Small Blood Vessels: Big Health Problems

Because of the aging of our population, the burden of dementia is projected to double worldwide in the next generation, making it one of the greatest challenges faced by healthcare systems globally. Cerebral small-vessel disease is a major contributor to age-related cognitive impairment. Recent epidemiological research provides evidence that hypertension, cerebral infarction, and diffuse white matter disease (leukoaraiosis) are associated with increased risk of cognitive impairment. Most people who die with a diagnosis of dementia have a mixture of Alzheimer and vascular disease. Studies from Europe have reported recent decreases in dementia risk as might be expected from the decreased stroke risk that occurred over a similar time period.Although these correlative studies are important, we have not yet established causality. Besides control of blood pressure, there are no targeted therapies that exist for small-vessel disease. The National Institute of Neurological Disorders and Stroke (NINDS)–funded Secondary Prevention of Small Subcortical Strokes study showed a strong trend toward a decrease in recurrent stroke with aggressive blood pressure …