Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain.
Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, New York.
J Am Coll Cardiol. 2020 Mar 3;75(8):942-951. doi: 10.1016/j.jacc.2019.10.062.
Alzheimer's disease, the leading cause of dementia in the elderly, is a neurodegenerative condition characterized by accumulation of amyloid plaques and neurofibrillary tangles in the brain. However, age-related vascular changes accompany or even precede the development of Alzheimer's pathology, raising the possibility that they may have a pathogenic role. This review provides an appraisal of the alterations in cerebral and systemic vasculature, the heart, and hemostasis that occur in Alzheimer's disease and their relationships to cognitive impairment. Although the molecular pathogenesis of these alterations remains to be defined, amyloid-β is a likely contributor in the brain as in the heart. Collectively, the evidence suggests that vascular pathology is a likely pathogenic contributor to age-related dementia, including Alzheimer's disease, inextricably linked to disease onset and progression. Consequently, the contribution of vascular factors should be considered in preventive, diagnostic, and therapeutic approaches to address one of the major health challenges of our time.
阿尔茨海默病是老年人痴呆的主要病因，是一种神经退行性疾病，其特征是大脑中淀粉样斑块和神经原纤维缠结的积累。然而，与年龄相关的血管变化伴随着或甚至先于阿尔茨海默病病理学的发展，这增加了它们可能具有致病作用的可能性。这篇综述评估了发生在阿尔茨海默病中的脑和全身血管、心脏和止血系统的改变及其与认知障碍的关系。尽管这些改变的分子发病机制仍有待确定，但淀粉样蛋白-β在大脑中可能像在心脏中一样是一个重要的贡献者。总的来说，证据表明血管病理学是与年龄相关的痴呆（包括阿尔茨海默病）的一个潜在致病因素，与疾病的发生和进展密切相关。因此，在预防、诊断和治疗方法中应考虑血管因素的贡献，以应对我们这个时代的主要健康挑战之一。
