PDF(Pubmed)
Abstract：
The dementia epidemic, attributed to aging populations, represents a growing socio-economic burden. It is estimated that in 2019 about 55 million people worldwide were living with dementia. With many possible causes of dementia and the possibility of mixed dementia combining Alzheimer\'s disease (AD) and vascular dementia the question is whether diagnostic uncertainty exists or whether diagnostic constructs based on single etiologies are incorrect. Vascular Cognitive Impairment and Dementia (VCID) designates the extent of cognitive dysfunctions from the most benign state to that of dementia, of vascular origin. We reviewed epidemiological, pathophysiological and clinical data on VCID with a focus on VaD, as well as key data on the development of a new therapeutic solution, SaiLuoTong (MLC-SLT). From documentary research executed on different web sources (PubMed, Clintrials.gov, Z-library and Google), our initial selection for the short review of VCID and VaD was based on keywords contained in each paragraph subtitles of this article with exclusion of publications in a language other than English or published before 2010. For the review of SaiLuoTong development, there was just the language exclusion criterion. Sorted by relevance and publication date, 47 references were selected from 140 shortlisted for review. With new evidence-based classification systems, vascular cognitive impairment was proposed as umbrella term covering all forms of cognitive deficits related to vascular causes. The scope of application expanded with the VCID which includes VaD and mixed pathologies. No drugs are approved for the treatment of VaD by major Western regulatory agencies, while some traditional Chinese medicines are registered in China. VCID treatment should have a dual focus: managing the underlying cerebrovascular disease and dementia symptoms. This is the objective set for the development of the MLC-SLT, the essential data of which are reviewed in detail. To strengthen VCID and VaD research, consensus groups should attempt to consolidate scattered local research initiatives into coordinated international programs. In two VaD clinical trials, MLC-SLT improved cognitive symptoms and activities of daily living, with good safety and potential disease-modifying effect. In a placebo-controlled study in 325 patients with mild to moderate VaD and randomized according to a delayed-start design, MLC-SLT demonstrated significant improvement in memory tests and performance in executive function tasks, expanding its place in the management of VCID. At week 26, changes in VADAS-cog scores (SD) from baseline were 23.25 (0.45) for MLC-SLT 180 mg bid), 23.05 (0.45) for MLC-SLT 120 mg bid (both p < 0.0001), and 20.57 (0.45) for placebo (p = 0.15). At week 52, differences between both groups MLC-SLT and placebo were 2.67 and 2.48, respectively (p < 0.0001), without significant difference between MLC-SLT groups.
摘要：
痴呆症的流行，归因于人口老龄化，代表着日益增长的社会经济负担。据估计，2019年全球约有5500万人患有痴呆症。由于痴呆的许多可能原因以及阿尔茨海默病（AD）和血管性痴呆的混合性痴呆的可能性，问题是是否存在诊断不确定性或基于单一病因的诊断结构是否不正确。血管性认知障碍和痴呆（VCID）是指从最良性状态到痴呆的认知功能障碍的程度，血管起源。我们回顾了流行病学，关于VCID的病理生理和临床数据，重点是VaD，以及开发新的治疗解决方案的关键数据，赛洛通(MLC-SLT)。从不同网络来源上执行的文献研究(PubMed，Clintrials.gov,Z-library和Google)，对于VCID和VaD的简短综述,我们最初的选择是基于本文每段字幕中包含的关键词,但不包括英文以外的其他语言或2010年之前出版的出版物.为了检讨赛洛塘的发展，只有语言排斥标准。按相关性和出版日期排序，从140个入围名单中选出47个参考文献进行审查。有了新的基于证据的分类系统，血管性认知障碍被认为是涵盖与血管原因相关的所有形式的认知障碍的总称.随着VCID的扩展，其应用范围包括VaD和混合病理学。西方主要监管机构没有批准任何药物用于治疗VaD，而一些中药在中国注册。VCID治疗应具有双重重点：管理潜在的脑血管疾病和痴呆症状。这是MLC-SLT开发的目标，其中的基本数据进行了详细的审查。为了加强VCID和VaD研究，共识小组应尝试将分散的本地研究计划合并为协调的国际计划。在两项VaD临床试验中，MLC-SLT改善认知症状和日常生活活动，具有良好的安全性和潜在的疾病改善作用。在一项针对325名轻度至中度VaD患者的安慰剂对照研究中，根据延迟启动设计随机分组，MLC-SLT在内存测试和执行功能任务的性能方面表现出显着改善，扩大其在VCID管理中的地位。在第26周，对于MLC-SLT180mgbid，VADAS-cog评分（SD）相对于基线的变化为23.25（0.45）），对于MLC-SLT120mgbid（均p<0.0001），23.05（0.45），安慰剂(p=0.15)为20.57(0.45)。在第52周，两组MLC-SLT和安慰剂之间的差异分别为2.67和2.48（p<0.0001），MLC-SLT组间无显著差异。
