血管性认知障碍发病机制的研究进展
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摘要
目前,血管性痴呆(vascular dementia,Va D)患者逐年增多,仅次于阿尔茨海默病(Alzheimer's disease,AD),居于痴呆发病原因第二位。而血管性痴呆是唯一可通过早诊断、早治疗达到控制病情进展,甚至达到临床痊愈的痴呆。VaD是由血管性认知障碍(vascular cognitive impairment,VCI)发展而来。由此可见,了解血管性认知障碍的发病机制,研究出早期防治的有效方法,具有重要的临床意义和社会价值。本文通过回顾近几年的相关文献,较为系统的阐述了VCI的发病机制,从影像学、病理生理学以及关键部位等几方面的研究进展进行重点介绍。
At present, patients with vascular dementia(VaD) are increasing year by year, ranking second in the cause of dementia, second only to Alzheimer's disease(AD). Vascular dementia is the only dementia that can be controlled by early diagnosis and early treatment and even cured. VaD is progressed from vascular cognitive impairment(VCI). It can be seen that understanding the pathogenesis of vascular cognitive impairment and studying effective methods for early prevention and treatment have important clinical and social value. By reviewing the relevant literatures in recent years,this paper systematically expounds the pathogenesis of VCI, focusing on the research progress in imaging, pathophysiology and key sites.
At present, patients with vascular dementia(VaD) are increasing year by year, ranking second in the cause of dementia, second only to Alzheimer's disease(AD). Vascular dementia is the only dementia that can be controlled by early diagnosis and early treatment and even cured. VaD is progressed from vascular cognitive impairment(VCI). It can be seen that understanding the pathogenesis of vascular cognitive impairment and studying effective methods for early prevention and treatment have important clinical and social value. By reviewing the relevant literatures in recent years,this paper systematically expounds the pathogenesis of VCI, focusing on the research progress in imaging, pathophysiology and key sites.
引文
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[7]Leonie Lampe,Shahrzad Kharabian-Masouleh,Kynast J,et al.Lesion location matters:The relationships between white matter hyperintensities oncognition in the healthy elderly[J].Journal of Cerebral Blood Flow&Metabolism,2017,10(100):1-8.
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[10]López Banet E,Páez Granda D,Orcajada Zamora V,et al.Strategic infarcts of the thalamus:An uncommon cause of vascular dementia[J].Med Clin(Barc),2017,S0025-7753(17):30340-30348.
[11]Duering M,Gesierich B,Seiler S,et al.Strategic white matter tracts for processing speed defcits in age-related small vessel disease[J].Neurology,2014,82:1946-1950.
[12]Tatemichi TK,Desmond DW,Prohovnik I.Strategic infarcts in vascular dementia:A clinical and brain imaging experience[J].Arzneimittelforschung,1995,45:371-385.
[13]袁丹,李冬华,王海鹏,等.不同部位急性脑梗死与血管性认知障碍的相关性[J].实用医学杂志,2017,33(11):1770-1773.
[14]陈奕桦.缺血性脑卒中患者发生认知功能障碍与病灶部位相关性的临床研究[J].世界最新医学信息文摘,2018,18(67):70-71.
[15]王茹,曾静,李丹丹,等.脑小血管病大鼠步态异常与基底节区星形胶质细胞活化及炎性因子表达的关系[J].中华实用诊断与治疗杂志,2018,32(9):851-854.
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[17]阮婕,计仁杰,魏果,等.后循环缺血性卒中与认知障碍相关性研究[J].中国卒中杂志,2015,10(12):1012-1018.
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[19]Geraldo AF,silva C,NeuteI D,et a1.Delayed leukoencephalop-athy after acute carbon monoxide intoxication[J].JRadiol Case Rep,2014,8(5):1-5.
[20]Viana-Baptista M,Bugalho P,Jordo C,et al.Cognitive function correlates with frontal white matter apparent diffusion coeffcients in patients with leukoaraiosis[J].JNeurol,2008,255:360-362.
[21]Edwards JD,Jacova C,Sepehry AA,et al.A quantitative systematic review of domain-specific cognitive impairment in lacunar stroke[J].Neurology,2013,80(3):315-322.
[22]韩鲜艳.血管性认知障碍的危险因素分析及其与脑血流动力学的相关性研究[D].东南大学,2016.
[23]Kalaria RN,Akinyemi R,Ihara M.Stroke injury,cognitive impairment and vascular dementia[J].Biochim Biophys Acta,2016,1862(5):915-925.
[24]朱志华.脑小血管病认知功能障碍[J].世界最新医学信息文摘,2018,18(9):66-67,69.
[25]Chen Y,Wang A,Tang J,et al.Association of white matter integrity and cognitive functions in patients with subcortical silent lacunar infarcts[J].Stroke,2015,46(4):1123-1126.
[26]Saczynski JS,Sigurdsson S,Jonsdottir MK,et al.Cerebral infarcts and c ognitive performance:Importance of location and number of infarcts[J].Stroke,2009,40(3):677-682.
[27]Jokinen H,Gouw AA,Madureira S,et al.Incident lacunes influence cognitive decline:The LADIS study[J].Neurology,2011,76(22):1872-1878.
[28]Wallin A,Román GC,Esiri M,et al.Update on vascular cognitive impairment associated with subcortical smallvessel disease[J].J Alzheimers Dis,2018,62(3):1417-1441.
[29]Nardone R,Bergmann J,Christova M,et al.Short latency afferent inhibition differs among the subtypes of mild cognitive impairment[J].J Neural Transm(Vrenna),2012,119(4):463-471.
[30]Cullen KM,Stone J,Stone J.Microvascular pathology in the aging human brain:Evidence that senile plaques are site of microhaemorrhages[J].Neurobiol Aging,2006,27(12):1786-1796.
[31]Yakushiji Y,Noguchi T,Charidimou A,et al.Basal ganglia cerebal microbleeds and global cognitive funtion:The Kashima Scan Study[J].J Stroke Cerebrovasc Dis,2015,24(2):431-439.
[32]Cheng HL,Lin CJ,Soong BW,et al.Impairments in cognitive function and brain connectivity in severe asymptomatic carotid stenosis[J].Stroke,2012,43:2567-2573.
[33]Balestrini S,Perozzi C,Altamura C,et al.Severe carotid stenosis and impaired cerebral hemodynamics can in uence cognitive deterioration[J].Neurology,2013,80:2145-2150.
[34]Stefansdottir H,Arnar DO,Altamura C,et al.Atrial fbrillation is associated with reduced brain volume and cognitive function independent of cerebral infarcts[J].Stroke,2013,44:1020-1025.
[35]Poels MM,Ikram MA,van der Lugt A,et al.Cerebral microbleeds are associated with worse cognitive function:The Rotterdam Scan Study[J].Neurology,2012,78(5):326-333.
[36]孙红莲.脑出血与脑梗塞所致精神障碍的临床分析[J].世界最新医学信息文摘,2015,(81):155-156.
[37]Vemuri P,Lesnick TG,Przybelski SA,et al.Vascular and amyloid pathologies are independent predictors of cognitive decline in normal elderly[J].Brain,2015,138:761-771.
[38]Ye BS,Seo SW,Kim JH,et al.Effects of amyloid and vascular markers on cognitive decline in subcortical vascular dementia[J].Neurology,2015,85:1687-1693.
[39]Launer LJ,Hughes TM,White LR.Microinfarcts,brain atrophy,and cognitive function:The honolulu Asia aging study autopsy study[J].Ann Neurol,2011,70:774-780.
[40]Arvanitakis Z,Capuano AW,Leurgans SE,et al.Relation of cerebral vessel disease to Alzheimer’s disease dementia and cognitive function in elderly people:A cross-sectional study[J].Lancet Neurol,2016,15:934-943.
[41]Charidimou A,Linn J,Vernooij MW,et al.Cortical superfcial siderosis:Detection and clinical signifcance in cerebral amyloid angiopathy and related conditions[J].Brain,2015,138:2126-2139.
[42]Adams HH,Hilal S,Schwingenschuh P,et al.A priori collaboration in population imaging:The uniform neuroimaging of virchow robin spaces enlargement consortium[J].Alzheimers Dement(Amst),2015,1:513-520.
[43]Martinez-Ramirez S,Pontes-Neto OM,Dumas AP,et al.Topography of dilated perivascular spaces in subjects from a memory clinic cohort[J].Neurology,2013,80:1551-1556.
[44]Rosenberg GA,Wallin A,Wardlaw JM,et al.Consensus statement for diagnosis of small vessel disease[J].J Cereb Blood Flow Metab,2016,36(1):6-25.
[45]Tikka S,Baumann M,Siitonen M,et al.CADASIL and CARASIL[J].Brain Pathol,2014,24(5):525-544.
[46]Fong JC.Genetic counseling for adult neurogenetic disease[M].New York:Springer US,2015:143-156.
[47]Hara K,Shiga A,Fukutake T,et al.Association of HTRA1mutations and familial ischemic cerebral small-vessel disease[J].N Engl J Med,2009,360:1729-1739.
[48]Beaufort N,Scharrer E,Kremmer E,et al.Cerebral small vessel disease-related protease HtrA1 processes latent TGF-βbinding protein 1 and facilitates TGF-βsignaling\\[J].Proc Natl Acad Sci U S A,2014,111:16496-16501.
[49]贺梦菲,尹昌浩,曹文慧,等.血管性认知障碍及其功能影像学的研究进展[J].中国卒中杂志,2018,13(7):697-700.
[50]Kim YJ,Kwon HK,Lee JM,et al.White matter microstructural changes in pure Alzheimer’s disease and subcortical vascular dementia[J].Eur J Neural,2015,22(4):709-716.
[51]郭会映,孙芳,倪玲,等.非痴呆型血管性认知功能障碍的结构及静息态功能磁共振研究[J].临床放射学杂志,2014,33(5):657-661.
[52]Soman S,Prasad G,Hitchner E,et al.Brain structural connectivity distinguishes patients at risk for cognitive decline after carotid interventions[J].Hum Brain Mapp,2016,37(6):2185-2194.
[2]Chaaya M,Phung TK,EI Asmar K,et al.Validation of the aribic rowland universal dementia assessment scale(A-RU-DAS)in elderly with mild and moderate demetia[J].Aging&Mental Health,2016,20:880-887.
[3]Hachinski VC,Lassen NA,Marshall J.Multi-infarct dementia:A cause of mental deterioration in the elderly[J].Lancet,1974,2:207-210.
[4]Erin McKay,Scott E Counts.Multi-infarct dementia:Ahistorical perspective[J].Dement Geriatr Cogn Disord Extra,2017,7:160-171.
[5]贾建平.痴呆与轻度认知障碍的流行病学、发病机制和诊治应用研究---2013年度国家科学技术进步二等奖[J].首都医科大学学报,2014,35(1):1-5.
[6]Korovessis P,Baikousis A,Zacharatos S,et al.Combined plusposterior short-segment instrumention and fusion for midlumber(L2-L4)burst fractures[J].Spine,2006,31(8):859-868.
[7]Leonie Lampe,Shahrzad Kharabian-Masouleh,Kynast J,et al.Lesion location matters:The relationships between white matter hyperintensities oncognition in the healthy elderly[J].Journal of Cerebral Blood Flow&Metabolism,2017,10(100):1-8.
[8]Lei Zhao,J Matthijs Biesbroek,Shi L,et al.Strategic infarct location for post-stroke cognitive impairment:Amultivariate lesion-symptom mapping study[J].Journal of Cerebral Blood Flow&Metabolism,2017,10(20):1-13.
[9]Szirmai I,Vastagh I,Yoshimasu F.Strategic infarcts of the thalamus in vascular dementia[J].J Neurol Sci,2002,203-204:91-7.
[10]López Banet E,Páez Granda D,Orcajada Zamora V,et al.Strategic infarcts of the thalamus:An uncommon cause of vascular dementia[J].Med Clin(Barc),2017,S0025-7753(17):30340-30348.
[11]Duering M,Gesierich B,Seiler S,et al.Strategic white matter tracts for processing speed defcits in age-related small vessel disease[J].Neurology,2014,82:1946-1950.
[12]Tatemichi TK,Desmond DW,Prohovnik I.Strategic infarcts in vascular dementia:A clinical and brain imaging experience[J].Arzneimittelforschung,1995,45:371-385.
[13]袁丹,李冬华,王海鹏,等.不同部位急性脑梗死与血管性认知障碍的相关性[J].实用医学杂志,2017,33(11):1770-1773.
[14]陈奕桦.缺血性脑卒中患者发生认知功能障碍与病灶部位相关性的临床研究[J].世界最新医学信息文摘,2018,18(67):70-71.
[15]王茹,曾静,李丹丹,等.脑小血管病大鼠步态异常与基底节区星形胶质细胞活化及炎性因子表达的关系[J].中华实用诊断与治疗杂志,2018,32(9):851-854.
[16]Schmahmann JD,Sherman JC.Cerebellar cognitive affective syndrome[J].Int Rev Neurobiol,1997,41:433-440.
[17]阮婕,计仁杰,魏果,等.后循环缺血性卒中与认知障碍相关性研究[J].中国卒中杂志,2015,10(12):1012-1018.
[18]Stephens S,Kenny RA,Rowan E,et al.Neuropsychological characteristics of mild vascular cognitive impairment and dementia after stroke[J].Int J Geriatr Psychiatry,2004,19:1053-1057.
[19]Geraldo AF,silva C,NeuteI D,et a1.Delayed leukoencephalop-athy after acute carbon monoxide intoxication[J].JRadiol Case Rep,2014,8(5):1-5.
[20]Viana-Baptista M,Bugalho P,Jordo C,et al.Cognitive function correlates with frontal white matter apparent diffusion coeffcients in patients with leukoaraiosis[J].JNeurol,2008,255:360-362.
[21]Edwards JD,Jacova C,Sepehry AA,et al.A quantitative systematic review of domain-specific cognitive impairment in lacunar stroke[J].Neurology,2013,80(3):315-322.
[22]韩鲜艳.血管性认知障碍的危险因素分析及其与脑血流动力学的相关性研究[D].东南大学,2016.
[23]Kalaria RN,Akinyemi R,Ihara M.Stroke injury,cognitive impairment and vascular dementia[J].Biochim Biophys Acta,2016,1862(5):915-925.
[24]朱志华.脑小血管病认知功能障碍[J].世界最新医学信息文摘,2018,18(9):66-67,69.
[25]Chen Y,Wang A,Tang J,et al.Association of white matter integrity and cognitive functions in patients with subcortical silent lacunar infarcts[J].Stroke,2015,46(4):1123-1126.
[26]Saczynski JS,Sigurdsson S,Jonsdottir MK,et al.Cerebral infarcts and c ognitive performance:Importance of location and number of infarcts[J].Stroke,2009,40(3):677-682.
[27]Jokinen H,Gouw AA,Madureira S,et al.Incident lacunes influence cognitive decline:The LADIS study[J].Neurology,2011,76(22):1872-1878.
[28]Wallin A,Román GC,Esiri M,et al.Update on vascular cognitive impairment associated with subcortical smallvessel disease[J].J Alzheimers Dis,2018,62(3):1417-1441.
[29]Nardone R,Bergmann J,Christova M,et al.Short latency afferent inhibition differs among the subtypes of mild cognitive impairment[J].J Neural Transm(Vrenna),2012,119(4):463-471.
[30]Cullen KM,Stone J,Stone J.Microvascular pathology in the aging human brain:Evidence that senile plaques are site of microhaemorrhages[J].Neurobiol Aging,2006,27(12):1786-1796.
[31]Yakushiji Y,Noguchi T,Charidimou A,et al.Basal ganglia cerebal microbleeds and global cognitive funtion:The Kashima Scan Study[J].J Stroke Cerebrovasc Dis,2015,24(2):431-439.
[32]Cheng HL,Lin CJ,Soong BW,et al.Impairments in cognitive function and brain connectivity in severe asymptomatic carotid stenosis[J].Stroke,2012,43:2567-2573.
[33]Balestrini S,Perozzi C,Altamura C,et al.Severe carotid stenosis and impaired cerebral hemodynamics can in uence cognitive deterioration[J].Neurology,2013,80:2145-2150.
[34]Stefansdottir H,Arnar DO,Altamura C,et al.Atrial fbrillation is associated with reduced brain volume and cognitive function independent of cerebral infarcts[J].Stroke,2013,44:1020-1025.
[35]Poels MM,Ikram MA,van der Lugt A,et al.Cerebral microbleeds are associated with worse cognitive function:The Rotterdam Scan Study[J].Neurology,2012,78(5):326-333.
[36]孙红莲.脑出血与脑梗塞所致精神障碍的临床分析[J].世界最新医学信息文摘,2015,(81):155-156.
[37]Vemuri P,Lesnick TG,Przybelski SA,et al.Vascular and amyloid pathologies are independent predictors of cognitive decline in normal elderly[J].Brain,2015,138:761-771.
[38]Ye BS,Seo SW,Kim JH,et al.Effects of amyloid and vascular markers on cognitive decline in subcortical vascular dementia[J].Neurology,2015,85:1687-1693.
[39]Launer LJ,Hughes TM,White LR.Microinfarcts,brain atrophy,and cognitive function:The honolulu Asia aging study autopsy study[J].Ann Neurol,2011,70:774-780.
[40]Arvanitakis Z,Capuano AW,Leurgans SE,et al.Relation of cerebral vessel disease to Alzheimer’s disease dementia and cognitive function in elderly people:A cross-sectional study[J].Lancet Neurol,2016,15:934-943.
[41]Charidimou A,Linn J,Vernooij MW,et al.Cortical superfcial siderosis:Detection and clinical signifcance in cerebral amyloid angiopathy and related conditions[J].Brain,2015,138:2126-2139.
[42]Adams HH,Hilal S,Schwingenschuh P,et al.A priori collaboration in population imaging:The uniform neuroimaging of virchow robin spaces enlargement consortium[J].Alzheimers Dement(Amst),2015,1:513-520.
[43]Martinez-Ramirez S,Pontes-Neto OM,Dumas AP,et al.Topography of dilated perivascular spaces in subjects from a memory clinic cohort[J].Neurology,2013,80:1551-1556.
[44]Rosenberg GA,Wallin A,Wardlaw JM,et al.Consensus statement for diagnosis of small vessel disease[J].J Cereb Blood Flow Metab,2016,36(1):6-25.
[45]Tikka S,Baumann M,Siitonen M,et al.CADASIL and CARASIL[J].Brain Pathol,2014,24(5):525-544.
[46]Fong JC.Genetic counseling for adult neurogenetic disease[M].New York:Springer US,2015:143-156.
[47]Hara K,Shiga A,Fukutake T,et al.Association of HTRA1mutations and familial ischemic cerebral small-vessel disease[J].N Engl J Med,2009,360:1729-1739.
[48]Beaufort N,Scharrer E,Kremmer E,et al.Cerebral small vessel disease-related protease HtrA1 processes latent TGF-βbinding protein 1 and facilitates TGF-βsignaling\\[J].Proc Natl Acad Sci U S A,2014,111:16496-16501.
[49]贺梦菲,尹昌浩,曹文慧,等.血管性认知障碍及其功能影像学的研究进展[J].中国卒中杂志,2018,13(7):697-700.
[50]Kim YJ,Kwon HK,Lee JM,et al.White matter microstructural changes in pure Alzheimer’s disease and subcortical vascular dementia[J].Eur J Neural,2015,22(4):709-716.
[51]郭会映,孙芳,倪玲,等.非痴呆型血管性认知功能障碍的结构及静息态功能磁共振研究[J].临床放射学杂志,2014,33(5):657-661.
[52]Soman S,Prasad G,Hitchner E,et al.Brain structural connectivity distinguishes patients at risk for cognitive decline after carotid interventions[J].Hum Brain Mapp,2016,37(6):2185-2194.