An introduction to therapeutic approaches to vascular cognitive impairment.
An introduction to therapeutic approaches to vascular cognitive impairment.
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DOI：
10.1016/j.cccb.2021.100033
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发表时间：
2021
期刊：
影响因子：
--
通讯作者：
Corriveau RA
中科院分区：
文献类型：
--
作者：
Hainsworth AH;Elahi FM;Corriveau RA
血管疾病是常见痴呆症临床表现的重要组成部分。多种联系将血管风险、血管疾病和认知障碍联系起来。这激发了多种治疗方法，请参阅此特刊。血管性认知功能障碍（VCI），包括血管性痴呆，被认为是仅次于阿尔茨海默病的“第二大常见痴呆”。无论这是否属实，大多数老年痴呆症的临床表现都包括血管疾病。目前尚无有效的预防或治疗VCI的药理学靶点。这激发了许多潜在的治疗方法，反映在本特刊的文章中。其中包括新型口服抗凝剂达比加群预防β-淀粉样蛋白神经毒性的体外试验，以及MarkVCID研究确定的VCI中神经炎症和循环标志物（PIGF，VEGF-D）作用的概述。有潜在的治疗方法，包括肾上腺髓质素和促智制剂（如胰高血糖素）的审查。睡眠的作用进行了审查，可能的治疗目标（5 HT 2A受体）。小血管疾病二级预防试验有一项临床研究方案（ESTGATE-SVD）和一项可行性分析。临床数据包括来自纵向临床试验（NILVAD）的血压和脑血流量的次要分析，哌甲酯和加兰他敏反应者和非反应者之间的差异（STREAM-VCI），印度治疗方法的评估，以及来自阿根廷探戈舞的随机试验的主要结果，以保护非洲裔美国妇女的认知（ACT）。治疗血管疾病具有改善全球认知健康的巨大潜力，对公共卫生的影响与个人利益并存。血管疾病负担因人群而异，提供了使用血管干预措施积极解决痴呆症健康不平等的可能性。未来5-10年将见证具有成本效益的生活方式干预，重新利用药物和新疗法。
Vascular disease is a significant part of the clinical picture in common dementias. Multiple connections link vascular risk, vascular disease and cognitive impairment. This has inspired multiple therapeutic approaches, see this special issue. Vascular cognitive impairment (VCI), encompassing vascular dementia, has been claimed as the “second-most common dementia” after Alzheimer Disease. Whether or not this is true, the clinical picture of most dementia in older people includes vascular disease. There are no validated pharmacological targets for prevention or treatment of VCI. This has inspired a multitude of potential treatment approaches, reflected by the articles in this Special Issue. These include in vitro testing of the novel oral anticoagulant dabigatran for protection against β-amyloid neurotoxicity, and an overview of neuroinflammation in VCI and the role of circulating markers (PIGF, VEGF-D) identified by the MarkVCID study. There are reviews of potential therapeutics, including adrenomedullin and nootropic preparations (exemplified by cerebrolysin). The role of sleep is reviewed, with possible therapeutic targets (5HT2A receptors). There is a clinical study protocol (INVESTIGATE-SVD) and a feasibility analysis for a secondary prevention trial in small vessel disease. Clinical data include secondary analyses of blood pressure and cerebral blood flow from a longitudinal clinical trial (NILVAD), differences between methylphenidate and galantamine responders and non-responders (STREAM-VCI), appraisal of treatment approaches in India, and primary outcomes from a randomised trial of Argentine tango dancing to preserve cognition in African American women (ACT). Treating vascular disease has great potential to improve global cognitive health, with public health impacts alongside individual benefit. Vascular disease burden varies across populations, offering the possibility of proactively addressing health inequity in dementia using vascular interventions. The next 5–10 years will witness cost-effective lifestyle interventions, repurposed drugs and novel therapeutics.
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DOI：
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