摘要:

In spite of the fact that hypertension is the main risk factor for cerebrovascular disease, retrospective studies have not given a clear answer concerning the role of hypertension in vascular dementia. Hypertension predisposes to intracerebral and extracerebral arterial alterations which may cause cerebrovascular events by a number of mechanisms. In addition to the established association between hypertension and stroke, the role of hypertension for silent white matter hyperintensities (WMHIs) observed on magnetic resonance imaging is debated. Data are presented indicating that WMHIs are rare below the age of 55 in normotensive individuals but are not infrequent when the blood pressure is moderately or markedly increased. It is proposed that the possible role of hypertension in vascular dementia should be evaluated in prospective studies of hypertensive populations.

ISSN:1420-8008    

DOI:10.1159/000106717

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

Vascular dementia (VAD) is common, and small vessel disease is one of the most frequent etiologies of the disorder. Lacunar state and Binswanger''s disease are the two types of VAD associated with small vessel disease. Lacunar state and Binswanger''s disease produce a dementia syndrome with characteristics of subcortical dementia including slowing of information processing, impaired memory, and poor sustained attention. Executive dysfunction includes poor word list generation and verbal fluency (design generation), impaired motor programming with perseveration and impersistence, and difficulty with set shifting. Memory loss in subcortical VAD is characterized by poor retrieval and intact recognition. Apathy is ubiquitous in VAD and depression and psychosis are common. Parkinsonism with prominent gait disturbances in conjunction with pyramidal tract signs, dysarthria, pseudobulbar affect, and incontinence are frequent motor manifestations of VAD with small vessel disease. The lesions of subcortical VAD affect the structures – caudate nucleus, globus pallidus, thalamus – and connecting fibers of frontal-subcortical circuits and produce a clinical syndrome similar to that seen in other subcortical disea

ISSN:1420-8008    

DOI:10.1159/000106718

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

The question was addressed whether the three vascular dementia (VAD) subtypes, multi-infarct dementia (MID), strategic-infarct dementia (SID), and subcortical white matter dementia (SWMD) fulfil the basic criteria for a disease: does a distinct pattern of clinical features match a distinct pathological picture for the various VAD subtypes? No obvious correspondence between structural pathological changes and symptoms or signs was found in the MID and SID subtypes. Therefore, the disease status of these VAD subtypes can be questioned. The VAD subtype SWMD, however, appeared to fulfil the basic criteria for a disease, as the subcortical white matter changes corresponded to the subcortical symptom pattern, with mental slowness, extrapyramidal and bilateral pyramidal deficits.

ISSN:1420-8008    

DOI:10.1159/000106719

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

The World Health Organization recently introduced the new ICD-10. Chapter V (‘Mental and behavioural disorders including disorders of psychological development’) contains operationalized diagnostic guidelines for the classification of psychiatric disorders, i.e. the term vascular dementia is clearly defined. Furthermore, the criteria of the ICD-10 allow a differentiation of vascular dementia into subtypes (vascular dementia of acute onset, multi-infarct dementia, subcortical vascular dementia, and mixed or unspecified types). The clinical feasibility of the ICD-10 criteria for subtypes of vascular dementia is proven in an investigation of 72 demented patients (75.0 ± 8.3 years) showing vascular lesions of the computed tomography scan. Only 18 cases (25.0%) fulfill the ICD-10 criteria for vascular dementia. 61.1% of the cases could be sufficiently classified into subtypes. These results suggest that the ICD-10 criteria for vascular dementia are rather selec

ISSN:1420-8008    

DOI:10.1159/000106720

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

Vascular dementia (VAD) is the second most common cause of dementia. In addition, cerebrovascular disease (CVD) coexists with other causes, including Alzheimer''s disease. Cognitive impairment related to CVD may be preventable, and these patients could benefit from therapy. This emphasizes the need for early detection, diagnostic consistency and accuracy of the clinical diagnosis of VAD. A number of current limitations in our knowledge about VAD have restricted the construction of clinical criteria, especially the concept of a behavioral syndrome due to vascular factors affecting the brain, and the main pathophysiological factors related to VAD. The latter include the type, extent, location and tempo of vascular brain lesions, as well as the causality between brain lesions and cognitive impairment. However, relevant information on VAD is beginning to emerge. The NINDS-AIREN Workshop on VAD made an attempt to facilitate international discussion and cooperation by defining consequences of CVD and the criteria for the VAD syndrome, for epidemiological and clinical studies. Here the concepts, pathophysiological factors, current conceptual barriers, and the criteria for the clinical diagnosis are reviewed.

ISSN:1420-8008    

DOI:10.1159/000106721

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

Computed X-ray tomography and magnetic resonance imaging are two imaging modalities widely used in the evaluation of patients with dementia disorders. The role of the methods in relation to vascular dementia is discussed as well as their physical and clinical differences. Moreover, the concept of leukoaraiosis or white matter hyperintensities in relation to normal aging and dementia is also discussed. Finally, the relationship between white matter hyperintensities and the cognitive decline in patients with vascular dementia is discussed.

ISSN:1420-8008    

DOI:10.1159/000106722

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

The objective of this study was to correlate clinical and brain imaging findings with walking inabilities in patients with possible vascular dementia. For 24 patients with suspected initial vascular dementia according to DSM-III-R, structured neurological, neuropsychological and neuroimaging (magnetic resonance tomography) examinations were evaluated alongside computerized gait analysis. All patients revealed an increased variability of gait lines of various degrees: mild (11%), moderate (32%) and severe (57%). Lateralization of gait patterns was present in 68% and bipedal instabilities of posture in 54%. These findings were significantly correlated with frontal periventricular white matter lesions (WMLs), which probably affect the thalamo-cortico-mediocapsular pathways. The association of gait abnormalities with WMLs of the frontocentral subcortical and periventricular territories in patients with possible vascular dementing illnesses may be used as an early indicator of the disease for follow-up and treatment trials. However, since the degree of gait impairment varies considerably relative to the common mild intellectual limitations, these structural lesions are unlikely to be directly related to the dementing process.

ISSN:1420-8008    

DOI:10.1159/000106723

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

The hypothesis that vascular dementia (VAD) may be associated with a specific pattern of neuropsychological dysfunction as compared to Alzheimer''s disease (AD) is reviewed. The empirical findings were evaluated with regard to methodology, most importantly the comparability between groups regarding demographic variables and severity of dementia. They were also classified according to the cognitive and sensory-motor functions affected. No consistent differences were found between VAD and AD patients in neuropsychological performance testing general cognitive functioning, syntax, verbal comprehension, visuospatial tasks, and primary as well as semantic memory, indicating a functional similarity between VAD and AD. However, inferior performance was found for VAD in executive functioning, verbal fluency, attention, and motor performance. Superior performance for VAD was found in naming and with regard to intrusion errors. The findings on episodic memory were inconclusive. These results should be considered in light of possible selection bias due to the fact that all studies used a hospital-based sample of subjects and not subjects from the community. Bias may also arise from the variations in lesion site, size, number, and timing between different VAD groups. Third, the risk of confounding errors due to a lack of comparability between etiological groups in terms of demographic variables as well as cognitive decline cannot be excluded. Future studies should take into account variation in the severity of cognitive decline, variation regarding lesion characteristics, etiological factors, and subtypes of VAD in order to increase our knowledge about the functional features of VAD.

ISSN:1420-8008    

DOI:10.1159/000106724

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

Amyloid depositions mainly consist of proteins with a fibrillary structure. A large number of different proteins have amyloidogenic properties. Amyloids are now categorized on the basis of their chemical structure, but the clinical classification of localized and systemic amyloid is still useful. The proteins that can be found in cerebral amyloid angiopathy are cystatin C, β/A4 and transthyretin. Cerebral amyloid angiopathy can remain symptom free, but can also give a broad spectrum of clinical and radiological manifestations, including (vascular) dementia, cerebellar and cerebral hemorrhage, subarachnoid hemorrhage, and leukoencephalopathy. It is debated whether amyloid angiopathy plays a causative role in Alzheimer''s disease, but it is strongly correlated with the presence of cerebral plaques. In this review, the clinical spectrum of cerebral amyloid angiopathy will be described, based on retrospective studies from the literature. Hereditary cerebral hemorrhage with amyloidosis (Dutch) will be presented as a ''prospective'' model to study the clinical effects of amyloid angiopathy

ISSN:1420-8008    

DOI:10.1159/000106725

出版商:S. Karger AG    

年代:1994

数据来源: Karger

ISSN:1420-8008    

DOI:10.1159/000106726

出版商:S. Karger AG    

年代:1994

数据来源: Karger