Vascular Dementia: Potential of Antiplatelet Agents in Prevention

Chabriat, Hugues; Bousser, Marie Germaine

doi:10.1159/000091981

Cited by 17 publications

(9 citation statements)

References 125 publications

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“…To reduce infarcts that trigger/exacerbate VCID, current ICAD treatment includes cholesterol management, antiplatelet therapy (i.e., aspirin or P2Y 12 inhibitors), and interventional methods (Chabriat and Bousser, 2006;Flusty et al, 2020).…”

Section: Potential Future Therapies Targeting Cholesterol In Cerebral Arteries: Statins and Atherosclerosis Therapymentioning

confidence: 99%

Cholesterol, Atherosclerosis, and APOE in Vascular Contributions to Cognitive Impairment and Dementia (VCID): Potential Mechanisms and Therapy

Duong

Nasrallah

Wolk

et al. 2021

Front. Aging Neurosci.

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Vascular contributions to cognitive impairment and dementia (VCID) are a common cause of cognitive decline, yet limited therapies exist. This cerebrovascular disease results in neurodegeneration via acute, chronic, local, and systemic mechanisms. The etiology of VCID is complex, with a significant impact from atherosclerosis. Risk factors including hypercholesterolemia and hypertension promote intracranial atherosclerotic disease and carotid artery stenosis (CAS), which disrupt cerebral blood flow and trigger ischemic strokes and VCID. Apolipoprotein E (APOE) is a cholesterol and phospholipid carrier present in plasma and various tissues. APOE is implicated in dyslipidemia and Alzheimer disease (AD); however, its connection with VCID is less understood. Few experimental models for VCID exist, so much of the present information has been drawn from clinical studies. Here, we review the literature with a focus on the clinical aspects of atherosclerotic cerebrovascular disease and build a working model for the pathogenesis of VCID. We describe potential intermediate steps in this model, linking cholesterol, atherosclerosis, and APOE with VCID. APOE4 is a minor isoform of APOE that promotes lipid dyshomeostasis in astrocytes and microglia, leading to chronic neuroinflammation. APOE4 disturbs lipid homeostasis in macrophages and smooth muscle cells, thus exacerbating systemic inflammation and promoting atherosclerotic plaque formation. Additionally, APOE4 may contribute to stromal activation of endothelial cells and pericytes that disturb the blood-brain barrier (BBB). These and other risk factors together lead to chronic inflammation, atherosclerosis, VCID, and neurodegeneration. Finally, we discuss potential cholesterol metabolism based approaches for future VCID treatment.

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Section: Potential Future Therapies Targeting Cholesterol In Cerebral Arteries: Statins and Atherosclerosis Therapymentioning

confidence: 99%

Cholesterol, Atherosclerosis, and APOE in Vascular Contributions to Cognitive Impairment and Dementia (VCID): Potential Mechanisms and Therapy

Duong

Nasrallah

Wolk

et al. 2021

Front. Aging Neurosci.

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“…Some of these drug categories are vasodilators, calcium channel blockers, antiplatelet, etc. ( Romàn, 2000 ; Chabriat and Bousser, 2006 ; Nimmrich and Eckert, 2013 ; Table 5 ). One of the most effective and standard treatment are cholinesterase inhibitors ( Bullock, 2004 ).…”

Section: Accessible Treatments For Vadmentioning

confidence: 99%

Vascular Dementia and Underlying Sex Differences

Akhter

Persaud

Zaokari

et al. 2021

Front. Aging Neurosci.

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Vascular dementia (VaD) is the second most common form of dementia after Alzheimer’s disease (AD); where Alzheimer’s accounts for 60–70% of cases of dementia and VaD accounts for 20% of all dementia cases. VaD is defined as a reduced or lack of blood flow to the brain that causes dementia. VaD is also known occasionally as vascular contributions to cognitive impairment and dementia (VCID) or multi-infarct dementia (MID). VCID is the condition arising from stroke and other vascular brain injuries that cause significant changes to memory, thinking, and behavior, and VaD is the most severe stage while MID is produced by the synergistic effects caused by multiple mini strokes in the brain irrespective of specific location or volume. There are also subtle differences in the presentation of VaD in males and females, but they are often overlooked. Since 1672 when the first case of VaD was reported until now, sex and gender differences have had little to no research done when it comes to the umbrella term of dementia in general. This review summarizes the fundamentals of VaD followed by a focus on the differences between sex and gender when an individual is diagnosed. In addition, we provide critical evidence concerning sex and gender differences with a few of the main risk factors of VaD including pre-existing health conditions and family history, gene variants, aging, hormone fluctuations, and environmental risk factors. Additionally, the pharmaceutical treatments and possible mitigation of risk factors is explored.

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“…Specifically, one study has shown that cilostazol seemed to be safer than aspirin in terms of the risk of hemorrhagic stroke in hypertensive patients with SVD [88]. However, the use of antiplatelet begets the problem of degree of benefit/risk ratio in patients with vascular dementia according to the risk of hemorrhage, which is increased by the presence of silent microhemorrhages on MRI frequently detected in the presence of ischemic white matter lesions and by gait disturbances and falls [89]. Despite so, due to the relatively low efficacy of available drugs to improve cognition in patients with SVD, which may lead to the development of dementia, antiplatelet drugs could be one of the key treatments to managing patients with SVD in PD and in minimizing the risk of dementia in these patients.…”

Section: Managementmentioning

confidence: 99%

The Role of Cerebrovascular Disease in Parkinson’s Disease Related Cognitive Impairment

2016

J Parkinsons Dis Alzheimers Dis

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Vascular Dementia: Potential of Antiplatelet Agents in Prevention

Cited by 17 publications

References 125 publications

Cholesterol, Atherosclerosis, and APOE in Vascular Contributions to Cognitive Impairment and Dementia (VCID): Potential Mechanisms and Therapy

Cholesterol, Atherosclerosis, and APOE in Vascular Contributions to Cognitive Impairment and Dementia (VCID): Potential Mechanisms and Therapy

Vascular Dementia and Underlying Sex Differences

The Role of Cerebrovascular Disease in Parkinson’s Disease Related Cognitive Impairment

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