Table 1 Comparison of distributions of dementia types in the systematic review [1] and the Helsinki Businessmen Study [4] Although Alzheimer’s disease (AD) is frequently cited as the most common type of dementia, the relative contributions of vascular and neurodegenerative pathology to clinical dementia have been actually obscure. The systematic review of studies reporting clinicopathologic data of dementia cases sheds important light on this issue [1]. Ten reports were analyzed, and altogether they included 2856 individuals, 1544 clinically demented and 1312 nondemented, with postmortem neuropathologic diagnosis. The results showed that both vascular-type only and Alzheimer-type only pathologies were associated with similar prevalence of clinical dementias, whereas the greatest risk of clinical dementia was observed among those with mixed pathologies (AD plus vascular). Neuropathologic analyses actually suggest that any multipathology (AD, vascular, or Lewy-related) increases the risk of dementia significantly [2]. We have earlier sought to discern various dementia types and their risk factors in our longitudinal study of older men (Helsinki Businessmen Study [HBS] [3]). The analyses were based on diagnoses (not only as cause-of-death) and narratives in death certificates [4]. We defined as “pure” AD, if only AD was noted without any reference in the death certificate to atherosclerotic cardiovascular disease (ASCVD); as pure vascular, if dementia plus any ASCVD was noted; as “mixed” if both AD and ASCVD were mentioned in the death certificate. Minority of cases had other specific dementia diagnosis or undefined dementia without concomitant ASCVD or AD. The distributions of clinicopathologic diagnoses of dementia types in the systematic review and clinical diagnoses in the HBS had a striking resemblance, and they are compared in Table 1.

中文翻译：

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血管和阿尔茨海默病病理学对痴呆的贡献

表 1 系统评价中痴呆类型分布的比较 [1] 和赫尔辛基商人研究 [4] 虽然阿尔茨海默病 (AD) 经常被引用为最常见的痴呆类型，但血管和神经退行性病理学对临床的相对贡献老年痴呆症其实一直很模糊。对报告痴呆病例临床病理数据的研究进行的系统评价为这一问题提供了重要线索 [1]。分析了 10 份报告，总共包括 2856 名个体，1544 名临床痴呆和 1312 名非痴呆，死后神经病理学诊断。结果表明，仅血管型和仅阿尔茨海默型病理与临床痴呆症的患病率相似，而在混合病理（AD 加血管）的患者中观察到临床痴呆的风险最大。神经病理学分析实际上表明，任何多病理学（AD、血管或 Lewy 相关）都会显着增加痴呆风险 [2]。在我们对老年男性的纵向研究（赫尔辛基商人研究 [HBS] [3]）中，我们早些时候曾试图辨别各种痴呆类型及其危险因素。分析基于诊断（不仅是死因）和死亡证明中的叙述[4]。我们定义为“纯”AD，只要在死亡证明中没有提及动脉粥样硬化性心血管疾病 (ASCVD) 的情况下只记录了 AD；作为纯血管，如果注意到痴呆加上任何 ASCVD；如果死亡证明中同时提到 AD 和 ASCVD，则为“混合”。少数病例有其他特定的痴呆症诊断或未定义的痴呆症，但不伴有 ASCVD 或 AD。系统评价中痴呆类型的临床病理诊断分布与HBS中的临床诊断具有惊人的相似性，它们在表1中进行了比较。