Premium
S3‐01‐01: ALZHEIMER'S AND VASCULAR DISEASE: A PATHOBIOLOGICAL PERSPECTIVE
Author(s) -
Iadecola Costantino
Publication year - 2019
Publication title -
alzheimer's and dementia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 6.713
H-Index - 118
eISSN - 1552-5279
pISSN - 1552-5260
DOI - 10.1016/j.jalz.2019.06.4588
Subject(s) - neurodegeneration , dementia , vascular dementia , cerebral blood flow , medicine , neuroscience , neurovascular bundle , ischemia , cognitive decline , neuroinflammation , disease , pathology , psychology
Description: The brain is uniquely dependent on a well-regulated delivery of oxygen and glucose through the blood supply. If the delivery of cerebral blood flow is not adequate to match the dynamic energetic requirements imposed by neural activity, brain dysfunction and damage ensues. Although the mechanisms of the cognitive dysfunction caused by vascular factors (vascular cognitive impairment and dementia) or neurodegeneration (Alzheimer’s disease, AD) have traditionally been considered distinct, there is increasing evidence that alterations in cerebral blood flow play a role not only in vascular causes of cognitive impairment, but also in AD. Vascular risk factors, including ApoE4, and AD impair the structure and function of cerebral blood vessels and associated cells (neurovascular unit), effects mediated by vascular oxidative stress and inflammation. Injury to the neurovascular unit alters cerebral blood flow regulation, depletes vascular reserves, disrupts the blood-brain barrier and reduces the brain’s repair potential, effects that amplify the brain dysfunction and damage exerted by incident ischemia and coexisting neurodegeneration. Clinical-pathological studies support the notion that vascular lesions aggravate the deleterious effects of AD pathology by reducing the threshold for cognitive impairment and accelerating the pace of the dementia. In addition, to disturbances of cerebral perfusion and/or energy metabolism there is also evidence that hypothalamic dysfunction and leptin deficiency may play a role in the disease process by altering systemic metabolism. These observations, collectively, indicate that vascular and neurometabolic alterations are important factors in cognitive impairment, including AD. In the absence of mechanism-based approaches to counteract dementia, targeting vascular and metabolic risk factors and improving cerebrovascular function may offer the opportunity to mitigate the impact of one of the most disabling human afflictions.