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Nervenheilkunde 2004; 23(02): 80-85
DOI: 10.1055/s-0038-1626279
Original- und Übersichtsarbeiten - Original and Review Articles
Schattauer GmbH

Vaskuläre Demenz, Alzheimer-Demenz oder Mischdemenz?

Differenzialdiagnose vor dem Hintergrund neuropathologischer StudienVascular dementia, Alzheimer’s dementia or mixed dementia?Differential diagnosis and neuropathological studies
M. Hüll
1   Abteilung Psychiatrie und Psychotherapie (Direktor Prof. Dr. Matthias Berger), Universitätsklinikum Freiburg
2   Zentrum für Geriatrie und Gerontologie Freiburg (Leiter Prof. Dr. Wolfgang Heiss), Universitätsklinikum Freiburg
,
K. Schmidtke
2   Zentrum für Geriatrie und Gerontologie Freiburg (Leiter Prof. Dr. Wolfgang Heiss), Universitätsklinikum Freiburg
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Publication History

Publication Date:
19 January 2018 (online)

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Zusammenfassung

Unter dem Begriff »vaskuläre Demenz« verbergen sich heterogene Demenzformen mit unterschiedlichen vaskulären Pathomechanismen. Die bisherigen klinischen Kriterien müssen im Licht aktueller neuropathologischer Studien als ungenügend betrachtet werden. Vor allem die subkortikale vaskuläre Demenz lässt sich differenzialdiagnostisch nicht ohne weiteres von einer Alzheimer-Demenz abgrenzen. Neurobiologische und epidemiologische Studien lassen eine Interaktion zwischen vaskulären Pathomechanismen und der Alzheimer-Pathologie vermuten. Nach dem 75. Lebensjahr sind Mischdemenzen mit Alzheimer und subkortikaler Pathologie möglicherweise häufiger als reine subkortikale vaskuläre Demenzen. Untersuchungen der typischen neuropsychologischen Beeinträchtigungen der jeweiligen Demenzform können zur Differenzialdiagnose herangezogen werden. Visuokonstruktive Leistungen und das passive Gedächtnis sind bei subkortikalen vaskulären Demenzen auch nach Kontrolle für den Schweregrad der Demenz weniger beeinträchtigt als bei der Alzheimer-Demenz.

Summary

The term “vascular dementia” is used for a broad spectrum of different vascular pathologies that can lead to dementia. Clinico-pathological studies have shown poor correlations between clinical criteria for vascular dementia and neuropathology. Subcortical small vessel dementia is difficult to differentiate from mixed small vessel Alzheimer’s dementia. Neurobiological and epidemiological studies suggest an interaction between vascular pathomechanisms and Alzheimer’s pathology. After the age of 75, mixed Alzheimer and subcortical vascular pathology may be more prevalent than pure subcortical small vessel dementia. Both, subcortical small vessel dementia and Alzheimer’s dementia have typical neuropsychological profils. Patients with small vessel dementia perform better on visuoconstructive tasks and tests of recognition memory than patients with Alzheimer’s disease with the same degree of dementia.

Schlüsselwörter

Subkortikale vaskuläre Demenz - Neuropsychologie - M. Binswanger - Alzheimer-Demenz

Keywords

Small vessel dementia - neuropsychology - M. Binswanger - Alzheimer’s dementia
 

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