VAD results were compared with 42 normals and 19 cognitively intact stroke patients. Regional cerebral vasodilator responses were quantitated utilizing xenon contrasted computed tomography measures of local cerebral blood flow (LCBF) before and after oral administration of acetazolamide. LCBF changes (ALCBF) before and after acetazolamide were calculated within cortical and subcortical, gray and white matter. Clinical VAD subtypes were: type 1, multi-infarct dementia (MID); type 2, strategically placed infarcts; type 3, subcortical lacunar infarcts; type 4, Binswanger's subcortical arterioscle-rotic leukoencephalopathy; type 5, subcortical infarctions due to cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL), inflammatory angitis, or antiphospholipid antibodies; type 6, admixtures of above types; type 7, cerebral hemorrhagic lesions; and type 8, VAD combined with Alzheimer's disease (DAT). The group with subcortical VAD comprised types 3-5. The group with cortical VAD comprised the remainder (types 1, 2, and 6-8). Cerebral vasodilator responses were also compared between these two main groups. Results: Cerebral vasodilator responses identified differences between the two main groups of VAD patients, those with cortical and those with subcortical dementia. Leukoaraiosis was measurably greater in subcortical VAD compared with cortical VAD. Among subcortical VAD patients, cortical LCBF increases after administration of acetazolamide were greater compared with cortical VAD and with normal controls. Conclusions: Cognitive impairments in subcortical VAD are attributable to cortical disconnection syndromes. This concept is supported by reduced perfusion in deactivated cortex. In patients with subcortical VAD, deactivated cortical LCBF becomes promptly activated by acetazolamide resulting in marked cortical LCBF increases. Leukoaraiosis is greater among VAD patients and leukoaraiosis contributes to cortical disconnections, confirmed by excessive cortical vasodilator responses to acetazolamide.
机译：目的：根据临床，影像学和病原学特征，将37例血管性痴呆（VAD）患者分为8个亚型。然后将脑血管舒张剂对乙酰唑胺的反应与年龄匹配的正常对照组和无痴呆的中风患者进行比较。方法：将VAD结果与42例正常人和19例认知完整的中风患者进行比较。口服乙酰唑胺之前和之后，利用氙气对比计算机断层扫描测量局部脑血流量（LCBF），定量测定局部脑血管舒张反应。在皮质和皮质下，灰质和白质中计算出乙酰唑胺之前和之后的LCBF变化（ALCBF）。临床VAD亚型为：1型，多发性梗塞性痴呆（MID）;类型2，战略性梗塞; 3型皮质下腔隙性梗塞; Binswanger的4型皮质下动荡性脑白质脑病;由常染色体显性遗传性主动脉病变伴皮层下梗死和白脑病（CADASIL），炎性血管炎或抗磷脂抗体引起的5型皮层下梗死;类型6，上述类型的混合物; 7型，脑出血性病变;和8型VAD合并阿尔茨海默氏病（DAT）。皮质下VAD组为3-5型。皮质VAD组包括其余部分（1、2和6-8型）。还比较了这两个主要组的脑血管舒张反应。结果：脑血管舒张反应确定了两组主要的VAD患者之间的差异，即皮质痴呆和皮质下痴呆。与皮质VAD相比，皮质下VAD中的白细胞增多症明显增加。在皮质下VAD患者中，与皮质VAD和正常对照组相比，服用乙酰唑胺后皮质LCBF增加更大。结论：皮质下VAD的认知障碍可归因于皮质断开综合征。减少失活皮层的灌注支持了这一概念。在患有皮质下VAD的患者中，乙酰唑胺会迅速激活失活的皮质LCBF，导致皮质LCBF明显增加。在VAD患者中，白质疏松症的发生率更高，而白质疏松症则导致皮质断开，这是由于皮质醇对乙酰唑胺的过度反应所致。

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