Department of Neurology, University of Utah, Salt Lake City, UT, USA.
Department of Radiology, University of Utah, Salt Lake City, UT, USA.
Curr Atheroscler Rep. 2019 Jul 27;21(10):39. doi: 10.1007/s11883-019-0799-1.
Subclinical cerebrovascular disease (sCVD) is highly prevalent in older adults. The main neuroimaging findings of sCVD include white matter hyperintensities and silent brain infarcts on T2-weighted MRI and cerebral microbleeds on gradient echo or susceptibility-weighted MRI. In this paper, we will review the epidemiology of sCVD, the current evidence for best medical management, and future directions for sCVD research.
Numerous epidemiologic studies show that sCVD, in particular WMH, is an important risk factor for the development of dementia, stroke, worse outcomes after stroke, gait instability, late-life depression, and death. Effective treatment of sCVD could have major consequences for the brain health of a substantial portion of older Americans. Despite the link between sCVD and many vascular risk factors, such as hypertension or hyperlipidemia, the optimal medical treatment of sCVD remains uncertain. Given the clinical equipoise about the risk versus benefit of aggressive medical management for sCVD, clinical trials to examine pragmatic, evidence-based approaches to management of sCVD are needed. Such a trial could provide much needed guidance on how to manage a common clinical scenario facing internists and neurologists in practice.
亚临床脑血管疾病（sCVD）在老年人中高发。sCVD 的主要神经影像学表现包括 T2 加权 MRI 上的脑白质高信号和无症状性脑梗死，以及梯度回波或磁敏感加权 MRI 上的脑微出血。本文将综述 sCVD 的流行病学、最佳药物治疗的现有证据，以及 sCVD 研究的未来方向。
大量的流行病学研究表明，sCVD，特别是脑白质病变，是痴呆、卒中和卒后不良结局、步态不稳、老年期抑郁和死亡的重要危险因素。有效治疗 sCVD 可能对相当一部分美国老年人的大脑健康产生重大影响。尽管 sCVD 与高血压或高血脂等多种血管危险因素有关，但 sCVD 的最佳药物治疗仍不确定。鉴于积极药物治疗 sCVD 的风险与获益之间存在临床平衡，需要进行临床试验以评估实用的、基于证据的 sCVD 管理方法。这样的试验可以为内科医生和神经科医生在实践中面临的常见临床情况提供急需的管理指导。
