Department of Neurology and Stroke Unit, ASST Cremona, 26100 Cremona, Italy.
Department of Surgery and Medical-Surgical Specialties, University of Catania, 95123 Catania, Italy.
Int J Mol Sci. 2020 Apr 23;21(8):2977. doi: 10.3390/ijms21082977.
In the last years, there has been a significant growth in the literature exploring the pathophysiology of vascular cognitive impairment (VCI). As an "umbrella term" encompassing any degree of vascular-related cognitive decline, VCI is deemed to be the most common cognitive disorder in the elderly, with a significant impact on social and healthcare expenses. Interestingly, some of the molecular, biochemical, and electrophysiological abnormalities detected in VCI seem to correlate with disease process and progression, eventually promoting an adaptive plasticity in some patients and a maladaptive, dysfunctional response in others. However, the exact relationships between vascular lesion, cognition, and neuroplasticity are not completely understood. Recent findings point out also the possibility to identify a panel of markers able to predict cognitive deterioration in the so-called "brain at risk" for vascular or mixed dementia. This will be of pivotal importance when designing trials of disease-modifying drugs or non-pharmacological approaches, including non-invasive neuromodulatory techniques. Taken together, these advances could make VCI a potentially preventable cause of both vascular and degenerative dementia in late life. This review provides a timely update on the recent serological, cerebrospinal fluid, histopathological, imaging, and neurophysiological studies on this "cutting-edge" topic, including the limitations, future perspectives and translational implications in the diagnosis and management of VCI patients.
在过去的几年中，探索血管性认知障碍（VCI）病理生理学的文献数量显著增长。作为一个涵盖任何程度血管相关认知衰退的“伞状术语”，VCI 被认为是老年人最常见的认知障碍，对社会和医疗保健费用有重大影响。有趣的是，在 VCI 中检测到的一些分子、生化和电生理异常似乎与疾病过程和进展相关，最终在一些患者中促进了适应性可塑性，而在另一些患者中则促进了适应性不良、功能失调的反应。然而，血管病变、认知和神经可塑性之间的确切关系尚未完全理解。最近的发现还指出，有可能确定一组标记物，能够预测所谓的“有血管或混合性痴呆风险的大脑”中的认知恶化。当设计针对疾病修饰药物或非药物方法（包括非侵入性神经调节技术）的试验时，这将至关重要。综上所述，这些进展可能使 VCI 成为晚年血管性和退行性痴呆的一个潜在可预防的原因。本综述及时更新了关于这个“前沿”主题的血清学、脑脊液、组织病理学、影像学和神经生理学研究的最新进展，包括其在 VCI 患者诊断和管理中的局限性、未来展望和转化意义。
