Chung Chih-Ping, Ihara Masafumi, Hilal Saima, Chen Liang-Kung
Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; Center for Health Longevity and Aging Sciences, National Yang Ming Chiao Tung University College of Medicine, Taipei, Taiwan.
Department of Neurology, National Cerebral and Cardiovascular Center, Osaka, Japan.
Arch Gerontol Geriatr. 2023 Jul;110:104982. doi: 10.1016/j.archger.2023.104982. Epub 2023 Feb 26.
Cerebral small vessel disease (SVD), which is highly age-related, is the most common neuroimaging finding in community-dwelling elderly individuals. In addition to increasing the risk of dementia and stroke, SVD is associated with cognitive and physical (particularly gait speed) functional impairments in the elderly. Here, we provide evidence suggesting covert SVD, e.g. without clinically evident stroke or dementia, as a critical target to preserve the functional ability that enables well-being in older age. First, we discuss the relationship between covert SVD and geriatric syndrome. SVD lesions found in non-demented, stroke-free elderly are actually not "silent" but are associated with accelerated age-related functional decline. We also review the brain structural and functional abnormalities associated with covert SVD and the possible mechanisms underlying their contributions to SVD-related cognitive and physical functional impairments. Finally, we reveal current data, though limited, on the management of elderly patients with covert SVD to prevent SVD lesion progression and functional decline. Although it is important in aging health, covert SVD is still under-recognized or misjudged by physicians in both neurological and geriatric professions. Improving the acknowledgment, detection, interpretation, and understanding of SVD would be a multidisciplinary priority to maintain cognitive and physical functions in the elderly. The dilemmas and future directions of clinical practice and research for the elderly with covert SVD are also included in the present review.
脑小血管病（SVD）与年龄高度相关，是社区老年人群中最常见的神经影像学表现。除了增加痴呆和中风的风险外，SVD还与老年人的认知和身体（特别是步态速度）功能障碍有关。在此，我们提供证据表明隐匿性SVD，例如无临床明显中风或痴呆的情况，是维持老年人良好生活功能能力的关键靶点。首先，我们讨论隐匿性SVD与老年综合征之间的关系。在无痴呆、无中风的老年人中发现的SVD病变实际上并非“无症状”，而是与年龄相关的功能加速衰退有关。我们还回顾了与隐匿性SVD相关的脑结构和功能异常以及它们导致SVD相关认知和身体功能障碍的潜在机制。最后，我们揭示了目前关于隐匿性SVD老年患者管理以预防SVD病变进展和功能衰退的数据，尽管这些数据有限。尽管隐匿性SVD在老年健康中很重要，但神经科和老年科医生对其仍认识不足或判断错误。提高对SVD的认识、检测、解释和理解将是多学科的优先事项，以维持老年人的认知和身体功能。本综述还包括隐匿性SVD老年患者临床实践和研究的困境及未来方向。
