Vaskuläre Demenz – Kognitive Beeinträchtigungen durch zerebrovaskuläre Krankheiten

Die vaskuläre Demenz (VaD) ist nach der Alzheimer Demenz die häufigste Ursache einer Demenz. Die vaskulär bedingten Demenzen werden heute eher mit dem Begriff der vaskulären kognitiven Störung (engl. vascular cognitive impairment – VCI) bezeichnet und umfassen verschiedene nosologische Veränderungen, die sich sowohl klinisch als auch pathophysiologisch voneinander unterscheiden. Allen gemeinsam ist aber als Ursache die zerebrovaskuläre Erkrankung. Unklar ist das Verhältnis zwischen Alzheimer Demenz und vaskulärer Demenz, auch wenn es sicher Überschneidungen gibt. Daher betrachtet man diese Formen der Demenz eher als einander gegenüberstehende Enden eines gemeinsamen Spektrums dementieller Erkrankungen. Die verschiedenen Risikofaktoren für einen Schlaganfall wie Hypertonus, Diabetes und Fettstoffwechselstörungen sind sowohl mit einem erhöhten Risiko für die Entwicklung einer Alzheimer Demenz als auch mit dem einer vaskulären kognitiven Störung verbunden. Diese Übersicht soll die wichtigsten Formen der vaskulären Demenz erläutern.

Vascular dementia (VaD) after Alzheimer dementia is the second most frequent cause of dementia. Dementias due to vascular causes are today rather designated by the term vascular cognitive impairment (VCI) and include various heterogeneous nosological alterations that differ from each other not only in clinical but also in pathophysiological aspects. Common to all, however, is a cerebrovascular disease as underlying cause. The relationship between Alzheimer dementia and vascular dementia is still not clear even though there is certainly some overlapping. Thus, these forms of dementia are considered to be the opposite ends of a common spectrum of dementia-type illnesses. The various risk factors for stroke such as hypertension, diabetes, dyslipidemia are associated not only with an increased risk to develop Alzheimer dementia but also a vascular cognitive disorder. The present contribution discusses the most important forms of vascular dementia.

Key words

Dementia - vascular dementia - vascular cognitive disorder - vascular cognitive impairment

• Literatur

• 1 Hachinski VC, Lassen NA, Marshall J. Multi-infarct dementia. A cause of mental deterioration in the elderly. Lancet 1974; 2: 207-210
• 2 Gorelick PB, Scuteri A, Black SE et al. Vascular Contributions to Cognitive Impairment and Dementia: A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke 2011; 42: 2672-2713
• 3 O'Brien JT, Erkinjuntti T, Reisberg B et al. Vascular cognitive impairment. The Lancet Neurology 2003; 2: 89-98
• 4 Kase CS. Epidemiology of multi-infarct dementia. Alzheimer Dis Assoc Disord 1991; 5: 71-76
• 5 Jellinger KA, Attems J. Is there pure vascular dementia in old age?. Journal of the Neurological Sciences 2010; 299: 150-154
• 6 Zaccai J, Ince P, Brayne C. Population-based neuropathological studies of dementia: design, methods and areas of investigation – a systematic review. BMC Neurol 2006; 6: 2-2
• 7 Chui HC, Mack W, Jackson JE et al. Clinical criteria for the diagnosis of vascular dementia: a multicenter study of comparability and interrater reliability. Arch Neurol 2000; 57: 191-196
• 8 Leys D, Henon H, Mackowiak-Cordoliani MA, Pasquier F. Poststroke dementia. Lancet Neurol 2005; 4: 752-759
• 9 Korczyn AD, Bornstein NM, Guekht A. Vascular dementia. Journal of the Neurological Sciences 2012; 322: 1-1
• 10 Grinberg LT, Heinsen H. Toward a pathological definition of vascular dementia. J Neurol Sci 2010; 299: 136-138
• 11 Schneider JA, Arvanitakis Z, Bang W, Bennett DA. Mixed brain pathologies account for most dementia cases in community-dwelling older persons. Neurology 2007; 69: 2197-2204
• 12 Jellinger KA. The pathology of „vascular dementia”: a critical update. J Alzheimers Dis 2008; 14: 107-123
• 13 Riley KP, Snowdon DA, Markesbery WR. Alzheimer's neurofibrillary pathology and the spectrum of cognitive function: findings from the Nun Study. Ann Neurol 2002; 51: 567-577
• 14 Suemoto CK, Nitrini R, Grinberg LT et al. Atherosclerosis and dementia: a cross-sectional study with pathological analysis of the carotid arteries. Stroke 2011; 42: 3614-3615
• 15 Pantoni L. Cerebral small vessel disease: from pathogenesis and clinical characteristics to therapeutic challenges. Lancet Neurol 2010; 9: 689-701
• 16 Simpson JE, Wharton SB, Cooper J et al. Alterations of the blood-brain barrier in cerebral white matter lesions in the ageing brain. Neurosci Lett 2010; 486: 246-251
• 17 Fazekas F, Kleinert R, Offenbacher H et al. Pathologic correlates of incidental MRI white matter signal hyperintensities. Neurology 1993; 43: 1683-1689
• 18 Hoffmann M, Schmitt F, Bromley E. Vascular cognitive syndromes: relation to stroke etiology and topography. Acta Neurol Scand 2009; 120: 161-169
• 19 Pendlebury ST, Rothwell PM. Prevalence, incidence, and factors associated with pre-stroke and post-stroke dementia: a systematic review and meta-analysis. Lancet Neurol 2009; 8: 1006-1018
• 20 Caplan LR, Gomes JA. Binswanger disease. An update. Journal of the Neurological Sciences 2010; 299: 9-10
• 21 De Reuck J, Auger F, Cordonnier C et al. Comparison of 7.0-T T(2)*-magnetic resonance imaging of cerebral bleeds in post-mortem brain sections of Alzheimer patients with their neuropathological correlates. Cerebrovasc Dis 2011; 31: 511-517
• 22 Sachdev PS, Brodaty H, Valenzuela MJ et al. The neuropsychological profile of vascular cognitive impairment in stroke and TIA patients. Neurology 2004; 62: 912-919
• 23 DGN, DGPPN. S3-Leitlinie „Demenzen”. DGN, DGPPN. http://www.awmf.org/uploads/tx_szleitlinien/038-013_S3_Demenzen_lang_11-2009_11-2011.pdf 2013
• 24 Roman GC, Tatemichi TK, Erkinjuntti TET et al. Vascular dementia: diagnostic criteria for research studies. Report of the NINDS-AIREN International Workshop. Neurology 1993; 43: 250-260
• 25 O'Brien JT. Role of imaging techniques in the diagnosis of dementia. Br J Radiol 2007; 80: 71-77
• 26 Forette F, Seux ML, Staessen JA et al. The prevention of dementia with antihypertensive treatment: new evidence from the Systolic Hypertension in Europe (Syst-Eur) study. Arch Intern Med 2002; 162: 2046-2052
• 27 Mogi M, Horiuchi M. Effects of angiotensin II receptor blockers on dementia. Hypertens Res 2009; 32: 738-740
• 28 Meyer JS, Chowdhury MH, Xu G, Li YS, Quach M. Donepezil treatment of vascular dementia. Ann N Y Acad Sci 2002; 977: 482-486
• 29 Auchus AP, Brashear HR, Salloway S et al. Galantamine treatment of vascular dementia: a randomized trial. Neurology 2007; 69: 448-458
• 30 Moretti R, Torre P, Antonello RM, Cazzato G. Rivastigmine in subcortical vascular dementia: a comparison trial on efficacy and tolerability for 12 months follow-up. Eur J Neurol 2001; 8: 361-362
• 31 Ray WA, Chung CP, Murray KT et al. Atypical antipsychotic drugs and the risk of sudden cardiac death. N Engl J Med 2009; 360: 225-235