非痴呆型血管性认知障碍(vascular cognitive impairment no dementia,VCIND)是认知障碍的早期阶段,认知损害尚未达到痴呆的标准。本文从中医“虚、痰、瘀”的病因病机进行阐述,脾肾亏虚为发病基础,痰瘀互结为致病因素,导致髓海不足,清...非痴呆型血管性认知障碍(vascular cognitive impairment no dementia,VCIND)是认知障碍的早期阶段,认知损害尚未达到痴呆的标准。本文从中医“虚、痰、瘀”的病因病机进行阐述,脾肾亏虚为发病基础,痰瘀互结为致病因素,导致髓海不足,清窍失养,发为痴呆。胆碱能通路与认知障碍的发生发展密切相关,包括神经递质乙酰胆碱的缺乏、脑白质病变影响胆碱能通路的网络连接以及胆碱能抗炎通路等。探讨中医虚痰瘀的病机演变与胆碱能通路发病机制之间的关系,有助于进一步发掘中医中药治疗在胆碱能通路的作用。展开更多
Background and Purpose -One possible mechanism of cognitive decline in individuals with subcortical vascular disease is disruption of cholinergic fibers by ischemic lesions, such as strategically located white matter ...Background and Purpose -One possible mechanism of cognitive decline in individuals with subcortical vascular disease is disruption of cholinergic fibers by ischemic lesions, such as strategically located white matter hyperintensities (WMH). The authors applied a new MRI visual rating scale to assess WMH within cholinergic pathways in patients with Alzheimer Disease (AD) and subcortical ischemic microvascular disease. Methods -Subjects included 60 AD patients with and with out WMH, matched for age, as well as 15 control subjects. A visual rating scale was developed based on published immunohistochemical tracings of the cholinergic pathways in humans. On 4 selected axial images, the severity of WMH in the chol inergic pathways was rated on a 3-point scale for ten regions, identified with major anatomical landmarks. A published, consensus-derived, general WMH scale w as also applied. All subjects underwent standardized neuropsychological testing. Results -The Cholinergic Pathways HyperIntensities Scale showed reliability an d was validated with volumetry of strategic WMH. After accounting for age and ed ucation in a multiple linear regression model, The Cholinergic Pathways Hyperint ensities Scale ratings were associated with impaired performance on the Mattis D ementia Rating Scale (r=0.40; P=0.02) and accounted for 12%of the variance (cor rected r2). A similar model was not significant for general WMH scores. Conclusi ons -The new MRI rating scale for WMH in cholinergic pathways is reliable and s hows stronger correlations with cognitive performance than a general WMH rating scale in AD with WMH. This new rating scale provides indirect evidence that loca lization of WMH within neurotransmitter systems may contribute to cognitive decl ine.展开更多
文摘非痴呆型血管性认知障碍(vascular cognitive impairment no dementia,VCIND)是认知障碍的早期阶段,认知损害尚未达到痴呆的标准。本文从中医“虚、痰、瘀”的病因病机进行阐述,脾肾亏虚为发病基础,痰瘀互结为致病因素,导致髓海不足,清窍失养,发为痴呆。胆碱能通路与认知障碍的发生发展密切相关,包括神经递质乙酰胆碱的缺乏、脑白质病变影响胆碱能通路的网络连接以及胆碱能抗炎通路等。探讨中医虚痰瘀的病机演变与胆碱能通路发病机制之间的关系,有助于进一步发掘中医中药治疗在胆碱能通路的作用。
文摘Background and Purpose -One possible mechanism of cognitive decline in individuals with subcortical vascular disease is disruption of cholinergic fibers by ischemic lesions, such as strategically located white matter hyperintensities (WMH). The authors applied a new MRI visual rating scale to assess WMH within cholinergic pathways in patients with Alzheimer Disease (AD) and subcortical ischemic microvascular disease. Methods -Subjects included 60 AD patients with and with out WMH, matched for age, as well as 15 control subjects. A visual rating scale was developed based on published immunohistochemical tracings of the cholinergic pathways in humans. On 4 selected axial images, the severity of WMH in the chol inergic pathways was rated on a 3-point scale for ten regions, identified with major anatomical landmarks. A published, consensus-derived, general WMH scale w as also applied. All subjects underwent standardized neuropsychological testing. Results -The Cholinergic Pathways HyperIntensities Scale showed reliability an d was validated with volumetry of strategic WMH. After accounting for age and ed ucation in a multiple linear regression model, The Cholinergic Pathways Hyperint ensities Scale ratings were associated with impaired performance on the Mattis D ementia Rating Scale (r=0.40; P=0.02) and accounted for 12%of the variance (cor rected r2). A similar model was not significant for general WMH scores. Conclusi ons -The new MRI rating scale for WMH in cholinergic pathways is reliable and s hows stronger correlations with cognitive performance than a general WMH rating scale in AD with WMH. This new rating scale provides indirect evidence that loca lization of WMH within neurotransmitter systems may contribute to cognitive decl ine.
