Swanson Randel L, Acharya Nimish K, Cifu David X
Center for Neurotrauma, Neurodegeneration and Restoration, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, USA.
Physical Medicine and Rehabilitation, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA.
Cureus. 2022 May 25;14(5):e25318. doi: 10.7759/cureus.25318. eCollection 2022 May.
Traumatic brain injury (TBI) exposure has been associated with an increased risk of age-related cognitive decline or dementia in multiple epidemiological studies. Current therapeutic interventions in the field of Brain Injury Medicine focus largely on episodic symptom management during the chronic phase of TBI recovery, rather than targeting specific underlying pathological processes. This approach may be especially problematic for secondary age-related cognitive decline or dementia following TBI exposure. Although there are likely multiple pathophysiological mechanisms involved, a growing body of literature demonstrates that cerebral microvascular pathology is a common endophenotype across the spectrum of TBI severity. Similarly, a combination of pre-clinical and clinical research over the past two decades has implicated cerebral microvascular pathology in the initiation and progression of multiple neurodegenerative diseases, including Alzheimer's disease and other dementias. We hypothesize that cerebral microvascular pathology is a common endophenotype between TBI, cardiovascular disease (CVD), and dementia, which can be targeted through modifiable cardiovascular risk factor reductions during the chronic phase of TBI recovery. We posit that our hypothesis is supported by the currently available scientific literature, as detailed in our review.
多项流行病学研究表明，创伤性脑损伤（TBI）与年龄相关的认知能力下降或痴呆风险增加有关。目前，脑损伤医学领域的治疗干预主要集中在TBI恢复慢性期的发作性症状管理上，而不是针对特定的潜在病理过程。对于TBI暴露后继发性年龄相关的认知能力下降或痴呆，这种方法可能尤其成问题。尽管可能涉及多种病理生理机制，但越来越多的文献表明，脑微血管病理是TBI严重程度范围内的一种常见内表型。同样，过去二十年的临床前和临床研究表明，脑微血管病理与包括阿尔茨海默病和其他痴呆症在内的多种神经退行性疾病的发生和发展有关。我们假设，脑微血管病理是TBI、心血管疾病（CVD）和痴呆之间的一种常见内表型，在TBI恢复的慢性期，可以通过降低可改变的心血管危险因素来针对这一内表型。我们认为，正如我们综述中所详述的，目前的科学文献支持我们的假设。
