Caruso Paola, Signori Riccardo, Moretti Rita
Department of Medical, Surgical and Health Sciences, Neurology Clinic, University of Trieste, Trieste, Italy.
Vasc Health Risk Manag. 2019 Aug 7;15:259-281. doi: 10.2147/VHRM.S190470. eCollection 2019.
Small vessels have the pivotal role for the brain's autoregulation. The arteriosclerosis-dependent alteration of the brain perfusion is one of the major determinants in small vessel disease. Endothelium distress can potentiate the flow dysregulation and lead to subcortical vascular dementia (sVAD). sVAD increases morbidity and disability. Epidemiological studies have shown that sVAD shares with cerebrovascular disease most of the common risk factors. The molecular basis of this pathology remains controversial.
To detect the possible mechanisms between small vessel disease and sVAD, giving a broad vision on the topic, including pathological aspects, clinical and laboratory findings, metabolic process and cholinergic dysfunction.
We searched MEDLINE using different search terms ("vascular dementia", "subcortical vascular dementia", "small vessel disease", "cholinergic afferents", etc). Publications were selected from the past 20 years. Searches were extended to Embase, Cochrane Library, and LILIACS databases. All searches were done from January 1, 1998 up to January 31, 2018.
A total of 560 studies showed up, and appropriate studies were included. Associations between traditional vascular risk factors have been isolated. We remarked that SVD and white matter abnormalities are seen frequently with aging and also that vascular and endothelium changes are related with age; the changes can be accelerated by different vascular risk factors. Vascular function changes can be heavily influenced by genetic and epigenetic factors.
Small vessel disease and the related dementia are two pathologies that deserve attention for their relevance and impact in clinical practice. Hypertension might be a historical problem for SVD and SVAD, but low pressure might be even more dangerous; CBF regional selective decrease seems to be a critical factor for small vessel disease-related dementia. In those patients, endothelium damage is a super-imposed condition. Several issues are still debatable, and more research is needed.
小血管在大脑的自动调节中起关键作用。依赖动脉硬化的脑灌注改变是小血管疾病的主要决定因素之一。内皮功能障碍可加剧血流调节异常并导致皮质下血管性痴呆（sVAD）。sVAD会增加发病率和残疾率。流行病学研究表明，sVAD与脑血管疾病具有大多数共同的危险因素。这种病理的分子基础仍存在争议。
探讨小血管疾病与sVAD之间的可能机制，全面了解该主题，包括病理方面、临床和实验室检查结果、代谢过程及胆碱能功能障碍。
我们使用不同的检索词（“血管性痴呆”、“皮质下血管性痴呆”、“小血管疾病”、“胆碱能传入神经”等）在MEDLINE上进行检索。选取过去20年的出版物。检索范围扩展至Embase、Cochrane图书馆和LILIACS数据库。所有检索均从1998年1月1日至2018年1月31日进行。
共检索到560项研究，并纳入了合适的研究。已分离出传统血管危险因素之间的关联。我们注意到，SVD和白质异常在衰老过程中经常出现，而且血管和内皮变化与年龄有关；不同的血管危险因素可加速这些变化。血管功能变化可能受到遗传和表观遗传因素的严重影响。
小血管疾病及相关痴呆是两种因其在临床实践中的相关性和影响而值得关注的病理状态。高血压可能是SVD和SVAD的一个历史遗留问题，但低血压可能更危险；脑血流量区域选择性降低似乎是与小血管疾病相关痴呆的一个关键因素。在这些患者中，内皮损伤是一种叠加状态。几个问题仍存在争议，需要更多的研究。
