Subcortical vascular dementia: epidemiology and risk factors

详细信息    查看全文

• 作者：Leys ; D. ; Pasquier ; F.
• 关键词：dementia ; vascular dementia ; subcortical dementia ; white matter changes ; stroke ; epidemiology
• 刊名：Archives of Gerontology and Geriatrics
• 出版年：1998
• 出版时间：1998
• 年：1998
• 卷：26
• 期：Supplement 1
• 页码：281-294
• 全文大小：644 K

文摘

Uncertainties in the clinical and pathological definition of vascular dementia (VaD) have impeded the development of valid epidemiological studies. VaD occurs in the same age category than Alzheimer's disease (AD) and Alzheimer pathology is found in up to 20 % of patients with VaD. The most currently used criteria for VaD are those summarized by the National Institute of Neruological Disorders and Stroke and the “Association Internationale pour la Recerche et l'Enseignement en Neursciences” (NINDS-AIREN): they require criteria for dementia, clinical or radiological evidence for a vascular pathology of the brain, and a temporal relationship between both. Descriptive epidemiological studies usually include VaD of any type. Small subcortical infarcts account for one sixth of all ischemic strokes, but this proportion is probably higher in patients with VaD. The sex-specific prevalence rates of VaD over the age of 60 in Europe is 2.6 % for men and 2.1 % for women. The prevalence increases steeply with age, but patients with AD and coincidental vascular lesions of the brain are often included. The incidence rate of VaD increases approximately from 20/100.000 between 60 and 69 years to 700/100.000 over 80. There was an overall decline in incidence of VaD over the last 2 decades. The incidence of new-onset dementia is increased after an ischemic stroke. However, VaD probably accounts for only half of dementia occurring after stroke. Approximately one sixth of stroke patients have pre-existing dementia. Subcortical VaD are due to subcortical infarcts, leukoencephalopathies or both. Subcortical infarcts are likely to be the cause of dementia in (i) strategic sucortical (e.g., thalamic) infarcts with previous normal cognitive functioning; (ii) lacunar state; and (iii) cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL). The first 2 types are usually the consequence of lipohyalinosis of the small perforating arteries; their main risk factor is arterial hypertension. CADASIL is an autosomal dominant inherited disorder. White matter abnormalities are often associated with risk factors for stroke such as age, arterial hypertension, cardiac diseases and diabetes mellitus. The main risk factor of subcortical VaD is arterial hypertension. Further studies should now determine whether its treatment can reduce the risk of subcortical VaD.