Department of Psychiatry, University of Oxford, UK; Oxford Centre for Human Brain Activity, Wellcome Centre for Integrative Neuroimaging, University of Oxford, UK.
Department of Psychiatry, University of Oxford, UK.
Neurosci Biobehav Rev. 2023 May;148:105140. doi: 10.1016/j.neubiorev.2023.105140. Epub 2023 Mar 20.
Cumulative evidence suggests that impaired cerebrovascular reactivity (CVR), a regulatory response critical for maintaining neuronal health, is amongst the earliest pathological changes in dementia. However, we know little about how CVR is affected by dementia risk, prior to disease onset. Understanding this relationship would improve our knowledge of disease pathways and help inform preventative interventions. This systematic review investigates 59 studies examining how CVR (measured by magnetic resonance imaging) is affected by modifiable, non-modifiable, and clinical risk factors for dementia. We report that non-modifiable risk (older age and apolipoprotein ε4), some modifiable factors (diabetes, traumatic brain injury, hypertension) and some clinical factors (stroke, carotid artery occlusion, stenosis) were consistently associated with reduced CVR. We also note a lack of conclusive evidence on how other behavioural factors such as physical inactivity, obesity, or depression, affect CVR. This review explores the biological mechanisms underpinning these brain-behaviour associations, highlights evident gaps in the literature, and identifies the risk factors that could be managed to preserve CVR in an effort to prevent dementia.
累积证据表明，脑血管反应性（CVR）受损是痴呆症最早的病理变化之一，这是一种对维持神经元健康至关重要的调节反应。然而，我们对痴呆症发病前 CVR 如何受到痴呆症风险因素的影响知之甚少。了解这种关系将提高我们对疾病途径的认识，并有助于为预防干预措施提供信息。本系统综述调查了 59 项研究，探讨了 CVR（通过磁共振成像测量）如何受到痴呆症的可改变、不可改变和临床风险因素的影响。我们报告说，不可改变的风险（年龄较大和载脂蛋白 E4）、一些可改变的因素（糖尿病、脑外伤、高血压）和一些临床因素（中风、颈动脉闭塞、狭窄）与 CVR 降低有一致性关联。我们还注意到，关于其他行为因素（如身体活动不足、肥胖或抑郁）如何影响 CVR，目前还没有确凿的证据。本综述探讨了这些脑-行为关联的生物学机制，突出了文献中的明显差距，并确定了可以管理的风险因素，以保护 CVR，从而预防痴呆症。
