Download PDF
Psychiatr Prax 2004; 31(7): 330-338
DOI: 10.1055/s-2004-828378
Übersicht
© Georg Thieme Verlag KG Stuttgart · New York

Vaskuläre Demenzen - Diagnostik, Prävention und Therapie

Vascular Dementia - Diagnosis, Prevention and TreatmentHenrike  Wolf1 , Hermann-Josef  Gertz2
  • 1Karolinska Institutet, Neurotec, Abteilung für Klinische Geriatrie, Huddinge, Schweden
  • 2Klinik und Poliklinik für Psychiatrie der Universität Leipzig
Die Arbeit wurde unterstützt durch das Interdisziplinäre Zentrum für klinische Forschung (Leipzig, IZKF C8). H. W. erhielt Stipendien der Gun och Bertil Stohnes Stiftelse und Demensstiftelse (Schweden)
Further Information

Publication History

Publication Date:
05 October 2004 (online)

Also available at
    Permissions and Reprints

Zusammenfassung

Anliegen: Die vorliegende Arbeit gibt einen Überblick über aktuelle Trends auf dem Gebiet der vaskulären Demenzen (VaD). Methode: Ausgehend von Definition und Pathophysiologie der VaD werden diagnostische Ansätze und aktuelle Ergebnisse aus Studien zur Prävention und Therapie der VaD dargestellt. Ergebnisse: Erste randomisierte Interventionsstudien belegen die Wirksamkeit präventiver Strategien bei VaD. Für die medikamentöse Therapie der manifesten VaD hat bisher keine Substanz eine Zulassung erhalten. Schlussfolgerungen: Die langfristige Kontrolle vaskulärer Risikofaktoren vor dem Auftreten einer Demenz ist die wichtigste Maßnahme zur Reduzierung der Inzidenz vaskulärer Demenzen.

Abstract

Objective: In this article, current trends in diagnosis, prevention and therapy of vascular dementias (VaD) are summarized. Methods: Based on the conceptual background and pathophysiology of VaD, current diagnostic approaches and results from recent large-scale randomised preventative and therapeutic studies are reviewed. Results: Epidemiological cohort studies and first intervention trials with anithypertensive drugs demonstrated the usefulness of antihypertensive drugs in the prevention of dementia. For the treatment of manifest VaD, no pharmaceutical substance has been approved to date, despite positive results in controlled studies with acetylcholinestere inhibitors. Conclusions: Long-term control of vascular risk factors before dementia has occurred appears to be the most important strategy to reduce the incidence of VaD.

Literatur

  • 1 Fratiglioni L, Launer L J, Andersen K, Breteler M M, Copeland J R, Dartigues J F, Lobo A, Martinez-Lage J, Soininen H, Hofman A. Incidence of dementia and major subtypes in Europe: A collaborative study of population-based cohorts. Neurologic Diseases in the Elderly Research Group.  Neurology. 2000;  54 S10-S15
    PubMedGoogle Scholar
  • 2 Statistisches Bundesamt .Gesundheitsbericht für Deutschland. Stuttgart; Metzler-Poeschel 1998
    Google Scholar
  • 3 Pohjasvaara T, Erkinjuntti T, Vataja R, Kaste M. Comparison of stroke features and disability in daily life in patients with ischemic stroke aged 55 to 70 and 71 to 85 years.  Stroke. 1997;  28 729-735
    PubMedGoogle Scholar
  • 4 Vermeer S E, Prins N D, Heijer T den, Hofman A, Koudstaal P J, Breteler M M. Silent brain infarcts and the risk of dementia and cognitive decline.  N Engl J Med. 2003;  348 1215-1222
    CrossrefPubMedGoogle Scholar
  • 5 Snowdon D A, Greiner L H, Mortimer J A, Riley K P, Greiner P A, Markesbery W R. Brain infarction and the clinical expression of Alzheimer disease. The Nun Study.  JAMA. 1997;  277 813-817
    CrossrefPubMedGoogle Scholar
  • 6 Esiri M M, Nagy Z, Smith M Z, Barnetson L, Smith A D. Cerebrovascular disease and threshold for dementia in the early stages of Alzheimer's disease.  Lancet. 1999;  354 919-920
    CrossrefPubMedGoogle Scholar
  • 7 Wolf H, Ecke G M, Bettin S, Dietrich J, Gertz H J. Do white matter changes contribute to the subsequent development of dementia in patients with mild cognitive impairment? A longitudinal study.  Int J Geriatr Psychiatry. 2000;  15 803-812
    PubMedGoogle Scholar
  • 8 Torre J C de la. Alzheimer disease as a vascular disorder: nosological evidence.  Stroke. 2002;  33 1152-1162
    CrossrefPubMedGoogle Scholar
  • 9 Alzheimer A. Die Seelenstörungen auf arteriosklerotischer Grundlage.  Allg Z Psychiat. 1902;  59 695-711
    PubMedGoogle Scholar
  • 10 Pohjasvaara T, Mantyla R, Ylikoski R, Kaste M, Erkinjuntti T. Clinical features of MRI-defined subcortical vascular disease.  Alzheimer Dis Assoc Disord. 2003;  17 236-242
    PubMedGoogle Scholar
  • 11 Nissl F. Zur Kasuisitik der arteriosklerotischen Demenz (Ein Fall von sogenannter „Encephalitis subcorticalis”).  Z ges Neurol Psychiat. 1920;  19 438-443
    PubMedGoogle Scholar
  • 12 Roman G C, Erkinjuntti T, Wallin A, Pantoni L, Chui H C. Subcortical ischaemic vascular dementia.  Lancet Neurol. 2002;  1 426-436
    CrossrefPubMedGoogle Scholar
  • 13 Roman G C, Tatemichi T K, Erkinjuntti T, Cummings J L, Masdeu J C, Garcia J H, Amaducci L, Orgogozo J M, Brun A, Hofman A. Vascular dementia: diagnostic criteria for research studies. Report of the NINDS-AIREN International Workshop.  Neurology. 1993;  43 250-260
    CrossrefPubMedGoogle Scholar
  • 14 American Psychiatric Association .DSM-IV: Diagnostic and Statistical Manual of Mental Disorders, ed 4th. Washington D. C.; American Psychiatric Press 1994
    Google Scholar
  • 15 Chui H C, Victoroff J I, Margolin D, Jagust W, Shankle R, Katzman R. Criteria for the diagnosis of ischemic vascular dementia proposed by the State of California Alzheimer's Disease Diagnostic and Treatment Centers.  Neurology. 1992;  42 473-480
    CrossrefPubMedGoogle Scholar
  • 16 World Health Organisation .International Classification of Diseases, ed. 10. Geneva; 1990
    Google Scholar
  • 17 Binswanger O. Die Abgrenzung der allgemeinen progressiven Paralyse (Referat erstattet auf der Jahresversammlung des Vereins deutscher Irrenärzte zu Dresden am 20. September 1804).  Berl klin Wschr. 1894;  31 1103-1105, 1137 - 1139, 1180 - 1189
    PubMedGoogle Scholar
  • 18 Erkinjuntti T, Inzitari D, Pantoni L, Wallin A, Scheltens P, Rockwood K, Roman G C, Chui H, Desmond D W. Research criteria for subcortical vascular dementia in clinical trials.  J Neural Transm Suppl. 2000;  59 23-30
    PubMedGoogle Scholar
  • 19 Pasquier F. Early diagnosis of dementia: neuropsychology.  J Neurol. 1999;  246 6-15
    PubMedGoogle Scholar
  • 20 O'Brien J T, Erkinjuntti T, Reisberg B, Roman G, Sawada T, Pantoni L, Bowler J V, Ballard C, DeCarli C, Gorelick P B, Rockwood K, Burns A, Gauthier S, DeKosky S T. Vascular cognitive impairment.  Lancet Neurol. 2003;  2 89-98
    PubMedGoogle Scholar
  • 21 Rosen W G, Terry R D, Fuld P A, Katzman R, Peck A. Pathological verification of ischemic score in differentiation of dementias.  Ann Neurol. 1980;  7 486-488
    CrossrefPubMedGoogle Scholar
  • 22 Wolf H, Hensel A, Kruggel F, Riedel-Heller S G, Arendt T, Wahlund L O, Gertz H J. Structural correlates of mild cognitive impairment.  Neurobiol Aging. 2004;  25 913-924
    CrossrefPubMedGoogle Scholar
  • 23 Behrens T E, Johansen-Berg H, Woolrich M W, Smith S M, Wheeler-Kingshott C A, Boulby P A, Barker G J, Sillery E L, Sheehan K, Ciccarelli O, Thompson A J, Brady J M, Matthews P M. Non-invasive mapping of connections between human thalamus and cortex using diffusion imaging.  Nat Neurosci. 2003;  6 750-757
    CrossrefPubMedGoogle Scholar
  • 24 Klunk W E, Engler H, Nordberg A, Wang Y, Blomqvist G, Holt D P, Bergstrom M, Savitcheva I, Huang G F, Estrada S, Ausen B, Debnath M L, Barletta J, Price J C, Sandell J, Lopresti B J, Wall A, Koivisto P, Antoni G, Mathis C A, Langstrom B. Imaging brain amyloid in Alzheimer's disease with Pittsburgh Compound-B.  Ann Neurol. 2004;  55 306-319
    CrossrefPubMedGoogle Scholar
  • 25 Weih M, Muller-Nordhorn J, Amberger N, Masuhr F, Lurtzing F, Dreier J P, Hetzel A. Risk in ischemic stroke-review of evidence in primary prevention.  Nervenarzt. 2004;  75 324-335
    CrossrefPubMedGoogle Scholar
  • 26 Leys D, Kwiecinski H, Bogousslavsky J, Bath P, Brainin M, Diener H C, Kaste M, Sivenius J, Hennerici M G, Hacke W. Prevention. European Stroke Initiative.  Cerebrovasc Dis. 2004;  17, Suppl 2 15-29
    PubMedGoogle Scholar
  • 27 Moroney J T, Bagiella E, Desmond D W, Paik M C, Stern Y, Tatemichi T K. Risk factors for incident dementia after stroke. Role of hypoxic and ischemic disorders.  Stroke. 1996;  27 1283-1289
    PubMedGoogle Scholar
  • 28 Forette F, Seux M L, Staessen J A, Thijs L, Babarskiene M R, Babeanu S, Bossini A, Fagard R, Gil-Extremera B, Laks T, Kobalava Z, Sarti C, Tuomilehto J, Vanhanen H, Webster J, Yodfat Y, Birkenhager W H. 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
    PubMedGoogle Scholar
  • 29 Tzourio C, Anderson C, Chapman N, Woodward M, Neal B, MacMahon S, Chalmers J. Effects of blood pressure lowering with perindopril and indapamide therapy on dementia and cognitive decline in patients with cerebrovascular disease.  Arch Intern Med. 2003;  163 1069-1075
    CrossrefPubMedGoogle Scholar
  • 30 Lithell H, Hansson L, Skoog I, Elmfeldt D, Hofman A, Olofsson B, Trenkwalder P, Zanchetti A. The Study on Cognition and Prognosis in the Elderly (SCOPE): principal results of a randomized double-blind intervention trial.  J Hypertens. 2003;  21 875-886
    CrossrefPubMedGoogle Scholar
  • 31 Castelli W P, Anderson K, Wilson P W, Levy D. Lipids and risk of coronary heart disease. The Framingham Study.  Ann Epidemiol. 1992;  2 23-28
    PubMedGoogle Scholar
  • 32 Stamler J, Vaccaro O, Neaton J D, Wentworth D. Diabetes, other risk factors, and 12-yr cardiovascular mortality for men screened in the Multiple Risk Factor Intervention Trial.  Diabetes Care. 1993;  16 434-444
    CrossrefPubMedGoogle Scholar
  • 33 Piechowski-Jozwiak B, Bogousslavsky J. Cholesterol as a risk factor for stroke: the fugitive?.  Stroke. 2004;  35 1523-1524
    CrossrefPubMedGoogle Scholar
  • 34 Amarenco P, Lavallee P, Touboul P J. Stroke prevention, blood cholesterol, and statins.  Lancet Neurol. 2004;  3 271-278
    PubMedGoogle Scholar
  • 35 Notkola I L, Sulkava R, Pekkanen J, Erkinjuntti T, Ehnholm C, Kivinen P, Tuomilehto J, Nissinen A. Serum total cholesterol, apolipoprotein E epsilon 4 allele, and Alzheimer's disease.  Neuroepidemiology. 1998;  17 14-20
    PubMedGoogle Scholar
  • 36 Kivipelto M, Helkala E L, Laakso M P, Hanninen T, Hallikainen M, Alhainen K, Soininen H, Tuomilehto J, Nissien A. Midlife vascular risk factors and Alzheimer's disease in later life: longitudinal, population based study.  BMJ. 2001;  322 1447-1451
    CrossrefPubMedGoogle Scholar
  • 37 Launer L J, White L R, Petrovitch H, Ross G W, Curb J D. Cholesterol and neuropathologic markers of AD: a population-based autopsy study.  Neurology. 2001;  57 1447-1452
    PubMedGoogle Scholar
  • 38 Exel E van, Craen A JM de, Gussekloo J, Houx P, Bootsma-Wiel A van der, Macfarlane P W, Blauw G J, Westendorp R GJ. Association between high-density lipoprotein and cognitive impairment in the oldest old.  Ann Neurol. 2002;  51 716-721
    CrossrefPubMedGoogle Scholar
  • 39 Wolozin B, Kellman W, Ruosseau P, Celesia G G, Siegel G. Decreased prevalence of Alzheimer disease associated with 3-hydroxy-3-methyglutaryl coenzyme A reductase inhibitors.  Arch Neurol. 2000;  57 1439-1443
    CrossrefPubMedGoogle Scholar
  • 40 Jick H, Zornberg G L, Jick S S, Seshadri S, Drachman D A. Statins and the risk of dementia.  Lancet. 2000;  356 1627-1631
    CrossrefPubMedGoogle Scholar
  • 41 Yaffe K, Barrett-Connor E, Lin F, Grady D. Serum lipoprotein levels, statin use, and cognitive function in older women.  Arch Neurol. 2002;  59 378-384
    CrossrefPubMedGoogle Scholar
  • 42 Collins R, Armitage J, Parish S, Sleight P, Peto R. Effects of cholesterol-lowering with simvastatin on stroke and other major vascular events in 20 536 people with cerebrovascular disease or other high-risk conditions.  Lancet. 2004;  363 757-767
    CrossrefPubMedGoogle Scholar
  • 43 Shepherd J, Blauw G J, Murphy M B, Bollen E L, Buckley B M, Cobbe S M, Ford I, Gaw A, Hyland M, Jukema J W, Kamper A M, Macfarlane P W, Meinders A E, Norrie J, Packard C J, Perry I J, Stott D J, Sweeney B J, Twomey C, Westendorp R G. Pravastatin in elderly individuals at risk of vascular disease (PROSPER): a randomised controlled trial.  Lancet. 2002;  360 1623-1630
    CrossrefPubMedGoogle Scholar
  • 44 Gorelick P B. Neuroprotection in acute ischaemic stroke: a tale of for whom the bell tolls?.  Lancet. 2000;  355 1925-1926
    CrossrefPubMedGoogle Scholar
  • 45 Nhan H, Barquist K, Bell K, Esselman P, Odderson I R, Cramer S C. Brain function early after stroke in relation to subsequent recovery.  J Cereb Blood Flow Metab. 2004;  24 756-763
    PubMedGoogle Scholar
  • 46 Gertz H J, Wolf H, Arendt T. Vaskuläre Demenz (Vascular Dementia).  Nervenarzt. 2002;  73 393-404
    CrossrefPubMedGoogle Scholar
  • 47 Lopez-Arrieta J M, Birks J. Nimodipine for primary degenerative, mixed and vascular dementia. Cochrane Database Syst Rev 2002, CD000147
    Google Scholar
  • 48 Wilcock G, Mobius H J, Stoffler A. A double-blind, placebo-controlled multicentre study of memantine in mild to moderate vascular dementia (MMM500).  Int Clin Psychopharmacol. 2002;  17 297-305
    PubMedGoogle Scholar
  • 49 Orgogozo J M, Rigaud A S, Stoffler A, Mobius H J, Forette F. Efficacy and safety of memantine in patients with mild to moderate vascular dementia: a randomized, placebo-controlled trial (MMM 300).  Stroke. 2002;  33 1834-1839
    CrossrefPubMedGoogle Scholar
  • 50 Wallin A, Alafuzoff I, Carlsson A, Eckernas S A, Gottfries C G, Karlsson I, Svennerholm L, Winblad B. Neurotransmitter deficits in a non-multi-infarct category of vascular dementia.  Acta Neurol Scand. 1989;  79 397-406
    PubMedGoogle Scholar
  • 51 Black S, Roman G C, Geldmacher D S, Salloway S, Hecker J, Burns A, Perdomo C, Kumar D, Pratt R. Efficacy and tolerability of donepezil in vascular dementia: positive results of a 24-week, multicenter, international, randomized, placebo-controlled clinical trial.  Stroke. 2003;  34 2323-2330
    CrossrefPubMedGoogle Scholar
  • 52 Wilkinson D, Doody R, Helme R, Taubman K, Mintzer J, Kertesz A, Pratt R D. Donepezil in vascular dementia: a randomized, placebo-controlled study.  Neurology. 2003;  61 479-486
    PubMedGoogle Scholar
  • 53 Erkinjuntti T, Kurz A, Gauthier S, Bullock R, Lilienfeld S, Damaraju C V. Efficacy of galantamine in probable vascular dementia and Alzheimer's disease combined with cerebrovascular disease: a randomised trial.  Lancet. 2002;  359 1283-1290
    CrossrefPubMedGoogle Scholar
  • 54 Moretti R, Torre P, Antonello R M, Cazzato G, Bava A. Rivastigmine in subcortical vascular dementia: a randomized, controlled, open 12-month study in 208 patients.  Am J Alzheimers Dis Other Demen. 2003;  18 265-272
    PubMedGoogle Scholar
  • 55 Bates J, Boote J, Beverley C. Psychosocial interventions for people with a milder dementing illness: a systematic review.  J Adv Nurs. 2004;  45 644-658
    CrossrefPubMedGoogle Scholar
  • 56 Kruglov L S. The early stage of vascular dementia: significance of a complete therapeutic program.  Int J Geriatr Psychiatry. 2003;  18 402-406
    PubMedGoogle Scholar
  • 57 Spector A, Thorgrimsen L, Woods B, Royan L, Davies S, Butterworth M, Orrell M. Efficacy of an evidence-based cognitive stimulation therapy programme for people with dementia: randomised controlled trial.  Br J Psychiatry. 2003;  183 248-254
    PubMedGoogle Scholar
  • 58 Koch K. MONICA-Projekt. Eine Todesursache ändert ihren Charakter.  Deutsches Ärzteblatt. 2000;  97 A583-A584
    PubMedGoogle Scholar
  • 59 Scherpinski U, Bickel H, Gnahn H, Forstl H, Conrad B, Sander D. Intervention project on cerebrovascular diseases and dementia in the Ebersberg district (INVADE): rationale and design.  Nervenarzt. 2002;  73 1199-1204
    CrossrefPubMedGoogle Scholar

Dr. Henrike Wolf

Karolinska Institutet · Neurotec

Karolinska Sjukhus Huddinge, B 84

14155 Huddinge · Schweden

Email: henrike.wolf@neurotec.ki.se