摘要：

研究背景 血管性轻度认知损害为血管性痴呆的早期阶段，是药物治疗之关键靶点。目前由于国内有关血管性轻度认知损害的诊断标准和筛查技术尚存争议，影响其临床诊断水平的提高，拟通过探讨其临床特征、诊断标准和筛查技术，以为临床提供循证医学参考依据。方法 以“vascular mild cognitive impairment OR vascular cognitive impairment no dementia” 作为检索式，计算机检索1997 年1 月-2015 年3 月美国国立医学图书馆生物医学信息检索系统，获得关于血管性轻度认知损害的指南与共识、临床研究等相关英文文献，参照2004 年欧洲神经病协会联盟修订的神经疾病管理指南准备指引进行证据分级。结果 最终纳入32 篇英文文献，指南与共识3 篇，临床研究29 篇（Ⅰ类研究11 篇、Ⅱ类研究18 篇）。其中7 篇文献（Ⅰ类2 篇、Ⅱ类5 篇）报告血管性轻度认知损害的神经心理学特征，显示以信息处理速度减慢和执行功能下降为主要特征；2 篇文献报告血管性轻度认知损害的诊断标准（2011 年美国心脏协会/美国卒中协会诊断与治疗指南、2014 年国际血管性行为与认知障碍学会基于美国精神障碍诊断与统计手册第5 版的诊断标准）；15 篇文献（Ⅰ类4 篇、Ⅱ类11 篇）对血管性轻度认知损害的操作性诊断标准进行描述，总结临床常用的6 项标准；14 篇文献（Ⅰ类4 篇、Ⅱ类10 篇）对血管性轻度认知损害的神经心理学评价技术进行描述，美国国立神经病学与卒中研究所?加拿大卒中网的5 分钟方案与其他测验量表的一致性较高。结论 血管性轻度认知损害的神经心理学特征对诊断具有指导意义，国际血管性行为与认知障碍学会公布的诊断标准临床实用性佳，5分钟方案适用于临床快速筛查。

关键词: 痴呆, 血管性, 认知障碍, 神经心理学测验, 诊断, 循证医学

Abstract:

Background  Vascular mild cognitive impairment (VaMCI) is the prodromal syndrome of vascular dementia (VaD) and key target for drug treatment. There is controversy over the diagnostic criteria and screening tools of VaMCI, which affects its clinical diagnosis. This paper aims to explore the clinical features, diagnostic criteria and screening technique of VaMCI.  Methods  Taking "vascular mild cognitive impairment OR vascular cognitive impairment no dementia" as retrieval terms, search in PubMed database from January 1997 to March 2015 and screen relevant literatures concerning VaMCI. According to Guidance for the Preparation of Neurological Management Guidelines revised by European Federation of Neurological Societies (EFNS) in 2004, evidence grading was performed on literatures. Results  A total of 32 literatures in English were selected according to inclusion and exclusion criteria, including 3 guidelines and consensus and 29 clinical studies. Seven literatures (2 on Level Ⅰ, 5 on Level Ⅱ) studied on neuropsychological features in VaMCI patients and found reduced processing speed and executive function impairment were main features. Two literatures reported the diagnostic criteria of VaMCI, including VaMCI criteria published by American Heart Association (AHA)/American Stroke Association (ASA) in 2011 and "Diagnostic Criteria for Vascular Cognitive Disorders" published by International Society for Vascular Behavioral and Cognitive Disorders (VASCOG) in 2014. Fifteen literatures (4 on LevelⅠ, 11 on Level Ⅱ) described the diagnostic criteria of VaMCI used in clinical research, from which 6 operational diagnostic items were extracted. Fourteen literatures (4 on Level Ⅰ, 10 on Level Ⅱ) described neuropsychological assessment tools for VaMCI screening, and found the 5-minute protocol recommended by National Institute of Neurological Disorders and Stroke-Canadian Stroke Network (NINDS-CSN) was being good consistency with other neuropsychological assessment tools.  Conclusions  The neuropsychological features of VaMCI have guiding significance for diagnosis. VASCOG diagnostic criteria for VaMCI is practical in clinical practice, and 5-minute protocol is suitable for clinical rapid screening of VaMCI.

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