Cerebral small vessel disease: Capillary pathways to stroke and cognitive decline

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  • Leif Østergaard
    Center of Functionally Integrative Neuroscience and MINDLab, Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark
  • Thorbjørn S Engedal
    Center of Functionally Integrative Neuroscience and MINDLab, Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark
  • Fiona Moreton
    Institute of Neuroscience and Psychology, University of Glasgow, Glasgow, UK
  • Mikkel B Hansen
    Center of Functionally Integrative Neuroscience and MINDLab, Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark
  • Joanna M Wardlaw
    Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
  • Turgay Dalkara
    Institute of Neurological Sciences and Psychiatry and Department of Neurology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
  • Hugh S Markus
    Department of Clinical Neuroscience, University of Cambridge, Cambridge, UK
  • Keith W Muir
    Institute of Neuroscience and Psychology, University of Glasgow, Glasgow, UK

説明

<jats:p> Cerebral small vessel disease (SVD) gives rise to one in five strokes worldwide and constitutes a major source of cognitive decline in the elderly. SVD is known to occur in relation to hypertension, diabetes, smoking, radiation therapy and in a range of inherited and genetic disorders, autoimmune disorders, connective tissue disorders, and infections. Until recently, changes in capillary patency and blood viscosity have received little attention in the aetiopathogenesis of SVD and the high risk of subsequent stroke and cognitive decline. Capillary flow patterns were, however, recently shown to limit the extraction efficacy of oxygen in tissue and capillary dysfunction therefore proposed as a source of stroke-like symptoms and neurodegeneration, even in the absence of physical flow-limiting vascular pathology. In this review, we examine whether capillary flow disturbances may be a shared feature of conditions that represent risk factors for SVD. We then discuss aspects of capillary dysfunction that could be prevented or alleviated and therefore might be of general benefit to patients at risk of SVD, stroke or cognitive decline. </jats:p>

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