【正文】 ciated with dementia include Largevessel lesions of the dominant hemisphere Bilateral largevessel hemispheric strokes Leukoencephalopathy involving at least 25% of the total white matter (beginning to become confluent in four regions, i.e., frontal bilaterally and parietal bilaterally),Neuroradiology. 2007。49(1):122.,第五十九頁，共七十二頁。,Angular gyrus infarct,Fig. 1 Angular gyrus infarct in a 63yearold woman with cognitive impairment. a Axial and b coronal FLAIR MR images show infarct in the left dominant angular gyrus. There are also periventricular and deep white matter hyperintensities,Neuroradiology. 2007。49(1):122.,第六十頁，共七十二頁。,Thalamic infarct,Fig. 2 Thalamic infarct in a 58yearold 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 T1weighted 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):122.,第六十一頁，共七十二頁。,VCI的診治(zhěnzh236。)新進(jìn)展,VCI的定義/診斷標(biāo)準(zhǔn) VCI的神經(jīng)心理學(xué)評估 VCI的影像學(xué)診斷 如何(rh233。)確定影像學(xué)與認(rèn)知損害的關(guān)系 VCI的治療進(jìn)展 小結(jié),第六十二頁，共七十二頁。,VCI的治療(zh236。li225。o),VCI治療首先應(yīng)給于病因(b236。ngyīn)治療。出現(xiàn)病癥時可給于對癥治療藥物 針對血管因素以防治卒中的治療 特異針對提高認(rèn)知水平的藥物治療 加強(qiáng)康復(fù)訓(xùn)練、積極開展非藥物治療,第六十三頁，共七十二頁。,血管(xu232。guǎn)危險因素/腦血管病變是VCI的起始環(huán)節(jié),危險因素 首要(shǒuy224。o)病理學(xué) 血管改變 終末期結(jié)果 中間因素 后果,認(rèn)知(r232。n zhī)功能損害,高血壓,糖尿病,吸煙,高脂血癥,炎癥,動脈粥樣硬化,動脈僵硬度,內(nèi)皮損傷,小血管病 血管/管腔狹窄 心功能不全,腔隙性梗死 關(guān)鍵部位梗死 慢性低灌注,自主調(diào)節(jié)損傷 高白質(zhì)信號,基因(ApoE, Notch3),AD病理學(xué),Stroke. 2022。42:221226.,第六十四頁，共七十二頁。,VCI的危險因素(yīn s249。)控制推薦,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, 2022。42(9):2672713.,第六十五頁，共七十二頁。,VCI的危險因素控制(k242。ngzh236。)推薦,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, 2022。42(9):2672713.,第六十六頁，共七十二頁。,VaD患者(hu224。nzhě)腦脊液中Ach顯著下降,r=0.62, P0.02 in VD,J Neural Transm, 1996。103:12111220,第六十七頁，共七十二頁。,VCI藥物治療(zh236。li225。o)的推薦,Stroke, 2022。42(9):2672713.,第六十八頁，共七十二頁。,VCI的診治(zhěnzh236。)新進(jìn)展,VCI的定義(d236。ngy236。)/診斷標(biāo)準(zhǔn) VCI的神經(jīng)心理學(xué)評估 VCI的影像學(xué)診斷 如何確定影像學(xué)與認(rèn)知損害的關(guān)系 VCI的治療進(jìn)展 小結(jié),第六十九頁，共七十二頁。,小結(jié)(xiǎoji233。),VCI的定義(d236。ngy236。) VCI診斷核心要素：認(rèn)知損害、影像學(xué)、兩者有因果關(guān)系 VCI的神經(jīng)心理學(xué)評估：MoCA量表 SVD的影像學(xué)診斷 VaD的放射學(xué)診斷 VCI的治療：危險因素控制、病癥治療,第七十頁，共七十二頁。,Thank you very much!,第七十一頁，共七十二頁。,內(nèi)容(n232。ir243。ng)總結(jié),VCI的診治新進(jìn)展。動脈(d242。ngm224。i)硬化性(年齡和血管病危險因素相關(guān)的腦小血管病〕。影像發(fā)現(xiàn)近期位于穿動脈(d242。ngm224。i)分布區(qū)的小梗死〔20mm〕，影像或臨床病癥提示病變于過去數(shù)周發(fā)生。(1)病灶大?。?mm病灶均被認(rèn)為是dVRS。2=smooth “halo“。高血壓,糖尿病,吸煙,高脂血癥,炎癥。VaD的放射學(xué)診斷,第七十二頁，共七十二