Cerebral blood flow in normal aging adults: cardiovascular determinants, clinical implications, and aerobic fitness.
Cerebral blood flow in normal aging adults: cardiovascular determinants, clinical implications, and aerobic fitness.
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DOI：
10.1111/jnc.14234
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发表时间：
2018-03
影响因子：
4.7
通讯作者：
Zhang R
中科院分区：
文献类型：
--
作者：
Tarumi T;Zhang R
衰老是老年人死亡、残疾和非传染性慢性病的主要原因。越来越多的证据表明，心血管疾病和危险因素的存在会增加血管性认知障碍和阿尔茨海默病（AD）的发病率。与年龄相关的心血管功能下降可能损害脑血流（CBF）调节，导致神经元微环境稳态的破坏。脑是代谢最活跃的器官，细胞内能量储存有限，严重依赖脑血流维持神经元代谢。在AD患者中，有报道称，在直立应激期间，脑灌注不足、CBF脉搏增加和血压控制受损，表明大脑和心血管功能与年龄相关的严重衰退。目前，阿尔茨海默病缺乏有效的治疗方法；因此，迫切需要制定预防战略。有规律的有氧运动可以改善心血管功能，从而更好地调节脑血流，从而降低痴呆风险。在本文中，我们讨论了衰老对CBF心血管调节的影响，并为认知障碍的血管机制和有氧运动训练对CBF调节的潜在作用提供了新的见解。我们认为年龄相关的心血管功能障碍深刻地改变了脑血流量（CBF）。中央弹性动脉的硬化和壁增厚使收缩压和脉压升高，从而增加CBF的脉动性。平均动脉压（MAP）升高，由总外周阻力（TPR）增加和内皮功能障碍引起，可诱导脑血管重构，增加阻力（CVR）和阻抗。在外部刺激（如体位变化）时，心血管压力反射敏感性（BRS）的钝化可能导致BP和CBF的不稳定。
Senescence is a leading cause of mortality, disability, and non-communicable chronic diseases in older adults. Mounting evidence indicates that the presence of cardiovascular disease and risk factors elevates the incidence of both vascular cognitive impairment and Alzheimer’s disease (AD). Age-related declines in cardiovascular function may impair cerebral blood flow (CBF) regulation, leading to the disruption of neuronal micro-environmental homeostasis. The brain is the most metabolically active organ with limited intracellular energy storage and critically depends on CBF to sustain neuronal metabolism. In patients with AD, cerebral hypoperfusion, increased CBF pulsatility, and impaired blood pressure control during orthostatic stress have been reported, indicating exaggerated, age-related decline in both cerebro- and cardiovascular function. Currently, AD lacks effective treatments; therefore, development of preventive strategy is urgently needed. Regular aerobic exercise improves cardiovascular function, which in turn may lead to a better CBF regulation, thus reducing the dementia risk. In this review, we discuss the effects of aging on cardiovascular regulation of CBF and provide new insights into the vascular mechanisms of cognitive impairment and potential effects of aerobic exercise training on CBF regulation. We propose that age-related cardiovascular dysfunction profoundly alters cerebral blood flow (CBF). The stiffening and wall thickening of central elastic arteries elevate systolic (SBP) and pulse (PP) pressure which subsequently augment CBF pulsatility. The elevated mean arterial pressure (MAP), resulting from increased total peripheral resistance (TPR) and endothelial dysfunction, may induce cerebrovascular remodeling to increase the resistance (CVR) and impedance. The blunted cardiovagal baroreflex sensitivity (BRS) may lead to BP and CBF instability during extrinsic stimuli (e.g. postural change).
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影响因子：
37.8
作者：
BRANDFONBRENER, M;LANDOWNE, M;SHOCK, NW
通讯作者：
SHOCK, NW
影响因子：
3.3
作者：
Claassen, Jurgen A. H. R.;Zhang, Rong;Levine, Benjamin D.
通讯作者：
Levine, Benjamin D.
影响因子：
20.1
作者：
GUO, GB;THAMES, MD;ABBOUD, FM
通讯作者：
ABBOUD, FM
影响因子：
3.3
作者：
Claassen, Jurgen A. H. R.;Levine, Benjamin D.;Zhang, Rong
通讯作者：
Zhang, Rong
影响因子：
8.3
作者：
AASLID, R;LINDEGAARD, KF;NORNES, H
通讯作者：
NORNES, H