Objective: Alzheimer's disease and vascular dementia are responsible for more than 80% of dementia cases. These two conditions share common risk factors including hypertension. Cerebral small vessel disease (CSVD) is strongly associated with both hypertension and cognitive impairment. In this review, we identify the pathophysiological changes in CSVD that are caused by hypertension and further explore the relationship between CSVD and cognitive impairment.
Data sources: We searched and scanned the PubMed database for recently published literatures up to December 2017. We used the keywords of "hypertension", "cerebral small vessel disease", "white matter lesions", "enlarged perivascular spaces", "lacunar infarcts", "cerebral microbleeds", and "cognitive impairment" in the database of PubMed.
Study selection: Articles were obtained and reviewed to analyze the hypertension-induced pathophysiological changes that occur in CSVD and the correlation between CSVD and cognitive impairment.
Results: In recent years, studies have demonstrated that hypertension-related changes (e.g., small vascular lesions, inflammatory reactions, hypoperfusion, oxidative stress, damage to autoregulatory processes and the blood-brain barrier, and cerebral amyloid angiopathy) can occur over time in cerebral small vessels, potentially leading to lower cognitive function when blood pressure (BP) control is poor or lacking. Both isolated and co-occurrent CSVD can lead to cognitive deterioration, and this effect may be attributable to a dysfunction in either the cholinergic system or the functionality of cortical and subcortical tracts.
Conclusions: We explore the currently available evidence about the hypertensive vasculopathy and inflammatory changes that occur in CSVD. Both are vital prognostic indicators of the development of cognitive impairment. Future studies should be performed to validate the relationship between BP levels and CSVD progression and between the numbers, volumes, and anatomical locations of CSVD and cognitive impairment.
高血压相关性脑小血管病引起认知障碍摘要目的：80%痴呆为阿尔茨海默病和/或血管性痴呆，两者的共同危险因素包括高血压。脑小血管病（cerebral small vessel disease，CSVD）与高血压和认知功能障碍均密切相关。本文对高血压引起CSVD的病理机制及CSVD与认知功能障碍的额关系进行综述，以期更好的了解CSVD与高血压、认知障碍的关系。 方法：通过使用高血压、脑小血管病、白质病变、扩大的血管周围间隙、腔隙性脑梗塞、脑微出血和认知障碍等关键词检索PubMed数据库最新文献。对相关文章进行回顾分析，整理并分析高血压引起CSVD的病理生理变化及CSVD与认知障碍的关系。 结果：近年研究表明，高血压相关性病理改变：小血管病变、炎症反应、氧化应激、低灌注，自身调节障碍，血脑屏障破坏及脑淀粉样血管病等可致CSVD，进而引起认知功能障碍。血压控制欠佳时，单一或多种CSVD可致认知功能下降，这种作用可能是由于胆碱能系统功能障碍或皮质与皮质下传导束功能紊乱所致。 结论：高血压相关性血管病变和炎症反应可引起CSVD。两者均是认知功能障碍发展的重要预后指标。不同解剖部位CSVD，CSVD数量等对认知功能领域的影响尚存在争议。血压水平与EPVS的发生发展，CSVD数量、体积及解剖位置的变化与认知功能障碍的关系需进一步探索。.
Keywords: Cerebral Microbleeds; Cerebral Small Vessel Disease; Cognitive Impairment; Hypertension.