血管性认知障碍诊治新进展-.ppt

Thalamic infarct Fig. 2 Thalamic infarct in a 58-year-old man with dementia. a Axial FLAIR MR image shows infarct in the left dominant thalamus (arrow). There are also periventricular and deep white matter hyperintensities and global mild cerebral atrophy. b Coronal 3D SPGR T1-weighted MR image confirms the thalamic infarct and the cerebral atrophy. It also shows mild bilateral hippocampal atrophy. The white matter abnormalities are difficult to see as periventricular hypointensities (arrows) Neuroradiology. 2007;49(1):1-22. VCI的诊治新进展 VCI的定义/诊断标准 VCI的神经心理学评估 VCI的影像学诊断 如何确定影像学与认知损害的关系 VCI的治疗进展 小结 VCI的治疗 VCI治疗首先应给于病因治疗。出现症状时可给于对症治疗药物 针对血管因素以防治卒中的治疗 特异针对提高认知水平的药物治疗 加强康复训练、积极开展非药物治疗 血管危险因素/脑血管病变是VCI的起始环节 危险因素 首要病理学 血管改变 终末期结果 中间因素 后果 认知功能损害 高血压,糖尿病,吸烟,高脂血症,炎症 动脉粥样硬化,动脉僵硬度,内皮损伤 小血管病 血管/管腔狭窄 心功能不全 腔隙性梗死 关键部位梗死 慢性低灌注 自主调节损伤 高白质信号 基因(ApoE, Notch3) AD病理学 Stroke. 2011;42:221-226. VCI的危险因素控制推荐 In people at risk for VCI, smoking cessation is reasonable (Class IIa; Level of Evidence A). In people at risk for VCI, the following lifestyle interventions may be reasonable: moderation of alcohol intake (Class IIb; Level of Evidence B); weight control (Class IIb; Level of Evidence B); and physical activity (Class IIb; Level of Evidence B). 3. In people at risk for VCI, the use of antioxidants and B vitamins is not beneficial, based on current evidence (Class III; Level of Evidence A). Lifestyle Factors Stroke, 2011;42(9):2672-713. VCI的危险因素控制推荐 In people at risk for VCI, treatment of hypertension is recommended (Class I; Level of Evidence A). In people at risk for VCI, treatment of hyperglycemia may be reasonable (Class IIb; Level of Evidence C). In people at risk for VCI, treatment of hypercholesterolemia may be reasonable (Class IIb; Level of Evidence B). In people at risk for VCI, it is uncertain whether treatment of inflammation will reduce such risk (Class IIb; Level of Evidence C). Physiological Risk Factors Stroke, 2011;42(9):2672-713. Va