Cardiovascular risk factors promote brain hypoperfusion leading to cognitive decline and dementia.
Cardiovascular risk factors promote brain hypoperfusion leading to cognitive decline and dementia.
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DOI：
10.1155/2012/367516
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发表时间：
2012
期刊：
影响因子：
--
通讯作者：
de la Torre JC
中科院分区：
文献类型：
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作者：
de la Torre JC
心脏病是世界上死亡和残疾的主要原因。主要影响老年人群的心脏病及其主要结局心血管疾病，已成为认知功能减退和阿尔茨海默病（AD）发展的重要危险因素。本文探讨了证据连接慢性脑灌注不足引起的各种心血管缺陷的认知功能障碍的发展前AD。证据表明AD与心血管风险因素（包括ApoE4、房颤、血栓形成事件、高血压、低血压、心力衰竭、高血清炎症标志物、冠状动脉疾病、低心脏指数和瓣膜病变）之间存在强相关性。在脑灌注已经因高龄而减少的老年人中，由心脑血管回路异常引起的脑血流量的额外减少表面上增加了发展AD的可能性。证据还表明，由无情的脑灌注不足引起的神经元能量危机可能是蛋白质合成异常的原因，蛋白质合成异常随后导致经典的神经退行性病变，包括淀粉样蛋白β斑块和神经元缠结的形成。深入了解心血管危险因素如何诱导进行性认知功能障碍，可以加深对AD特征的多因素病理生理学的理解，以及预防或管理这种痴呆症的心血管前体的方法。
Heart disease is the major leading cause of death and disability in the world. Mainly affecting the elderly population, heart disease and its main outcome, cardiovascular disease, have become an important risk factor in the development of cognitive decline and Alzheimer's disease (AD). This paper examines the evidence linking chronic brain hypoperfusion induced by a variety of cardiovascular deficits in the development of cognitive impairment preceding AD. The evidence indicates a strong association between AD and cardiovascular risk factors, including ApoE4, atrial fibrillation, thrombotic events, hypertension, hypotension, heart failure, high serum markers of inflammation, coronary artery disease, low cardiac index, and valvular pathology. In elderly people whose cerebral perfusion is already diminished by their advanced age, additional reduction of cerebral blood flow stemming from abnormalities in the heart-brain vascular loop ostensibly increases the probability of developing AD. Evidence also suggests that a neuronal energy crisis brought on by relentless brain hypoperfusion may be responsible for protein synthesis abnormalities that later result in the classic neurodegenerative lesions involving the formation of amyloid-beta plaques and neurofibrillary tangles. Insight into how cardiovascular risk factors can induce progressive cognitive impairment offers an enhanced understanding of the multifactorial pathophysiology characterizing AD and ways at preventing or managing the cardiovascular precursors of this dementia.