Vaskuläre Demenz, Alzheimer-Demenz oder Mischdemenz?

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

• Literatur

• 1 Carmelli D, Reed T, De Carli C. A bivariate genetic analysis of cerebral white matter hyperintensities and cognitive performance in elderly male twins. Neurobiol Aging 2002; 23: 413-20.
• 2 de la Torre JC. Alzheimer disease as a vascular disorder: nosological evidence. Stroke 2002; 33: 1152-62.
• 3 Erkinjuntti T, Inzitari D, Pantoni L, Wallin A, Scheltens P, Rockwood K, Roman GC, Chui H, Desmond DW. Research criteria for subcortical vascular dementia in clinical trials. J Neural Transm Suppl 2000; 59: 23-30.
• 4 Erkinjuntti T, Rockwood K. Vascular dementia. Semin Clin Neuropsychiatry 2003; 08: 37-45.
• 5 Geroldi C, Galluzzi S, Testa C, Zanetti O, Frisoni GB. Validation study of a CT-based weighted rating scale for subcortical ischemic vascular disease in patients with mild cognitive deterioration. Eur Neurol 2003; 49: 193-209.
• 6 Hachinski VC. Multi-infarct dementia: a reappraisal. Alzheimer Dis Assoc Disord 1991; 02: 64-8.
• 7 Hampel H, Goernitz A, Buerger K. Advances in the development of biomarkers for Alzheimer’s disease: from CSF total tau and Abeta(1-42) proteins to phosphorylated tau protein. Brain Res Bull 2003; 61: 243-53.
• 8 Jeong J, Chae JH, Kim SY, Han SHJ. Nonlinear dynamic analysis of the EEG in patients with Alzheimer’s disease and vascular dementia. Clin Neurophysiol 2001; 18: 58-67.
• 9 Kantarci K, Jack Jr CR. Neuroimaging in Alzheimer disease: an evidence-based review. Neuroimaging Clin N Am 2003; 13: 197-209.
• 10 Knopman DS, Parisi JE, Boeve BF, Cha RH, Apaydin H, Salviati A, Edland SD, Rocca WA. Vascular dementia in a population-based autopsy study. Arch Neurol 2003; 60: 569-75.
• 11 Korczyn AD. Mixed dementia – the most common cause of dementia. Ann N Y Acad Sci 2002; 977: 129-34.
• 12 Medical Research Council Cognitive function and Aging Study (MRC-FAS, Neuropathology Group). Pathological correlates of late-onset dementia in a multicentre, community-based population in England and Wales. Lancet 2001; 357: 169-75.
• 13 Möbius HJ, Stöffler A. New approaches to clinical trials in vascular dementia: Memantine in small vessel disease. Cerebrovasc Dis 2002; 13 (Suppl. 02) 61-6.
• 14 O’Brien JT, Paling S, Barber R, Williams ED, Ballard C, McKeith IG, Gholkar A, Crum WR, Rossor MN, Fox NC. Progressive brain atrophy on serial MRI in dementia with Lewy bodies, AD, and vascular dementia. Neurology 2001; 56: 1386-8.
• 15 Posner HB, Tang MX, Luchsinger J, Lantigua R, Stern Y, Mayeux R. The relationship of hypertension in the elderly to AD, vascular dementia, and cognitive function. Neurology 2002; 58: 1175-81.
• 16 Roman GC, Tatemichi TK, Erkinjuntti T, Cummings JL, Masdeu JC, Garcia JH, Amaducci L, Orgogozo JM, Brun A, Hofman A. et al. Vascular dementia: diagnostic criteria for research studies. Neurology 1993; 43: 250-60.
• 17 Roman GC. Binswanger disease: the history of a silent epidemic. Ann N Y Acad Sci 2000; 903: 19-23.
• 18 Schmidt R, Fazekas F, Kapeller P, Schmidt H, Hartung HP. MRI white matter hyperintensities. Three-year follow-up of the Austrian Stroke Prevention Study. Neurology 1999; 53: 132-9.
• 19 Schmidtke K, Hull M. Neuropsychological differentiation of small vessel disease, Alzheimer’s disease and mixed dementia. J Neurol Sci 2002; 203-204: 17-22.
• 20 Snowdon DA, Greiner LH, Mortimer JA, Riley KP, Greiner PA, Markesbery WR. Brain infarction and the clinical expression of Alzheimer disease. The Nun Study. JAMA 1997; 277: 813-7.
• 21 Supprian T, Kessler H, Retz W, Rosler M, Grunwald I, Reith W, Falkai P. White matter alterations in neurodegenerative and vascular dementia. Radiologe 2003; 07: 543-51.
• 22 Tatemichi TK, Desmond DW, Prohovnik I. Strategic infarcts in vascular dementia. A clinical and brain imaging experience. Arzneimittelforschung 1995; 3A: 371-85.
• 23 van Straaten EC, Scheltens P, Knol DL, van Buchem MA, van Dijk EJ, Hofman PA, Karas G, Kjartansson O, de Leeuw FE, Prins ND, Schmidt R, Visser MC, Weinstein HC, Barkhof F. Operational definitions for the NINDSAIREN criteria for vascular dementia: an interobserver study. Stroke 2003; 34: 1907-12.
• 24 Wetterling T, Kanitz RD, Borgis KJ. Comparison of different diagnostic criteria for vascular dementia (ADDTC, DSM-IV, ICD-10, NINDS-AIREN). Stroke 1996; 27: 30-6.
• 25 Zekry D, Duyckaerts C, Belmin J, Geoffre C, Herrmann F, Moulias R, Hauw JJ. The vascular lesions in vascular and mixed dementia: the weight of functional neuroanatomy. Neurobiol Aging 2003; 02: 213-9.