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認知症予防研究所

血管性認知症とは?

血管性認知症とは、脳血管障害が原因となって起こる認知症のことを指します。血管性認知症の原因となる脳血管障害には、クモ膜下出血・脳梗塞・脳出血などがあります。
血管性認知症はアルツハイマー型認知症に次いで多く、レビー小体型認知症よりもやや少ないといわれていますが、認知症の中では比較的多い症例です。
アルツハイマー型認知症は女性の患者が多いですが、血管性認知症は男性が罹患する例が多くなっています。

血管性認知症の原因

血管性認知症の原因は、脳血管障害によって脳出血が起こった際に、その周囲の神経細胞が損傷することにあり、特に脳梗塞は血管性認知症につながる危険性が高いといわれています。

直接的な原因はこういった脳血管障害ですが、遠因としてはこれらの脳血管障害を引き起こす動脈硬化があげられ、その動脈硬化を起こす成人病などを予防することによって血管性認知症の予防もできるということになります。

血管性認知症の症状

血管性認知症の症状には、認知機能障害、行動・心理症状、運動障害、言語障害が挙げられ、特に感情失禁とよばれる症状には注意が必要です。

・認知機能障害
自分の置かれた状況を正しく認識できなくなる症状ですが、他の認知症と違ってある部分では可能である部分には障害があるなどの傾向をみせるため「まだら認知症」とよばれることもありあます。

・行動・心理症状
うつ病によく似た無気力感や不安感を生じたり、妄想や幻覚を伴うこともあります。性格の変化、徘徊なども行動・心理症状の一部です。

・運動障害
脳血管障害によってもたらされるものでもあり、手足の麻痺や神経面での異変が見られます。

・言語障害
原因になった脳血管障害の位置によっては言語機能に大きな障害が発生します。

・感情失禁
感情のコントロールが上手くできなくなり、悲しみや怒りを制御できなくなり、脈絡無く急に泣いたり怒ったりするようになります。

血管性認知症の症状で特徴的なのは、アルツハイマー型認知症とは症状の進行に違いが見られることです。
アルツハイマー型認知症は症状は緩急をつけながらも悪化する方向に遷移しますが、血管性認知症では、症状の悪化と小康状態が繰り返されるのが特徴的です。原因となる脳血管障害による影響も大きく、脳梗塞が原因でその再発が繰り返されると、認知症の症状もそれを追って悪化していくようになります。また、脳血管障害によってダメージを受けた部位によって認知症の症状にも直接的な影響が確認されます。

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