AD_VaD鉴别.ppt

AD和VaD流行病学 中国人群痴呆患病率65岁以上的人群为7.6%,与西方国家相似1 中国人痴呆患病率ADVaD ADI专家引用及评价课题组的痴呆研究 研究结果被国际组织ADI引用于预测我国疾病的巨大负担 。 推测2040年中国的痴呆病人数将等于世界发达国家痴呆数的总和。 伦敦精神病研究院Martin Prince评价：这些发现对中国以及对全世界作为一个整体都十分重要(hugely important)。 Distribution of Dementia subtypes (1,141 cases) in four regional centers of China Distribution of subtypes of incident dementia cases by study 痴呆(变性和血管性)分类的再认识 AD临床诊断和病理诊断的比较 痴呆(变性和血管性)分类的再认识 ‘Pure AD’AD with severe cerebral amyloid angiopathyMild AD with vascular involvement AD with vascular lesions AD with cerebrovascular diseaseVD with AD changesVD with small-vessel disease ‘Pure VD’ VCI的新理念 脑卒中的新管理模式--- 认知损害早期诊断和干预 卒中后认知功能损害发生率明显增高 脑卒中后痴呆的发生率 Stroke increases the risk of dementia ↑Prevalence 13.6% 3 mo after stroke 32% one year after stroke ↑Incidence 24% 3 years after stroke 33.3% 5 years after stroke Mortality rate: stroke only 6.9%; stroke + dementia 19.8% 血管性认知损害定义(NINDS/CNS，2006 ) 柳叶刀神经病学分刊—2008年3月必威体育精装版综述 更新旧概念 旧VaD Not account for the ever-growing neuro-pathological evidence: most of dementia have both neurodegenerative and vascular features Not sensitive to the clinical phenotype of CI (memory?) 旧VCI criteria MCI+Subcortical VFeatures, vCIND, vMCI, MCI+VD (CVD FHis+risk) Pre-V CI (His CVD+≧3 risk) 新VCI is an umbrella VCIND, VaD, CI of Mixed (AD+VaD) MCI VCI MCI concept na-, a-MCI, single-, multi-domain MCI Not a disease VCI≠MCI; MCI≌ VCIND 诊断标准: old, not cover VCIND; New, informing Clinical evaluation: cognitive, V-risk, history, exam Cognitive assessment: follow-up 1y after stroke Related sub-/cortical, global cognition, MOCA, MMSE screen Neuroimaging: MRI-based Location amount/ incomplete Infarct, hypoperfusion ?normal, WMD: may/ may not ischaemic, MTA Neuropathology: large/small VI, WMC, Hemorrhage, gliosis, mixed V+AD Biomarkers albumin index/BBB integrity, Metalloproteinases/markers of demyelination Negative marker: Total Tau, P Tau 血管性认知损害亚型 VaD subtype Poststroke, MID