脑小血管病合并认知障碍
Cerebral Small Vessel Disease with Cognitive Impairment
摘要: 脑小血管病(cerebral small vessel disease, CSVD)是导致血管性认知障碍和痴呆的主要病因，但其病理机制复杂，临床管理仍面临诸多挑战。本文系统综述了CSVD合并认知障碍的最新研究进展，重点探讨影像学技术革新、多模态数据整合及干预策略优化。高分辨率神经影像技术(如7T MRI和动态功能磁共振)显著提升了微血管病变的早期检测能力，而人工智能驱动的多模态模型(融合影像、基因组和代谢数据)为揭示认知衰退的时空演变规律提供了新工具。在治疗层面，联合运动与认知训练、代谢管理(如二甲双胍联合生活方式干预)被证实可延缓认知功能恶化，但其疗效受限于个体异质性和长期依从性不足。本文进一步分析了当前研究的核心瓶颈，包括数据标准化缺失、模型可解释性不足及跨学科协作机制不完善。撰写本综述的目的在于整合CSVD领域的关键突破，强调从病理机制探索到临床转化的全链条视角，为开发精准干预方案提供理论框架，并推动神经科学、影像学与人工智能的深度融合，以改善患者认知结局。
Abstract: Cerebral small vessel disease (CSVD) is a leading cause of vascular cognitive impairment and dementia, yet its pathological mechanisms remain complex and clinical management faces significant challenges. This review synthesizes recent advancements in CSVD-related cognitive impairment, focusing on innovations in neuroimaging, multimodal data integration, and intervention strategies. High-resolution imaging techniques (e.g., 7T MRI and dynamic fMRI) have enhanced early detection of microvascular pathology, while artificial intelligence-driven multimodal models (integrating imaging, genomic, and metabolic data) offer new insights into the spatiotemporal dynamics of cognitive decline. Therapeutically, combined exercise-cognitive training and metabolic interventions (e.g., metformin with lifestyle modification) demonstrate efficacy in slowing cognitive deterioration, though their benefits are limited by individual heterogeneity and poor long-term adherence. We further analyze critical barriers, including lack of data standardization, limited model interpretability, and insufficient interdisciplinary collaboration. The purpose of this review is to consolidate key breakthroughs in CSVD research, emphasize a holistic perspective from mechanistic exploration to clinical translation, and provide a theoretical framework for developing precision interventions. By bridging neuroscience, imaging, and AI, this work aims to advance cross-disciplinary innovation and improve cognitive outcomes for patients.
文章引用：张国平, 杜茂. 脑小血管病合并认知障碍[J]. 临床个性化医学, 2025, 4(4): 201-208. https://doi.org/10.12677/jcpm.2025.44436

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