Vaskuläre Demenzen^[*]

Zusammenfassung

Hintergrund Vaskuläre kognitive Beeinträchtigung (engl. Vascular Cognitive Impairment, VCI) umfasst das gesamte Spektrum von einer milden vaskulär bedingten kognitiven Beeinträchtigung (Mild Cognitive Impairment, MCI) bis hin zur vaskulären Demenz und beinhaltet neben rein vaskulären Pathologien auch gemischte Fälle von vaskulärer und neurodegenerativer Pathologie. Im klinischen Alltag bestehen oft erhebliche Unsicherheiten bezüglich des optimalen diagnostischen und therapeutischen Vorgehens.

Methoden Für die aktuelle Leitlinie (S1-Niveau) wurde seitens einer Expertengruppe mit den Schwerpunkten vaskuläre Neurologie, kognitive Neurologie, Gerontologie und akuter Schlaganfall in einem strukturierten Prozess zunächst eine Literaturrecherche durchgeführt. Darauf basierend wurden Empfehlungen erarbeitet mit folgenden Themenschwerpunkten: (1) Definition und Klassifikation der VCI unter Berücksichtigung der Vielzahl an vaskulären Ursachen und zerebralen Manifestationen; (2) Pathophysiologie; (3) Diagnostisches Vorgehen unter Einbeziehung bildgebender Verfahren (MRT und CT) und von Laboruntersuchungen (Blut und Liquor); (4) Diagnostische Algorithmen; und (5) Therapie. Die Regeln der Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e. V. (AWMF) und der DGN zum Umgang mit potenziellen Interessenkonflikten wurden berücksichtigt.

Ergebnisse Zu den wesentlichen Ergebnissen zählen: (1) Die Inzidenzrate von Demenz nach intrazerebraler Blutung bleibt auch über das 1. Jahr nach der Blutung hinaus hoch; (2) für die Diagnose einer vaskulär kognitiven Beeinträchtigung (VCI) ist es nicht erforderlich, dass Gedächtnisdefizite vorliegen, sofern Defizite in anderen kognitiven Domänen nachweisbar sind; (3) Die Behandlung umfasst etablierte Strategien zur Schlaganfallprävention, die nicht medikamentöse Behandlung sowie psychiatrische Begleittherapie, die spezifische Pharmakotherapie und neurorehabilitative Maßnahmen.

Zusammenfassung Die neue Leitlinie liefert praktische Empfehlungen zur Diagnostik und Behandlung der wachsenden Gruppe an Patienten mit vaskulär bedingter kognitiver Störung.

Abstract

Background Vascular Cognitive Impairment (VCI) encompasses the full spectrum from vascular mild cognitive impairment to vascular dementia and includes cases with isolated vascular disease as well as mixed vascular and neurodegenerative pathologies. There is considerable uncertainty in terms of optimal diagnostic strategies and therapeutic decision making.

Methods The German Neurological Society convened experts in the field of vascular neurology, cognitive neurology, gerontology, and acute stroke care. An interdisciplinary team of experts working in different clinical settings reviewed current literature with a specific focus on the following topics: (1) definitions and classifications considering the multiplicity of both vascular causes and manifestations in the brain; (2) pathophysiology; (3) diagnostic procedures including magnetic resonance imaging and laboratory investigations; (4) diagnostic algorithms; and (5) treatment. The guideline was prepared at an S1-level according to standards of the Association of the Scientific Medical Societies in Germany (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e. V., AWMF).

Results Among aspects currently gaining attention are the following: (1) the incidence rate of dementia after intracerebral hemorrhage (ICH) remains high even beyond the first year after ICH; (2) there is no requirement of a presence of memory deficits for a clinical diagnosis of VCI if deficits in other cognitive domains are present; (3) the treatment of VCI includes current strategies of stroke prevention, treatment of psychiatric symptoms, specific pharmacotherapy directed to the cognitive syndrome, and measures of neurorehabilitation.

Conclusion The new guideline offers practical advice for physicians and allied health care representatives working in different segments of the health care sector.

^* Den Leitlinientext zusammen mit der Interessenkonflikterklärung finden Sie auch auf www.dgn.org/leitlinien sowie www.awmf.de Vaskuläre Demenzen.

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