Cognitive impairment and cardiovascular disease: So near, so far

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• 作者：Eugenio Picano^a ; Rosa Maria Bruno^a ; ^{rosam.bruno@gmail.com" class="auth_mail} ; Gian Franco Ferrari^b ; Ubaldo Bonuccelli^c
• 关键词：AD ; Alzheimer's disease ; CABG ; coronary artery bypass surgery ; CNR ; Consiglio Nazionale delle Ricerche - National Research Council ; COPD ; Chronic Obstructive Pulmonary Disease ; C-PAP ; continuous positive airway pressure CVD ; Cardiovascular disease ; DCM ; Dilated cardiomyopathy ; EE ; Environmental enrichment ; MRI ; Magnetic resonance imaging ; NO ; nitric oxide ; OH ; orthostatic hypotension ; OSAS ; Obstructive sleep apnea syndrome ; SVD ; small vessel disease ; VCI ; vascular cognitive impairment
• 刊名：International Journal of Cardiology
• 出版年：15 July 2014
• 年：2014
• 卷：175
• 期：1
• 页码：21-29
• 全文大小：1164 K

文摘

In the spectrum of cognitive impairment, ranging from “pure” vascular dementia to Alzheimer's disease (AD), clinical interest has recently expanded from the brain to also include the vessels, shifting the pathophysiological focus from the leaves of synaptic dysfunction to the sap of cerebral microcirculation and the roots of cardiovascular function. From a diagnostic viewpoint, a thorough clinical evaluation of individuals presenting cognitive impairment might systematically include the assessment of the major cardiovascular rings of the chain linking regional perfusion to brain function: 1) lung (with assessment of asthma, chronic obstructive pulmonary disease, obstructive sleep apnea syndrome); 2) heart function (with clinical examination and echocardiography) and cardiovascular risk factors; 3) orthostatic hypotension (with medical history and measurement of heart rate and blood pressure in supine and upright positions); 4) aorta and large artery stiffness (with assessment of pulse wave velocity); 5) large cerebro-vascular vessel status (with neuroimaging techniques); 6) assessment of microcirculation (with cerebrovascular reactivity testing with transcranial Doppler sonography or MRI perfusion imaging); and 7) assessment of venous cerebral circulation. The apparent difference in approaches to “brain” and “vascular” environmental enrichment with physical, cognitive and sensorial training is conceptually identical to that of a constant gardener caring for an unhealthy tree, watering the leaves (“train the brain”) or simply the roots (“mind the vessel”). The therapeutic difference probably consists in the amount and quality of water added to the tree, rather than by where one pours it, with either a top-down (leaves to roots) or bottom-up (roots to leaves) approach.