Lee Kang-Po, Chang Alice Y W, Sung Pi-Shan
Department of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan.
Department of Neurology, E-DA Hospital, Kaohsiung 824, Taiwan.
Biomedicines. 2021 Jul 2;9(7):773. doi: 10.3390/biomedicines9070773.
After stroke, dynamic changes take place from necrotic-apoptotic continuum, inflammatory response to poststroke neurogenesis, and remodeling of the network. These changes and baseline brain pathology such as small vessel disease (SVD) and amyloid burden may be associated with the occurrence of early or late poststroke cognitive impairment (PSCI) or dementia (PSD), which affect not only stroke victims but also their families and even society. We reviewed the current concepts and understanding of the pathophysiology for PSCI/PSD and identified useful tools for the diagnosis and the prediction of PSCI in serological, CSF, and image characteristics. Then, we untangled their relationships with blood pressure (BP) and blood pressure variability (BPV), important but often overlooked risk factors for PSCI/PSD. Finally, we provided evidence for the modifying effects of BP and BPV on PSCI as well as pharmacological and non-pharmacological interventions and life style modification for PSCI/PSD prevention and treatment.
中风后，会发生从坏死-凋亡连续统、炎症反应到中风后神经发生以及网络重塑的动态变化。这些变化以及诸如小血管疾病（SVD）和淀粉样蛋白负荷等基线脑病理学特征可能与早期或晚期中风后认知障碍（PSCI）或痴呆（PSD）的发生有关，这不仅影响中风患者，还会影响他们的家庭甚至社会。我们回顾了当前对PSCI/PSD病理生理学的概念和理解，并确定了血清学、脑脊液和图像特征中用于PSCI诊断和预测的有用工具。然后，我们理清了它们与血压（BP）和血压变异性（BPV）的关系，BP和BPV是PSCI/PSD重要但常被忽视的危险因素。最后，我们提供了BP和BPV对PSCI的调节作用的证据，以及用于PSCI/PSD预防和治疗的药物和非药物干预措施及生活方式改变的证据。
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