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Neurotherapeutics : the Journal of the... Jan 2022Vascular cognitive impairment (VCI) is predominately caused by vascular risk factors and cerebrovascular disease. VCI includes a broad spectrum of cognitive disorders,... (Review)
Review
Vascular cognitive impairment (VCI) is predominately caused by vascular risk factors and cerebrovascular disease. VCI includes a broad spectrum of cognitive disorders, from mild cognitive impairment to vascular dementia caused by ischemic or hemorrhagic stroke, and vascular factors alone or in a combination with neurodegeneration including Alzheimer's disease (AD) and AD-related dementia. VCI accounts for at least 20-40% of all dementia diagnosis. Growing evidence indicates that cerebrovascular pathology is the most important contributor to dementia, with additive or synergistic interactions with neurodegenerative pathology. The most common underlying mechanism of VCI is chronic age-related dysregulation of CBF, although other factors such as inflammation and cardiovascular dysfunction play a role. Vascular risk factors are prevalent in VCI and if measured in midlife they predict cognitive impairment and dementia in later life. Particularly, hypertension, high cholesterol, diabetes, and smoking at midlife are each associated with a 20 to 40% increased risk of dementia. Control of these risk factors including multimodality strategies with an inclusion of lifestyle modification is the most promising strategy for treatment and prevention of VCI. In this review, we present recent developments in age-related VCI, its mechanisms, diagnostic criteria, neuroimaging correlates, vascular risk determinants, and current intervention strategies for prevention and treatment of VCI. We have also summarized the most recent and relevant literature in the field of VCI.
Topics: Alzheimer Disease; Cerebrovascular Disorders; Cognition Disorders; Cognitive Dysfunction; Dementia, Vascular; Humans
PubMed: 34939171
DOI: 10.1007/s13311-021-01170-y -
Soins; La Revue de Reference Infirmiere Sep 2018Stroke is a cerebrovascular disorder characterised by the sudden onset of symptoms and clinical signs. Each year, an estimated 140,000 people in France are hospitalised...
Stroke is a cerebrovascular disorder characterised by the sudden onset of symptoms and clinical signs. Each year, an estimated 140,000 people in France are hospitalised for stroke. Ischemic stroke is the most common kind of stroke, accounting for 80% of all cases. Haemorrhagic stroke accounts for about 20% of all strokes.
Topics: France; Humans; Semantics; Stroke
PubMed: 30213310
DOI: 10.1016/j.soin.2018.06.008 -
Journal of Cerebral Blood Flow and... Jan 2016The prevalence of dementia is increasing in our aging population at an alarming rate. Because of the heterogeneity of clinical presentation and complexity of disease... (Review)
Review
The prevalence of dementia is increasing in our aging population at an alarming rate. Because of the heterogeneity of clinical presentation and complexity of disease neuropathology, dementia classifications remain controversial. Recently, the National Plan to address Alzheimer’s Disease prioritized Alzheimer’s disease-related dementias to include: Alzheimer’s disease, dementia with Lewy bodies, frontotemporal dementia, vascular dementia, and mixed dementias. While each of these dementing conditions has their unique pathologic signature, one common etiology shared among all these conditions is cerebrovascular dysfunction at some point during the disease process. The goal of this comprehensive review is to summarize the current findings in the field and address the important contributions of cerebrovascular, physiologic, and cellular alterations to cognitive impairment in these human dementias. Specifically, evidence will be presented in support of small-vessel disease as an underlying neuropathologic hallmark of various dementias, while controversial findings will also be highlighted. Finally, the molecular mechanisms shared among all dementia types including hypoxia, oxidative stress, mitochondrial bioenergetics, neuroinflammation, neurodegeneration, and blood–brain barrier permeability responsible for disease etiology and progression will be discussed.
Topics: Blood-Brain Barrier; Cerebrovascular Disorders; Dementia; Humans; Lewy Bodies; Neurodegenerative Diseases; Neurogenic Inflammation; Prevalence; Risk Factors
PubMed: 26174330
DOI: 10.1038/jcbfm.2015.164 -
Stroke Jul 2021The global health burden of chronic kidney disease is rapidly rising, and chronic kidney disease is an important risk factor for cerebrovascular disease. Proposed... (Review)
Review
The global health burden of chronic kidney disease is rapidly rising, and chronic kidney disease is an important risk factor for cerebrovascular disease. Proposed underlying mechanisms for this relationship include shared traditional risk factors such as hypertension and diabetes, uremia-related nontraditional risk factors, such as oxidative stress and abnormal calcium-phosphorus metabolism, and dialysis-specific factors such as cerebral hypoperfusion and changes in cardiac structure. Chronic kidney disease frequently complicates routine stroke risk prediction, diagnosis, management, and prevention. It is also associated with worse stroke severity, outcomes and a high burden of silent cerebrovascular disease, and vascular cognitive impairment. Here, we present a summary of the epidemiology, pathophysiology, diagnosis, and treatment of cerebrovascular disease in chronic kidney disease from the Kidney Disease: Improving Global Outcomes Controversies Conference on central and peripheral arterial disease with a focus on knowledge gaps, areas of controversy, and priorities for research.
Topics: Cerebrovascular Disorders; Congresses as Topic; Consensus; Global Health; Humans; Ireland; Renal Insufficiency, Chronic; Risk Factors; Stroke
PubMed: 34078109
DOI: 10.1161/STROKEAHA.120.029680 -
Trends in Molecular Medicine Nov 2022Moyamoya disease (MMD) is a rare cerebrovascular disorder with unknown etiology. MMD is characterized by progressive narrowing of arteries of the brain and the formation... (Review)
Review
Moyamoya disease (MMD) is a rare cerebrovascular disorder with unknown etiology. MMD is characterized by progressive narrowing of arteries of the brain and the formation of a compensatory network of fragile vessels. Genetic studies have identified RNF213, also known as mysterin, as a susceptibility gene for MMD, but the low penetrance in genetically susceptible individuals suggests that a second hit is necessary to trigger disease onset. Recently, several molecular studies uncovered RNF213 as a key antimicrobial protein with important functions in the immune system. In addition, an increasing number of clinical reports describe the development of moyamoya angiopathy (MMA) associated with infection or autoimmune disorders. Together, this growing body of molecular and clinical evidence points towards immune-related responses as second hits to trigger MMD onset.
Topics: Humans; Moyamoya Disease; Adenosine Triphosphatases; Ubiquitin-Protein Ligases; Genetic Predisposition to Disease; Transcription Factors
PubMed: 36115805
DOI: 10.1016/j.molmed.2022.08.009 -
Circulation Research Mar 2019Hypertension has emerged as a leading cause of age-related cognitive impairment. Long known to be associated with dementia caused by vascular factors, hypertension has... (Review)
Review
Hypertension has emerged as a leading cause of age-related cognitive impairment. Long known to be associated with dementia caused by vascular factors, hypertension has more recently been linked also to Alzheimer disease-the major cause of dementia in older people. Thus, although midlife hypertension is a risk factor for late-life dementia, hypertension may also promote the neurodegenerative pathology underlying Alzheimer disease. The mechanistic bases of these harmful effects remain to be established. Hypertension is well known to alter in the structure and function of cerebral blood vessels, but how these cerebrovascular effects lead to cognitive impairment and promote Alzheimer disease pathology is not well understood. Furthermore, critical questions also concern whether treatment of hypertension prevents cognitive impairment, the blood pressure threshold for treatment, and the antihypertensive agents to be used. Recent advances in neurovascular biology, epidemiology, brain imaging, and biomarker development have started to provide new insights into these critical issues. In this review, we will examine the progress made to date, and, after a critical evaluation of the evidence, we will highlight questions still outstanding and seek to provide a path forward for future studies.
Topics: Animals; Antihypertensive Agents; Blood Pressure; Brain; Cerebrovascular Circulation; Cerebrovascular Disorders; Cognition; Cognitive Dysfunction; Humans; Hypertension; Neurovascular Coupling; Prognosis; Risk Assessment; Risk Factors
PubMed: 30920929
DOI: 10.1161/CIRCRESAHA.118.313260 -
BMC Cardiovascular Disorders Apr 2023Cerebrovascular disorders pose a global health concern. Advances in basic and clinical research, including induced pluripotent stem cell models and multi-omic...
Cerebrovascular disorders pose a global health concern. Advances in basic and clinical research, including induced pluripotent stem cell models and multi-omic approaches, have improved our understanding and management of these disorders. However, gaps in our knowledge remain. BMC Cardiovascular Disorders invites authors to submit articles investigating what drives and affects Cerebrovascular disorders to improve patient care.
Topics: Humans; Induced Pluripotent Stem Cells; Cerebrovascular Disorders; Cardiovascular Diseases
PubMed: 37118671
DOI: 10.1186/s12872-023-03225-8 -
Circulation Research Feb 2017The consequences of cerebrovascular disease are among the leading health issues worldwide. Large and small cerebral vessel disease can trigger stroke and contribute to... (Review)
Review
The consequences of cerebrovascular disease are among the leading health issues worldwide. Large and small cerebral vessel disease can trigger stroke and contribute to the vascular component of other forms of neurological dysfunction and degeneration. Both forms of vascular disease are driven by diverse risk factors, with hypertension as the leading contributor. Despite the importance of neurovascular disease and subsequent injury after ischemic events, fundamental knowledge in these areas lag behind our current understanding of neuroprotection and vascular biology in general. The goal of this review is to address select key structural and functional changes in the vasculature that promote hypoperfusion and ischemia, while also affecting the extent of injury and effectiveness of therapy. In addition, as damage to the blood-brain barrier is one of the major consequences of ischemia, we discuss cellular and molecular mechanisms underlying ischemia-induced changes in blood-brain barrier integrity and function, including alterations in endothelial cells and the contribution of pericytes, immune cells, and matrix metalloproteinases. Identification of cell types, pathways, and molecules that control vascular changes before and after ischemia may result in novel approaches to slow the progression of cerebrovascular disease and lessen both the frequency and impact of ischemic events.
Topics: Animals; Blood-Brain Barrier; Brain Ischemia; Cerebrovascular Disorders; Endothelium, Vascular; Humans; Risk Factors; Stroke
PubMed: 28154097
DOI: 10.1161/CIRCRESAHA.116.308427 -
Stroke Mar 2020
Topics: Cerebrovascular Disorders; Female; Humans; Incidence; Male; Prevalence; Risk Factors; Stroke
PubMed: 32078448
DOI: 10.1161/STROKEAHA.119.024159 -
Cardiovascular Diabetology Nov 2022The triglyceride glucose (TyG) index, which is a new surrogate indicator of insulin resistance (IR), is thought to be associated with many diseases, such as... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The triglyceride glucose (TyG) index, which is a new surrogate indicator of insulin resistance (IR), is thought to be associated with many diseases, such as cardiovascular disease, but its relationship with cerebrovascular disease is still controversial.
METHODS
The PubMed, EMBASE, Cochrane Library, Web of Science and Medline databases were searched until March 2022 to evaluate the association between the TyG index and cerebrovascular disease risk. A random‒effects model was used to calculate the effect estimates and 95% confidence intervals (CIs).
RESULTS
A total of 19 cohort studies and 10 case‒control/cross‒sectional studies were included in our study, which included 11,944,688 participants. Compared with a low TyG index, a higher TyG index increased the risk of cerebrovascular disease (RR/HR = 1.22, 95% CI [1.14, 1.30], P< 0.001; OR = 1.15, 95% CI [1.07, 1.23], P< 0.001). Furthermore, the results of the dose-response analysis of the cohort study demonstrated that the risk of cerebrovascular disease increased by 1.19 times per 1 mg/dl increment of the TyG index (relative risk = 1.19, 95% CI [1.13,1.25], P< 0.001).
CONCLUSION
TyG index is related to cerebrovascular disease. More data and basic research are needed to confirm the association.
Topics: Humans; Triglycerides; Glucose; Blood Glucose; Cross-Sectional Studies; Cohort Studies; Risk Factors; Biomarkers; Insulin Resistance; Cerebrovascular Disorders; Risk Assessment
PubMed: 36324146
DOI: 10.1186/s12933-022-01664-9