Current pathophysiological concepts in cerebral small vessel disease.

The association between cerebral small vessel disease (SVD) – in the form of white matter lesions, infarctions, and hemorrhages – with vascular cognitive impairment (VCI), has mostly been deduced from observational studies. Pathological conditions affecting the small vessels of the brain and leading to SVD have suggested plausible molecular mechanisms involved in vascular damage and their impact on brain function. However, much still needs to be clarified in understanding the pathophysiology of VCI, the role of neurodegenerative processes such as Alzheimer’s disease, and the impact of aging itself. In addition, both genetic predispositions and environmental exposures may potentiate the development of SVD and interact with normal aging to impact cognitive function and require further study. Advances in technology, in the analysis of genetic and epigenetic data, neuroimaging such as magnetic resonance imaging, and new biomarkers will help to clarify the complex factors leading to SVD and the expression of VCI.

脑小血管病（SVD）——以白质病变、梗死和出血的形式存在——与血管性认知障碍（VCI）之间的关联大多是从观察性研究中推断出来的。影响脑小血管并导致SVD的病理状况提示了血管损伤所涉及的合理分子机制及其对脑功能的影响。然而，在理解VCI的病理生理学、阿尔茨海默病等神经退行性过程的作用以及衰老本身的影响方面，仍有许多问题需要阐明。此外，遗传倾向和环境暴露都可能促进SVD的发展，并与正常衰老相互作用影响认知功能，这需要进一步研究。技术的进步，包括对遗传和表观遗传数据的分析、磁共振成像等神经影像学以及新的生物标志物，将有助于阐明导致SVD和VCI表现的复杂因素。