阿尔茨海默病合并脑血管病的综合管理:从病理机制到临床实践

doi:10.3969/j.issn.1003-9198.2026.05.001

摘要/Abstract

摘要： AD与脑血管病在老年人群中常共存,构成老年认知障碍中最常见且管理复杂的混合型痴呆。脑血管病变与AD核心病理协同作用,可加速患者认知功能的衰退,且老年患者常伴多种慢性病和多重用药,进一步增加临床管理挑战。随着多模态神经影像、血浆生物标志物及人工智能技术的发展,AD合并脑血管病的精准分型与早期诊断成为可能。综合管理应立足老年人特点,涵盖血管危险因素控制、个体化药物选择、认知康复、运动及营养干预,并依托多学科协作,构建从筛查到随访的全程管理路径。本文系统阐述其病理交互机制、分层诊断策略与综合管理方案,为老年患者提供循证、可操作的临床管理框架。

关键词: 阿尔茨海默病, 脑血管病, 共病, 生物标志物, 综合管理

Abstract: Alzheimer’s disease (AD) and cerebrovascular disease (CVD) frequently coexist in the elderly population, forming mixed dementia, which is the most common and clinically complex type of cognitive impairment in late life. The synergistic interaction between cerebrovascular lesions and the core pathology of AD significantly accelerates cognitive decline. Furthermore, elderly patients often present with multiple comorbidities and polypharmacy, further complicating clinical management. With recent advancements in multimodal neuroimaging, plasma biomarkers, and artificial intelligence, precise subtyping and early diagnosis of AD complicated with CVD have become feasible. Comprehensive management should be grounded in the physiological characteristics of the elderly, encompassing the control of vascular risk factors, individualized pharmacological interventions, cognitive rehabilitation, exercise, and nutritional support. A multidisciplinary collaborative approach is essential to establish a holistic management pathway from initial screening to long-term follow-up. This article systematically reviews the pathological interaction mechanisms, stratified diagnostic strategies, and integrated management protocols to provide an evidence-based and actionable clinical framework for elderly patients.

Key words: Alzheimer’s disease, cerebrovascular disease, comorbidity, biomarker, comprehensive management

中图分类号:

R 749.16

崔瑞萍, 王洁, 谢嘉宜, 徐俊. 阿尔茨海默病合并脑血管病的综合管理:从病理机制到临床实践[J]. 实用老年医学, 2026, 40(5): 433-438.

CUI Ruiping, WANG Jie, XIE Jiayi, XU Jun. Comprehensive management of Alzheimer’s disease complicated with cerebrovascular disease: from pathological mechanisms to clinical practice[J]. Practical Geriatrics, 2026, 40(5): 433-438.

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