VasculardementiaPPT課件

1、OutlineEpidemiology of VaDRisk factors of VaDPathogenesis of VaDSubtypes of VaDClinical evaluationTreatment of VaDDefinitions of VaD第1頁/共21頁Definitions of Vascular dementiaThe dominant feature of the cognitive syndrome is an abnormal executive function that interferes with social or occupational fun

2、ctioning.Vascular dementia is a general term describing problems with reasoning, planning, judgment, memory and other thought processes caused by brain damage from impaired blood flow to your brain.Definitions of Vascular dementia第2頁/共21頁Different types of pathology in VaD and how they overlapJ Geri

3、atr Psychiatry Neurol. 2016 Sep;29(5):281-301.第3頁/共21頁Epidemiology of VaDFront. Aging Neurosci., 10 April 2013第4頁/共21頁Risk factorsVasular dementiaNeuropsychiatr Dis Treat. 2014; 10: 16771691. 第5頁/共21頁Front. Aging Neurosci., 10 April 2013Pathogenesis of vascular dementia第6頁/共21頁Types of vascular deme

4、ntiaThe pathology and pathophysiology of vascular dementia.Neuropharmacology. 2018 May 15;134(Pt B):226-239A.Proportions of stroke subtypes and cerebrovascular pathologies associated with VaD. B.Different cerebrovascular pathologies as outcomes of clinically diagnosed VaD第7頁/共21頁1.Post-stroke dement

5、ia.BMC Med. 2017; 15: 112.Lancet. 2015 Oct 24;386(10004):1698-70601 Post-stroke dementiaDementia develops in around 1530% of subjects 3 months after a stroke2.Post-stroke dementia (PSD) is a clinical entity that encompasses all types of dementia following an index stroke, which may affect up to one

6、third of stroke survivors.第8頁/共21頁The distribution of the post-stroke cognitive impairment9after strokeSun JH, et al. Post-stroke cognitive impairment: epidemiology, mechanisms and management.Ann Transl Med. 2014 Aug;2(8):80.第9頁/共21頁The main mechanisms on post-stroke cognitive impairmentPost-stroke

7、cognitive impairment: epidemiology, mechanisms and management.Ann Transl Med. 2014 Aug; 2(8): 80. 第10頁/共21頁Block diagram of vascular cognitive impairment spectrum11Al-Qazzaz NK, et al. Neuropsychiatr Dis Treat. 2014 Sep 9;10:1677-91.第11頁/共21頁AMID is defined as cognitive impairment resulting from mul

8、tiple lesions and infarcts in both white and gray matter that follow occlusions in cerebral arteries and arteriolesBIt represents a minority of cases and is often associated with hypertension and/or extracerebral vascular diseaseCThe cause is atherosclerosis affecting large intra- or extra-cranial b

9、lood vessels, with local thromboses or emboli.02 Multi-Infarct DementiaJ Geriatr Psychiatry Neurol. 2016 Sep;29(5):281-301.第12頁/共21頁01Strategic infarct dementia is caused by isolated infarcts in regions that are important for cognition of the brain, such as the thalamus, hippocampus, caudate, or gen

10、u of the internal capsule. 0203 Dementia Associated With Strategic InfarctsHelena Chui.Subcortical Ischemic Vascular Dementia (SIVD).Neurol Clin. 2007 Aug; 25(3): 717vi. Infarcts in specific frontosubcortical circuits connecting the prefrontal cortex to the basal ganglia or in nonspecific thalamocor

11、tical projections may generate combinations of executive dysfunction, personality change, or apathy.第13頁/共21頁04 Subcortical Ischemic Vascular Dementia01SIVD is pathologically driven by severe stenosis and the occlusion of small vessels that culminate into white matter ischemia and multiple lacunar i

12、nfarctions in the subcortical structures02Patients exhibit motor and executive slowing, forgetfulness, dysarthria, and commonly a short-stepped gait mimicking parkinsonism.03Pure subcortical VaD with a slowly progressive course resembles AD without the characteristic brain amyloid burden of AD.第14頁/

13、共21頁Costantino Iadecola.The Pathobiology of Vascular Dementia.Neuron, 2013, 80: 844-866Brain Lesions Responsible for Vascular Cognitive Impairment第15頁/共21頁Mixed DementiaActa Neuropathol. 2016 May;131(5):659-85第16頁/共21頁Representative imaging scans of patients with pure subcortical ischemic vascular d

14、ementia (PiB-PET negative) or mixed dementia (PiB-PET positive). 第17頁/共21頁Clinical evaluationAbbreviations: CT, computed tomography; ECG, electrocardiography; EEG, electroencephalography; MRI, magnetic resonance imaging.Neuropsychiatr Dis Treat. 2014; 10: 16771691. 第18頁/共21頁Treatment of Vascular Dem

15、entiaBeta blockers: Drugs used to control hypertension.AAntidiabetics: Drugs used to control diabetes.BAntiplatelet: Drugs used to inhibit clot formation.CThere is no curative treatment but the treatment aims at preventing further deterioration.Certain drugs approved to treat Alzheimers may also off

16、er a modest benefit in people diagnosed with vascular dementia.第19頁/共21頁SummaryVascular dementia is a general term describing problems with reasoning, planning, judgment, memory and other thought processes caused by brain damage from impaired blood flow to your brain.There are different subtypes of VaD,such as post-stroke dementia,multi-Infarct dementia,dementia associated with strategic infarcts,subcortical isc