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中风后痴呆和认知障碍的模型与机制

Models and mechanisms of post-stroke dementia and cognitive impairment.

作者信息

Khan Romeesa, Devlin Patrick, Urayama Akihiko, Ritzel Rodney M

机构信息

Department of Neurology, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States.

University of Texas MD Anderson Cancer Center GSBS, Houston, TX, United States.

出版信息

Front Stroke. 2025;4. doi: 10.3389/fstro.2025.1563924. Epub 2025 May 8.

Abstract

Stroke is a leading cause of death and disability globally, with significant long-term impacts such as post-stroke cognitive impairment (PSCI). PSCI affects up to one-third of stroke survivors, substantially increasing their risk of dementia, especially after recurrent strokes. Despite advances in acute stroke treatments, the mechanisms underlying PSCI remain poorly understood. Emerging evidence highlights that PSCI arises from a complex interplay of vascular damage, neurodegenerative pathologies, and chronic inflammation. This review explores the epidemiology and clinical characteristics of PSCI, emphasizing the role of age, education, vascular integrity, and comorbidities such as diabetes. Additionally, we examine experimental findings that utilize rodent models to elucidate the time course and biological mechanisms of PSCI. Notable contributions include insights from transgenic Alzheimer's disease (AD) mouse models, revealing how vascular and amyloid pathologies accelerate cognitive decline post-stroke. Moreover, studies on neuroinflammation and immune responses, such as those involving TREM2, underscore the significance of inflammatory pathways in PSCI. By integrating clinical and experimental findings, this literature review provides a comprehensive understanding of PSCI mechanisms, offering a foundation for developing targeted diagnostic tools and therapeutic interventions to mitigate the long-term cognitive effects of stroke.

摘要

中风是全球死亡和残疾的主要原因,具有重大的长期影响,如中风后认知障碍(PSCI)。PSCI影响多达三分之一的中风幸存者,大幅增加了他们患痴呆症的风险,尤其是在复发性中风之后。尽管急性中风治疗取得了进展,但PSCI背后的机制仍知之甚少。新出现的证据表明,PSCI源于血管损伤、神经退行性病变和慢性炎症的复杂相互作用。本综述探讨了PSCI的流行病学和临床特征,强调了年龄、教育程度、血管完整性以及糖尿病等合并症的作用。此外,我们研究了利用啮齿动物模型阐明PSCI的时间进程和生物学机制的实验结果。显著的贡献包括来自转基因阿尔茨海默病(AD)小鼠模型的见解,揭示了血管和淀粉样病变如何加速中风后的认知衰退。此外,关于神经炎症和免疫反应的研究,如涉及TREM2的研究,强调了炎症途径在PSCI中的重要性。通过整合临床和实验结果,这篇文献综述全面理解了PSCI机制,为开发有针对性的诊断工具和治疗干预措施以减轻中风的长期认知影响提供了基础。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6f5a/12315578/7e24d385678e/nihms-2090730-f0001.jpg

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