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1、VasculardementiaVasculardementiaOutlineEpidemiologyofVaDRiskfactorsofVaDPathogenesisofVaDSubtypesofVaDYourYourSloganSloganherehereClinicalevaluationTreatmentofVaDDefinitionsofVaDDefinitionsofVasculardementiaThedominantfeatureofthecognitivesyndromeisanabnormalexecutivefunctionthatinterfereswithsocial
2、oroccupationalfunctioning.Vasculardementiaisageneraltermdescribingproblemswithreasoning,planning,judgment,memoryandotherthoughtprocessescausedbybraindamagefromimpairedbloodflowtoyourbrain.DefinitionsofVasculardementiaDifferenttypesofpathologyinVaDandhowtheyoverlapJGeriatrPsychiatryNeurol.2016Sep;29(
3、5):281-301.Epidemiology of VaDFront.AgingNeurosci.,10April2013Risk factorsVasular dementiaNeuropsychiatr Dis Treat. 2014; 10: 16771691. Front.AgingNeurosci.,10April2013PathogenesisofvasculardementiaTypesofvasculardementiaThe pathology and pathophysiology of vascular dementia.Neuropharmacology. 2018
4、May 15;134(Pt B):226-239A.ProportionsofstrokesubtypesandcerebrovascularpathologiesassociatedwithVaD.B.DifferentcerebrovascularpathologiesasoutcomesofclinicallydiagnosedVaD1.Post-strokedementia.BMCMed.2017;15:112.Lancet.2015Oct24;386(10004):1698-70601Post-strokedementiaDementiadevelopsinaround1530%of
5、subjects3monthsafterastroke2.Post-strokedementia(PSD)isaclinicalentitythatencompassesalltypesofdementiafollowinganindexstroke,whichmayaffectuptoonethirdofstrokesurvivors.Thedistributionofthepost-strokecognitiveimpairmentafter strokeSunJH,etal.Post-strokecognitiveimpairment:epidemiology,mechanismsand
6、management.AnnTranslMed.2014Aug;2(8):80.10Themainmechanismsonpost-strokecognitiveimpairmentPost-strokecognitiveimpairment:epidemiology,mechanismsandmanagement.AnnTranslMed.2014Aug;2(8):80.BlockdiagramofvascularcognitiveimpairmentspectrumAl-QazzazNK,etal.NeuropsychiatrDisTreat.2014Sep9;10:1677-91.12A
7、MID is defined as cognitive impairment resulting frommultiple lesions and infarcts in both white and graymatter that follow occlusions in cerebral arteries andarteriolesBItrepresentsaminorityofcasesandisoftenassociatedwithhypertensionand/orextracerebralvasculardiseaseCThecauseisatherosclerosisaffect
8、inglargeintra-orextra-cranialbloodvessels,withlocalthrombosesoremboli.02Multi-InfarctDementiaJGeriatrPsychiatryNeurol.2016Sep;29(5):281-301.01Strategicinfarctdementiaiscausedbyisolatedinfarctsinregionsthatareimportantforcognitionofthebrain,suchasthethalamus,hippocampus,caudate,orgenuoftheinternalcap
9、sule.0203DementiaAssociatedWithStrategicInfarctsHelenaChui.SubcorticalIschemicVascularDementia(SIVD).NeurolClin.2007Aug;25(3):717vi.Infarctsinspecificfrontosubcorticalcircuitsconnectingtheprefrontalcortextothebasalgangliaorinnonspecificthalamocorticalprojectionsmaygeneratecombinationsofexecutivedysf
10、unction,personalitychange,orapathy.04SubcorticalIschemicVascularDementia01SIVDispathologicallydrivenbyseverestenosisandtheocclusionofsmallvesselsthatculminateintowhitematterischemiaandmultiplelacunarinfarctionsinthesubcorticalstructures02Patientsexhibitmotorandexecutiveslowing,forgetfulness,dysarthr
11、ia,andcommonlyashort-steppedgaitmimickingparkinsonism.03PuresubcorticalVaDwithaslowlyprogressivecourseresemblesADwithoutthecharacteristicbrainamyloidburdenofAD.CostantinoIadecola.ThePathobiologyofVascularDementia.Neuron,2013,80:844-866BrainLesionsResponsibleforVascularCognitiveImpairmentMixedDementi
12、aActaNeuropathol.2016May;131(5):659-85Representativeimagingscansofpatientswithpuresubcorticalischemicvasculardementia(PiB-PETnegative)ormixeddementia(PiB-PETpositive).ClinicalevaluationAbbreviations:CT,computedtomography;ECG,electrocardiography;EEG,electroencephalography;MRI,magneticresonanceimaging
13、.NeuropsychiatrDisTreat.2014;10:16771691.TreatmentofVascularDementiaBeta blockers:Drugsusedtocontrolhypertension.AAntidiabetics:Drugsusedtocontroldiabetes.BAntiplatelet:Drugsusedtoinhibitclotformation.CThereisnocurativetreatmentbutthetreatmentaimsatpreventingfurtherdeterioration.Certaindrugsapproved
14、totreatAlzheimersmayalsoofferamodestbenefitinpeoplediagnosedwithvasculardementia.SummaryVasculardementiaisageneraltermdescribingproblemswithreasoning,planning,judgment,memoryandotherthoughtprocessescausedbybraindamagefromimpairedbloodflowtoyourbrain.TherearedifferentsubtypesofVaD,suchaspost-strokedementia,multi-Infarctdementia,dementiaassociatedwithstrategicinfarcts,subcorticalischemicvasculardementia,mixeddementia.Thereisnocurativetreatmentbutthetreatmentaimsatpreventingfurtherdeterioration,certaindrugsapprovedtotreatAlzheimersmayalsoofferamodestbenefitinpeoplediagnosedwithVaD.结束结束
