非アルツハイマー型認知症—血管性認知症

Neurocognitive Disorders Other Than Alzheimer Disease: Vascular Dementia

血管性認知症をきたす病態の中核は脳小血管病である。動脈硬化性孤発性脳小血管病，CADASIL，CARASILなどの遺伝性脳小血管病，アミロイド血管症，アミロイドβ関連血管炎などが代表的疾患である。小血管の障害機序は疾患ごとに異なるが，大脳白質や深部灰白質に対して慢性的な低灌流状態を惹起する点で共通する病態が存在する。さらに脳小血管病はアルツハイマー病などの変性疾患の認知症にも影響を与えている。

Abstract

Vascular dementia involves several mechanism of pathogenesis. Cerebral small vessel diseases play a central role in vascular dementia, including sporadic cerebral small vessel diseases, cerebral autosomal-dominant or autosomal recessive arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL or CARASIL), cerebral amyloid angiopathy, and amyloid β-related angiitis. Although these diseases have different pathomechanisms, chronic white matter hypoperfusion contributes to development of neuronal dysfunction as a common pathway in vascular dementia. Vascular dementia also may affect the cognitive decline observed in neurodegenerative diseases such as Alzheimer's disease.