Cerebral small vessel disease and vascular cognitive impairment: from diagnosis to management. Issue 2 (23rd April 2021)

• Record Type: Journal Article
• Authors: Zanon Zotin, Maria Clara; Sveikata, Lukas; Viswanathan, Anand; Yilmaz, Pinar
• Is Part Of: Current opinion in neurology. Volume 34:Issue 2(2021)
• Page Start: 246
• Page End: 257
• Publication Date: 2021-04-23
• Subjects: imaging -- small vessel disease -- vascular cognitive impairment -- vascular dementia -- vascular risk factors; Neurology -- Periodicals; Nervous system -- Diseases -- Periodicals; 616.805
• DOI: 10.1097/WCO.0000000000000913
• Languages: English
• ISSNs: 1473-6551

Abstract

Abstract : Purpose of review: We present recent developments in the field of small vessel disease (SVD)-related vascular cognitive impairment, including pathological mechanisms, updated diagnostic criteria, cognitive profile, neuroimaging markers and risk factors. We further address available management and therapeutic strategies. Recent findings: Vascular and neurodegenerative pathologies often co-occur and share similar risk factors. The updated consensus criteria aim to standardize vascular cognitive impairment (VCI) diagnosis, relying strongly on cognitive profile and MRI findings. Aggressive blood pressure control and multidomain lifestyle interventions are associated with decreased risk of cognitive impairment, but disease-modifying treatments are still lacking. Recent research has led to a better understanding of mechanisms leading to SVD-related cognitive decline, such as blood-brain barrier dysfunction, reduced cerebrovascular reactivity and impaired perivascular clearance. Summary: SVD is the leading cause of VCI and is associated with substantial morbidity. Tackling cardiovascular risk factors is currently the most effective approach to prevent cognitive decline in the elderly. Advanced imaging techniques provide tools for early diagnosis and may play an important role as surrogate markers for cognitive endpoints in clinical trials. Designing and testing disease-modifying interventions for VCI remains a key priority in healthcare.