Vascular risk factors and neurodegeneration in ageing related dementias: Alzheimer's disease and vascular dementia.
Vascular risk factors and neurodegeneration in ageing related dementias: Alzheimer's disease and vascular dementia.
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DOI：
10.2174/15672050113109990037
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发表时间：
2013-06
影响因子：
2.1
通讯作者：
R. Akinyemi;E. Mukaetova-Ladinska;J. Attems;M. Ihara;R. Kalaria
中科院分区：
文献类型：
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作者：
R. Akinyemi;E. Mukaetova-Ladinska;J. Attems;M. Ihara;R. Kalaria
年龄是脑退化的最大危险因素，无论它是由血管或神经退行性机制引起的，还是两者兼而有之。为了评估目前关于血管疾病对痴呆最常见原因影响的观点，从Pubmed、Cochrane数据库和生物学文摘等常用数据库中回顾了2011年11月之前选定主题标题的大多数相关文章。在过去的十年里，人们对神经变性和痴呆的血管基础的兴趣增加了四倍。血管老化包括动脉僵硬、内皮改变和血脑屏障功能障碍，通过损害几种细胞内保护机制导致慢性灌注不足来影响神经元的存活。与阿尔茨海默病和血管性痴呆相关的高血压、糖尿病、血脂异常和肥胖等可改变的风险因素会促进血管系统的退化并降低其再生能力。这些与异常蛋白（如β淀粉样蛋白）的积累相结合，可能在不同程度上破坏大脑的自调节、神经血管耦合和深层结构的灌注，从而产生白质变化和选择性脑萎缩。脑病理改变可能进一步受到载脂蛋白E ε4等位基因等遗传因素的修饰。维持或改善血管健康的生活方式措施，包括健康饮食、适度饮酒和经常进行体育锻炼，似乎对降低痴呆风险有效。改善血管功能的干预措施对于即使在衰老期间维持认知状态也很重要，而减少血管疾病风险的预防措施预计将减轻长期痴呆症的负担。
Age is the strongest risk factor for brain degeneration whether it results from vascular or neurodegenerative mechanisms or both. To evaluate the current views on the impact of vascular disease on the most common causes of dementia, most relevant articles to the selected subject headings were reviewed until November 2011 from the popularly used databases including Pubmed, Cochrane Database and Biological Abstracts. Within the past decade, there has been four-fold increased interest in the vascular basis of neurodegeneration and dementia. Vascular ageing involving arterial stiffness, endothelial changes and blood-brain barrier dysfunction affects neuronal survival by impairing several intracellular protective mechanisms leading to chronic hypoperfusion. Modifiable risk factors such as hypertension, diabetes, dyslipidaemia and adiposity linked to Alzheimer's disease and vascular dementia promote the degeneration and reduce the regenerative capacity of the vascular system. These in tandem with accumulation of abnormal proteins such as amyloid β likely disrupt cerebral autoregulation, neurovascular coupling and perfusion of the deeper structures to variable degrees to produce white matter changes and selective brain atrophy. Brain pathological changes may be further modified by genetic factors such as the apoliopoprotein E ε4 allele. Lifestyle measures that maintain or improve vascular health including consumption of healthy diets, moderate use of alcohol and implementing regular physical exercise in general appear effective for reducing dementia risk. Interventions that improve vascular function are important to sustain cognitive status even during ageing whereas preventative measures that reduce risk of vascular disease are predicted to lessen the burden of dementia in the long-term.