The Role of Cardiovascular Disease in Cognitive Impairment
The Role of Cardiovascular Disease in Cognitive Impairment
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DOI：
10.1007/s13670-020-00309-7
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发表时间：
2020-03-01
影响因子：
1.2
通讯作者：
Gottesman, Rebecca F.
中科院分区：
文献类型：
--
作者：
Johansen, Michelle C.;Langton-Frost, Nicole;Gottesman, Rebecca F.
由于目前还没有针对阿尔茨海默病（AD）的疾病改善治疗方法，公共卫生的优先事项是预防认知能力下降和痴呆症。心血管疾病（CVD）的治疗和预防可能提供这样的机会。虽然动脉粥样硬化和动脉粥样硬化性脑血管病的病理学曾被认为与AD病理学不同，但越来越多的证据表明，血管和AD相关病理学的重叠比以前认识到的要多。在多项研究中，CVD及其危险因素与认知能力下降和痴呆症相关。鉴于CVD在老年人中普遍存在，了解血管疾病对痴呆的贡献是一个重要的研究领域。虽然确切的关系仍有待确定，但已经提出了将CVD与痴呆联系起来的几种机制：[1] CVD和痴呆具有共同的风险因素，这可能会改变脑毒素的清除或以其他方式增加神经变性; [2] CVD可能导致临床或亚临床中风，导致认知障碍;[3] CVD可能直接改变脑灌注。大多数先前的工作都集中在CVD的危险因素上，但终末器官CVD本身与痴呆症之间的关系在考虑预防方面是极其重要的。早期干预可能是最有益的，因为CVD风险似乎与痴呆发作前几年测量的认知关系最密切。执业医生应该将这些证据视为积极解决症状性CVD和CVD风险因素的动力，不仅在老年患者中，而且在中年患者中也很重要。
Purpose of the Review With no disease-modifying treatments for Alzheimer's disease (AD) currently established, a priority for public health is prevention of cognitive decline and dementia. Treatment and prevention of cardiovascular disease (CVD) may provide such an opportunity. Recent Findings While the pathology of athero- and arteriolosclerotic cerebrovascular disease was once thought of as distinct from AD pathobiology, accumulating evidence suggests that there is more overlap in vascular and AD-related pathologies than previously recognized. CVD and its risk factors are associated with cognitive decline and dementia, in multiple studies. Given that CVD is prevalent among older adults, understanding the contributions of vascular disease to dementia is an important area of research. While the exact relationship remains to be defined, several mechanisms linking CVD to dementia have been proposed: [1] CVD and dementia have shared risk factors, which might alter clearance of brain toxins or otherwise increase neurodegeneration; [2] CVD might lead to clinical or subclinical strokes, leading to cognitive impairment; and [3] CVD might directly alter cerebral perfusion. Most prior work has focused on risk factors for CVD, but the relationship between end-organ CVD itself and dementia is of extreme importance in considering prevention. Earlier intervention might be the most beneficial since CVD risk appears to have strongest relationships with cognition when measured years before the onset of dementia. The practicing physician should see such evidence as an impetus to aggressively address both symptomatic CVD and CVD risk factors, not only in their elderly patients but importantly in those of middle age.