22.大腦白質異常（white matter loss / hyperintensity / injury）非為下列那一個神經認知疾患（neurocognitive disorders）的主要神經病理變化？
(A)血管疾病引起的神經認知疾患（vascular neurocognitive disorder）
(B)人類免疫缺乏病毒（human immunodeficiency virus, HIV）感染
(C)長期酒精濫用（chronic alcohol abuse）
(D)甲基安非他命使用疾患（methamphetamine use disorder）

血管性失智症是由於血管病變，導致大腦供血減少所致。為了健康和正常運作，神經元需要充足的氧氣、葡萄糖和血液所提供的其他營養，這些血液通過複雜的血管（血管系統）輸送到大腦。如果該血管系統因血管薄弱或阻塞而受損，那麼血液的供應不足，腦細胞和組織將受到損害和/或死亡。
來源：https://www.caregiver.org/zh/resource/%E8%A1%80%E7%AE%A1%E6%80%A7%E5%A4%B1%E6%99%BA%E7%97%87-vascular-dementia/

DSM-5-TR: DSM 5 tr 這樣寫:Assessing for the presence of sufficient cerebrovascular disease relies on history, physical examination, and neuroimaging (Criterion C). Etiological certainty requires the demonstration of abnormalities on neuroimaging. The lack of neuroimaging can result in significant diagnostic inaccuracy by overlooking “silent” brain infarction and white matter lesions. However, if the neurocognitive impairment is temporally associated with one or more well-documented strokes, a probable diagnosis can be made in the absence of neuroimaging. Clinical evidence of cerebrovascular disease includes documented history of stroke, with cognitive decline temporally associated with the event, or physical signs consistent with stroke (e.g., hemiparesis; pseudobulbar syndrome, visual field defect). Neuroimaging (magnetic resonance imaging [MRI] or computed tomography [CT]) evidence of cerebrovascular disease comprises one or more of the following: one or more large vessel infarcts or hemorrhages, a strategically placed single infarct or hemorrhage (e.g., in angular gyrus, thalamus, basal forebrain), two or more lacunes outside the brain stem, or extensive and confluent white matter lesions. The latter is often termed small vessel disease or subcortical ischemic changes on clinical neuroimaging evaluations. MRI is the preferred mode of neuroimaging, and there has been interest in using specialized MRI techniques to detect cerebral microbleeds, cortical microinfarcts, dilated perivascular spaces, and diffusion-based analyses of white matter tracts and network connectivity. 評估是否有足以致病的腦血管疾病，需依據病史、身體檢查及神經影像學檢查（標準 C）。確立病因需要神經影像檢查證實有異常。若缺乏神經影像學檢查，可能會因漏診「靜止性」腦梗塞和白質病變而導致診斷出現顯著偏差。然而，如果神經認知功能障礙在時間上與一次或多次確診的卒中事件相關聯，即使沒有神經影像學檢查結果，也可作出「很可能」的診斷。腦血管疾病的臨床證據包括：有明確記錄的中風病史且認知功能衰退與此事件在時間上相關，或存在與中風相符的體徵（如偏癱、假性延髓麻痺、視野缺損）。腦血管疾病的神經影像學（磁振造影 [MRI] 或電腦斷層掃描 [CT]）證據包括以下一項或多項：一處或多處大血管梗死或出血；位於關鍵部位的單發梗死或出血（如角回、丘腦、基底前腦）；腦幹以外的兩處或多處腔隙性病灶；或廣泛且融合的白質病變。後者在臨床神經影像學評估中常被稱為小血管病變或皮質下缺血性改變。 MRI 是首選的神經影像學檢查方式；目前，利用專門的 MRI 技術檢測腦微出血、皮質微梗塞、血管周圍間隙擴大，以及對白質纖維束和網路連接性進行基於彌散成像的分析，已引起廣泛關注。