Vascular cognitive impairment2006/10/13 17:11:00

Nature Clinical Practice Neurology (2006) 2, 538-547

Vascular cognitive impairment

Ola A Selnes* and Harry V Vinters

Cognitive impairment commonly accompanies clinical syndromes associated with vascular disease of the brain. Because of evolving definitional criteria, however, the frequency of cognitive impairment attributable to cerebrovascular disease is difficult to determine. Dementia occurs in up to one-third of elderly patients with stroke, a subset of whom have Alzheimer's disease (AD) rather than a pure vascular dementia syndrome. In fact, pure vascular dementia has been shown to be uncommon in most large autopsy series. A mixed etiology of AD and cerebrovascular disease is thought to become more common with increasing age, although no clinical criteria for the diagnosis of AD with cerebrovascular disease are currently available. Epidemiological studies have implicated subcortical small-vessel disease as a risk factor for cognitive impairment and dementia, but the cognitive expression and clinical significance of MRI white matter changes in individual patients is difficult to establish. The frequency of specific neuropathologic features of vascular cognitive impairment depends largely on study inclusion criteria. Cerebral meningocortical microangiopathies with distinctive clinicopathological profiles are associated with dementia in both sporadic cases and familial syndromes. In patients with AD, the contribution of amyloid-beta protein to the degree of cognitive impairment has not been clearly defined.

  1. フレアでだれにでもみられる白質の白い病変をsubcortical small-vessel ischemic diseaseとよぶ。 これには高血圧、糖尿病、遺伝因子と年齢が関与する。 そしてこの病変が将来の痴呆の危険因子となる。 Alzheimer病の脳血管病変は最近注目されている。 遺伝性のある疾患としてCADASIL cerebral autosomal dominant arteriopathy with subcortical infarcts and leucoencephalopathyがある。 NOTCH3 geneの異常である。
  2. 脳梗塞の病理分類 cystic infarction(1cm以上) lacunar infarction(1cm以下、肉眼的に確認) == Ia,Ib,II--an old microhemorrhage with abundant hemosiderin-laden macrophages microinfarct(肉眼でわからず)
  3. 海馬の硬化--現在ではvascular dementiaの老人に共通に認められる所見
  4. Amyloid angiopathy vascular dementiaおよびAlzheimerに関与
Hit Counter by Digits Web Counter since August 17,2009