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Vaskuläre Demenz

Vascular dementia

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Zusammenfassung

Die vaskuläre Demenz (VaD) stellt nach der Alzheimer-Demenz (AD) die zweithäufigste Demenzursache dar. Bei der VaD handelt es sich nicht um eine einheitliche Erkrankung, sondern um einen Sammelbegriff für vaskulär verursachte Demenzen, denen eine Vielzahl vaskulärer Pathologien zugrunde liegt. Um die VaD frühzeitig erkennen und behandeln zu können, hat sich in jüngerer Vergangenheit das Konzept der vaskulären kognitiven Störungen (VCI) etabliert, das neben der VaD auch frühe Erkrankungsstadien kognitiver Störungen ohne manifeste Demenz umfasst. Die Diagnostik der VaD basiert vor allem auf klinischen und bildgebenden Untersuchungen. Die Therapie richtet sich nach der zugrunde liegenden vaskulären Erkrankung und zielt auf die Kontrolle der vaskulären Risikofaktoren ab. Die häufigste Form der VaD stellt die mit der zerebralen Mikroangiopathie assoziierte subkortikale ischämische vaskuläre Demenz (SIVD) dar, die weniger durch Gedächtnisstörungen, sondern insbesondere durch Störungen der Exekutivfunktionen und der Verarbeitungsgeschwindigkeit gekennzeichnet ist. Die erbliche Form der SIVD (CADASIL) stellt nicht nur eine wichtige Differenzialdiagnose, sondern auch eine Modellerkrankung für klinische und bildgebende Untersuchungen zur SIVD dar.

Summary

Vascular dementia (VaD) constitutes the second most frequent cause of dementia following Alzheimer’s disease (AD). In contrast to AD, VaD encompasses a variety of conditions and dementia mechanisms including multiple and strategic infarcts, widespread white matter lesions and hemorrhages. The diagnosis of VaD is based on the patient history, the clinical evaluation and neuroimaging. Treatment of VaD should account for the underlying vascular condition and is directed towards the control of vascular risk factors and stroke prevention. The need for early diagnosis and preventive treatment has promoted the concept of vascular cognitive impairment (VCI). Harmonization standards for the description and study of VCI have recently been published. A common and distinct subtype of VaD is subcortical ischemic vascular dementia (SIVD) which is related to cerebral small vessel disease. SIVD is clinically characterized by impairment of executive functions and processing speed with relatively preserved memory. Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL), a genetic variant of SIVD, represents an important differential diagnosis and may serve as a model of SIVD.

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Authors and Affiliations

  1. Neurologische Klinik und Poliklinik, Klinikum Großhadern, Ludwig-Maximilians-Universität München, Marchioninistraße 15, 81377, München, Deutschland

    N. Peters

  2. Institut für Schlaganfall- und Demenzforschung, Ludwig-Maximilians-Universität München, München, Deutschland

    M. Dichgans

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Peters, N., Dichgans, M. Vaskuläre Demenz. Nervenarzt 81, 1245–1255 (2010). https://doi.org/10.1007/s00115-009-2848-4

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