血管性认知障碍的诊治新进展-VIP免费

VCI的诊治新进展章军建刘汉兴武汉大学中南医院神经科湖北省痴呆与认知障碍医学临床研究中心2VCI的诊治新进展VCI的定义/诊断标准VCI的神经心理学评估VCI的影像学诊断如何确定影像学与认知损害的关系VCI的治疗进展小结3VCI的诊治新进展VCI的定义/诊断标准VCI的神经心理学评估VCI的影像学诊断如何确定影像学与认知损害的关系VCI的治疗进展小结4VCI的发展历史1899年1969年1974年动脉硬化性和老年性痴呆被认为是不同的综合征Mayer-Gross描述血管性痴呆(VaD)以便于与老年性精神病相鉴别Hachinski等提出多发梗死性痴呆（MID)和Hachinski缺血量表(HIS)1985年Loeb提出适用广泛的VaD概念1993年1997年Petersen提出VCI新概念Bowler和Hachinski提出血管性认知功能损害(VCI),又称血管性认知功能障碍52011年7月AHA/ASA联合发表科学声明-专门针对VCI定义：VCI指存在临床卒中或亚临床脑血管损伤，引起至少一个认知功能区认知功能受损的一组综合征，其中最严重的形式为VaD。Stroke,2011;42(9):2672-713.6AHA/ASA联合声明-VaD的诊断Thediagnosisofdementiashouldbebasedonadeclineincognitivefunctionfromapriorbaselineandadeficitinperformancein≥2cognitivedomainsthatareofsufficientseveritytoaffectthesubject’sactivitiesofdailyliving.Thediagnosisofdementiamustbebasedoncognitivetesting,andaminimumof4cognitivedomainsshouldbeassessed:executive/attention,memory,language,andvisuospatialfunctions.Stroke,2011;42(9):2672-713.7AHA/ASA联合声明-VaD的诊断Thedeficitsinactivitiesofdailylivingareindependentofthemotor/sensorysequelaeofthevascularevent.Stroke,2011;42(9):2672-713.8AHA/ASA联合声明-很可能VaD的诊断Thereiscognitiveimpairmentandimagingevidenceofcerebrovasculardiseaseand–a.Thereisacleartemporalrelationshipbetweenavascularevent(eg,clinicalstroke)andonsetofcognitivedeficits,or–b.Thereisaclearrelationshipintheseverityandpatternofcognitiveimpairmentandthepresenceofdiffuse,subcorticalcerebrovasculardiseasepathology(eg,asinCADASIL).Thereisnohistoryofgraduallyprogressivecognitivedeficitsbeforeorafterthestrokethatsuggeststhepresenceofanonvascularneurodegenerativedisorder.Stroke,2011;42(9):2672-713.9AHA/ASA联合声明-可能VaD的诊断Thereiscognitiveimpairmentandimagingevidenceofcerebrovasculardiseasebut–1.Thereisnoclearrelationship(temporal,severity,orcognitivepattern)betweenthevasculardisease(eg,silentinfarcts,subcorticalsmall-vesseldisease)andthecognitiveimpairment.–2.ThereisinsufficientinformationforthediagnosisofVaD(eg,clinicalsymptomssuggestthepresenceofvasculardisease,butnoCT/MRIstudiesareavailable).–3.Severityofaphasiaprecludespropercognitiveassessment.However,patientswithdocumentedevidenceofnormalcognitivefunction(eg,annualcognitiveevaluations)beforetheclinicaleventthatcausedaphasiacouldbeclassifiedashavingprobableVaD.Stroke,2011;42(9):2672-713.10AHA/ASA联合声明-可能VaD的诊断Thereiscognitiveimpairmentandimagingevidenceofcerebrovasculardiseasebut–4.Thereisevidenceofotherneurodegenerativediseasesorconditionsinadditiontocerebrovasculardiseasethatmayaffectcognition,suchas•a.Ahistoryofotherneurodegenerativedisorders(eg,Parkinsondisease,progressivesupranuclearpalsy,dementiawithLewybodies);•b.ThepresenceofAlzheimerdiseasebiologyisconfirmedbybiomarkers(eg,PET,CSF,amyloidligands)orgeneticstudies(eg,PS1mutation);or•c.Ahistoryofactivecancerorpsychiatricormetabolicdisordersthatmayaffectcognitivefunction.Stroke,2011;42(9):2672-713.11AHA/ASA联合声明-VaMCI的诊断VaMCIincludesthe4subtypesproposedfortheclassificationofMCI:amnestic,amnesticplusotherdomains,...