Koueik Joyce, Wesley Umadevi V, Dempsey Robert J
Department of Neurological Surgery, School of Medicine and Public Health, University of Wisconsin, Madison, WI, 53792, USA.
Department of Neurological Surgery, School of Medicine and Public Health, University of Wisconsin, Madison, WI, 53792, USA.
Neurochem Int. 2023 Mar;164:105499. doi: 10.1016/j.neuint.2023.105499. Epub 2023 Feb 4.
Cerebrovascular disease (CVD) is the second most common cause of cognitive impairment and dementia in aged population. CVD presents in a myriad number of clinical ways based on the functional location of pathology. While primary clinical emphasis has been placed on motor, speech and visual deficits, vascular cognitive decline is a vastly under recognized and devastating condition afflicting millions of Americans. CVD, a disease of the blood vessels that supply blood to brain involves an integration between small and large vessels. Cerebral large vessel diseases (LVD) are associated with atherosclerosis, artery-to-artery embolism, intracardiac embolism and a large vessel stroke leading to substantial functional disability. Cerebral small vessel disease (SVD) is critically involved in stroke, brain hemorrhages, cognitive decline and functional loss in elderly patients. An evolving understanding of cellular and molecular mechanisms emphasizes that inflammatory vascular changes contribute to systemic pathologic conditions of the central nervous systems (CNS), with specific clinical presentations including, cognitive decline. Advances in an understanding of pathophysiology of disease processes and therapeutic interventions may help improve outcomes. This review will focus on large and small vessels diseases and their relationship to vascular cognitive decline, atherosclerosis, stroke, and inflammatory neurodegeneration. We will also emphasize the molecular and cellular mechanisms, as well as genetic and epigenetic factors associated with LVD and SVD.
脑血管疾病（CVD）是老年人群认知障碍和痴呆的第二大常见病因。根据病理的功能位置，CVD有多种临床症状表现。虽然临床主要关注运动、言语和视觉缺陷，但血管性认知衰退是一种严重未被认识且极具破坏性的疾病，困扰着数百万美国人。CVD是一种向大脑供血的血管疾病，涉及小血管和大血管的相互作用。脑大血管疾病（LVD）与动脉粥样硬化、动脉到动脉栓塞、心内栓塞以及导致严重功能残疾的大血管中风有关。脑小血管疾病（SVD）在老年患者的中风、脑出血、认知衰退和功能丧失中起关键作用。对细胞和分子机制的不断深入理解强调，炎症性血管变化会导致中枢神经系统（CNS）的全身性病理状况，具体临床表现包括认知衰退。对疾病过程病理生理学和治疗干预的认识进展可能有助于改善治疗结果。本综述将聚焦于大血管和小血管疾病及其与血管性认知衰退、动脉粥样硬化、中风和炎症性神经退行性变的关系。我们还将强调与LVD和SVD相关的分子和细胞机制，以及遗传和表观遗传因素。
