Choroba małych naczyń – Epidemiologia

Choroba małych naczyń
Epidemiologia

Choroba małych naczyń mózgowych (CSVD) to zespół patologii obejmujących małe tętnice, tętniczki, żyłki i naczynia włosowate mózgu, stanowiący istotną przyczynę udarów niedokrwiennych (około 25%) oraz demencji (45% przypadków, w tym demencji naczyniowej). Występuje powszechnie, szczególnie u osób starszych, z częstością hiperintensywności istoty białej (WMH) sięgającą 92% w populacjach europejskich osób starszych, a mikrokrwawienia mózgowe (CMB) wzrastają z 6,5% u osób w wieku 45-50 lat do 36% u osób 80-89 lat. Diagnostyka opiera się głównie na neuroobrazowaniu MRI, które pozwala wykryć charakterystyczne markery CSVD, takie jak WMH, lakuny, mikrokrwawienia, poszerzone przestrzenie okołonaczyniowe i mikroinfarty. Czynniki ryzyka to przede wszystkim nadciśnienie tętnicze (>140/90 mm Hg), wiek, palenie tytoniu, cukrzyca, obturacyjny bezdech senny oraz przewlekła choroba nerek, przy czym nadciśnienie jest kluczowym modyfikowalnym czynnikiem wpływającym na progresję CSVD i zaburzenia funkcji poznawczych (VCI).

Wprowadzenie do choroby małych naczyń

Choroba małych naczyń (ang. Small Vessel Disease, SVD) stanowi grupę zaburzeń dotyczących małych tętnic, tętniczek, żyłek i naczyń włosowatych mózgu. Jest to powszechna choroba neurologiczna o ogromnym wpływie społecznym i ekonomicznym. Choroba małych naczyń mózgowych (ang. Cerebral Small Vessel Disease, CSVD) odpowiada za około 25% wszystkich udarów niedokrwiennych, przy czym przyczynia się do 45% przypadków demencji. Jest również najczęstszą przyczyną demencji naczyniowej i przyczynia się do około połowy wszystkich przypadków demencji na świecie¹²³.

CSVD to szeroki termin obejmujący procesy chorobowe wpływające na małe naczynia mózgu. Spektrum CSVD obejmuje hiperintensywności istoty białej (WMH) o przypuszczalnym pochodzeniu naczyniowym, świeże małe zawały podkorowe, lakuny, mikrokrwawienia, powierzchowną syderozę, poszerzone przestrzenie okołonaczyniowe, mikroinfarty i atrofię mózgu⁴. Diagnoza CSVD opiera się głównie na wykryciu charakterystycznych markerów neuroobrazowych, które można zaobserwować podczas badań obrazowych⁵.

Epidemiologia choroby małych naczyń

Choroba małych naczyń mózgu jest niezwykle powszechna, a jej występowanie wzrasta wraz z wiekiem, nie wykazując istotnych różnic związanych z płcią oraz niewykazując obecnie znanych różnic między grupami rasowo-etnicznymi czy położeniem geograficznym⁶. Badania oparte na populacji wykazały, że CSVD występuje znacznie częściej niż wcześniej sądzono i można ją lepiej wykrywać dzięki postępom w neuroobrazowaniu⁷.

Częstotliwość występowania w różnych populacjach

Choroba małych naczyń mózgowych występuje od 6 do 10 razy częściej niż udar mózgu⁸. W chińskiej kohorcie z dorosłymi w wieku 50-75 lat badania wykazały częstość występowania CSVD na poziomie 30,5%⁹. W populacjach o pochodzeniu europejskim, ogólna częstość występowania niemych zawałów mózgu (SBI) wynosi od 11 do 28%, podczas gdy w populacjach azjatyckich wynosi 10-16%¹⁰.

Lakuny mają wyższą częstość występowania wśród osób azjatyckich (15-25%) niż europejskich (7%)¹¹. Natomiast hiperintensywności istoty białej miały najwyższą częstość występowania wśród wszystkich markerów CSVD, osiągając 92% w próbkach europejskich osób starszych¹². Ogólna częstość występowania poszerzonych przestrzeni okołonaczyniowych (PVS) w populacjach azjatyckich wydaje się wyższa, wcześniej raportowana między 17-72%¹³.

W zdrowych populacjach częstość występowania lakun waha się od 8% do 31% (ze względu na różnice w wieku badanych populacji i zmienność w rozdzielczości przestrzennej badań obrazowych)¹⁴¹⁵.

Związek z wiekiem

Częstość występowania CSVD znacznie wzrasta wraz z wiekiem. Hiperintensywności istoty białej występują u około 5% osób w wieku 50 lat, a u prawie 100% osób w wieku 90 lat¹⁶¹⁷. Podobnie częstość występowania mikrokrwawień mózgowych (CMB) wzrasta z 6,5% u osób w wieku 45-50 lat do około 36% u osób w wieku 80-89 lat¹⁸.

Przewlekła choroba małych naczyń jest częstsza wraz z wiekiem. Częstość występowania zmian w istocie białej w populacji ogólnej wynosi od 39 do 96%¹⁹. Bezobjawowa choroba małych naczyń jest powszechna u osób starszych, przy czym do 90% osób powyżej 65 roku życia ma hiperintensywności istoty białej (WMH)²⁰.

Różnice geograficzne i etniczne

Epidemiologia CSVD może różnić się w populacjach azjatyckich w porównaniu z populacjami zachodnimi (skąd pochodzi większość wyników i wytycznych dotyczących CSVD i udaru mózgu), ale potrzebne są bardziej kompleksowe dane z badań społecznych i wyraźna stratyfikacja typów udaru, aby to ocenić²¹.

Częstość występowania udaru lakunarnego może być wyższa u pacjentów w Chinach, gdzie niedawne badania sugerują, że zawał lakunarny stanowi 38-46% udaru niedokrwiennego²². Przegląd systematyczny sugeruje, że nieme zawały mózgu są bardziej rozpowszechnione w populacji azjatyckiej niż w nieazjatyckiej²³.

Warto jednak zauważyć, że większość tych badań azjatyckich była prowadzona w szpitalach, podczas gdy wszystkie badania nieazjatyckie były prowadzone w społecznościach; dlatego potrzebne są bardziej odpowiednie porównania, aby ustalić, czy częstość występowania lakun i innych cech CSVD rzeczywiście różni się między regionami świata i grupami etnicznymi²⁴.

Związek z innymi chorobami

CSVD odpowiada za około 20% wszystkich udarów, w tym 25% udarów niedokrwiennych i 45% demencji naczyniowych²⁵. W Stanach Zjednoczonych i Europie choroba małych naczyń mózgowych odpowiada za 15-26% udarów niedokrwiennych, podczas gdy odsetek ten w Azji waha się od 25% do 54%²⁶.

Obecność choroby małych naczyń zwiększa ryzyko śmiertelności czterokrotnie w porównaniu ze zdrowymi kohortami²⁷. Nieme zawały mózgu są najczęściej identyfikowanymi przypadkowymi znaleziskami w skanach mózgu, szczególnie u starszych osób²⁸. Oceniono, że na każdy objawowy udar mózgu przypada około 10 niemych zmian w mózgu²⁹.

Przewlekła choroba małych naczyń jest często bezobjawowym przypadkowym znaleziskiem w badaniach obrazowych. Jednak wykazano, że powoduje demencję naczyniową i jest częstsza u pacjentów z demencją (demencja naczyniowa, choroba Alzheimera, demencja z ciałami Lewy’ego) w porównaniu z populacją ogólną (odpowiednio 100% i 92% w jednym badaniu)³⁰.

Obecność CMB prawie podwoiła ryzyko udaru niedokrwiennego w okresie 5 lat, przy czym większa liczba CMB wiązała się z wyższym ryzykiem udaru³¹.

Czynniki ryzyka choroby małych naczyń

Kilka populacyjnych badań zbadało czynniki ryzyka związane z rozwojem CSVD³²³³³⁴. Badania te identyfikują szereg czynników ryzyka, które mogą przyczyniać się do rozwoju i progresji CSVD.

Modyfikowalne czynniki ryzyka

Najważniejszym modyfikowalnym czynnikiem ryzyka jest nadciśnienie tętnicze, definiowane jako ciśnienie krwi wyższe niż 140/90 mm Hg³⁵. Inne czynniki ryzyka obejmują aktualne i byłe palenie tytoniu, cukrzycę, obturacyjny bezdech senny, przewlekłą chorobę nerek i chorobę gałązki aterosomatyczną z towarzyszącym udarem podkorowym³⁶.

Chociaż powiązane czynniki ryzyka różniły się między badaniami, nadciśnienie, wiek i (w mniejszym stopniu) palenie tytoniu wydają się być najczęściej powtarzającymi się³⁷. Częstość występowania CSVD wzrasta wraz z wiekiem i jest związana z tradycyjnymi naczyniowymi czynnikami ryzyka, takimi jak nadciśnienie, cukrzyca, hiperlipidemia, palenie tytoniu, wiek i czynniki genetyczne³⁸.

Badania sugerują, że nawet podwyższone ciśnienie krwi, które jest niższe niż kliniczne progi nadciśnienia, może być czynnikiem ryzyka rozwoju CSVD³⁹. Wysoki poziom BP reprezentuje główny modyfikowalny czynnik ryzyka związany z progresją SVD i zaburzeniami funkcji poznawczych (VCI)⁴⁰.

Przewlekła choroba nerek (CKD) jest związana z markerami CSVD (mikrokrwawienia mózgowe i zaniki korowe) w ogólnej starszej populacji z nadciśnieniem. W ogólnej starszej populacji bez nadciśnienia nie zaobserwowano związku między CKD a żadnymi markerami CSVD. Te wyniki mogą wskazywać, że nadciśnienie jest łącznikiem między CKD a CSVD⁴¹.

Czynniki genetyczne

Zaburzenia pojedynczego genu rzadko są przyczyną CSVD. Mózgowa autosomalnie dominująca arteriopatia z zawałami podkorowymi i leukoencefalopatią (CADASIL), być może najczęstsza dziedziczna przyczyna CSVD, ma częstość występowania w populacji wśród dorosłych w wieku produkcyjnym około 24 na 100 000⁴².

Chociaż większość przypadków CSVD była sporadyczna, kilka doniesień o dziedzicznych formach CSVD wskazało na zaburzenia pojedynczego genu⁴³. Cechy kliniczne autosomalnie dominującej SVD mogą wykazywać kilka podobieństw ze sporadyczną SVD, takich jak arteriopatia, dysfunkcje istoty białej i zawały w regionach podkorowych⁴⁴.

Genetyczne badania sporadycznej choroby małych naczyń mózgowych wykazały wysoki stopień dziedziczności, szczególnie wśród pacjentów z udarem o wczesnym początku⁴⁵. Szacowana dziedziczność dla mózgowych zmian w istocie białej jako zastępczego markera choroby małych naczyń mózgowych wahała się między 50% a 80%⁴⁶.

Związek z wczesnymi czynnikami życiowymi

Istnieją dowody sugerujące, że czynniki z wczesnego okresu życia mogą mieć wpływ na rozwój i wpływ CSVD. Te same czynniki z wczesnego okresu życia również przewidywały niższą częstość występowania schorzeń związanych z CSVD w niektórych badaniach, w tym chorób układu krążenia, udaru mózgu i demencji⁴⁷.

W dużej próbce ogólnie zdrowych, mieszkających w społeczności starszych osób, rekrutowanych z kohorty urodzonej w jednym roku, całkowite obciążenie mózgu przez CSVD w wieku 73 lat było związane z niższym IQ w wieku 11 lat i wykazywało zgodne z teorią tendencje do związku z indeksem deprywacji w wieku 11 lat, własną klasą zawodową i najwyższym poziomem wykształcenia⁴⁸.

Relacje między czynnikami z wczesnego okresu życia były silniej związane z całkowitym obciążeniem mózgu przez SVD niż jakimkolwiek jednym neuroradiologicznym składnikiem WMH, mikrokrwawień mózgowych, lakun lub poszerzonych przestrzeni okołonaczyniowych⁴⁹. Wyniki sugerują, że inteligencja w dzieciństwie może być czynnikiem ryzyka CSVD w późniejszym życiu⁵⁰.

Nadzór i monitorowanie choroby małych naczyń

Monitorowanie i nadzór nad chorobą małych naczyń mają kluczowe znaczenie dla zarządzania jej skutkami oraz dla rozwoju strategii prewencyjnych. Obecnie dostępne są różne podejścia do monitorowania i wykrywania CSVD.

Metody obrazowania

Neuroobrazowanie odgrywa kluczową rolę w zarządzaniu pacjentami z zaburzeniami funkcji poznawczych⁵¹. Neuroobrazowanie jest również istotne dla wykrywania sporadycznej SVD⁵². MRI pozostaje kluczową modalność neuroobrazowania w demencji naczyniowej (VaD)⁵³.

Unikalny potencjał PET w lokalizowaniu i ilościowym określaniu zmian metabolicznych w strukturach istoty szarej odpowiedzialnych za zaburzenia funkcjonalne/poznawcze i spowodowane przez SVD dotyczące głównie istoty białej sprawia, że technika ta jest preferowanym narzędziem do badania pacjentów z VCI⁵⁴.

Obrazowanie morfologiczne wskazuje zakres i nasilenie SVD, ale zaobserwowane zmiany nie są bezpośrednio związane z zaburzeniami funkcjonalnymi lub poznawczymi i rokowaniem⁵⁵.

Badania populacyjne

Kilka badań populacyjnych scharakteryzowało SVD w zdrowej populacji i zbadało czynniki ryzyka SVD⁵⁶⁵⁷. W populacyjnych badaniach prawdopodobnie zdrowych osób starszych, markery neuroobrazowe CSVD, w tym hiperintensywności istoty białej, lakuny, mikrokrwawienia mózgowe, poszerzone przestrzenie okołonaczyniowe, korowa powierzchowna syderoza i mikrozawały mózgowe są często wykrywane⁵⁸⁵⁹.

Chociaż prawdziwe obciążenie CSVD nie jest znane, szacunki sugerują, że co najmniej jedna trzecia zdrowych populacji ma lakuny (z których większość jest spowodowana przez CSVD), chociaż rzeczywista częstość występowania CSVD jest prawdopodobnie znacznie wyższa⁶⁰.

Biomarkery

W przekrojowych badaniach populacyjnych, liczne biomarkery, takie jak fibrynogen, białko C-reaktywne (CRP), interleukina-6, łańcuch lekki neurofilamentu, homocysteina i D-dimer, były związane z obecnością markerów CSVD, takich jak WMH, lakuny i PVS⁶¹.

Stosowanie tych biomarkerów może pomóc w identyfikacji osób z wysokim ryzykiem rozwoju CSVD lub przyspieszonym postępem choroby.

Wyzwania w badaniach przesiewowych

Główne powody, dla których MRI nie są wykonywane w zdrowych populacjach, to koszty i brak środków interwencyjnych, jeśli zostanie zidentyfikowana bezobjawowa CSVD⁶². Aktualnie nie zaleca się badań przesiewowych w kierunku bezobjawowej CSVD u osób bez objawów⁶³.

Nadal nie jest jasne, jak najlepiej identyfikować pacjentów z bezobjawową CSVD⁶⁴. Jednak bardziej efektywne kosztowo metody badań przesiewowych w kierunku CSVD mogą być w stanie wybrać pacjentów z grupy ryzyka, zwłaszcza tych z populacji wysokiego ryzyka, takich jak kobiety lub Afroamerykanie⁶⁵.

Niedawno proponowano ustanowienie specjalistycznych klinik prewencyjnych dla lepszego wykrywania i zarządzania niemą chorobą małych naczyń mózgowych (ccSVD), sugerując, że pacjenci z nadciśnieniem tętniczym i subtelnymi objawami powinni być priorytetowo poddawani badaniom przesiewowym⁶⁶.

Implikacje dla zdrowia publicznego

Choroba małych naczyń stanowi poważne obciążenie dla zdrowia publicznego ze względu na jej rozpowszechnienie i związek z poważnymi stanami neurologicznymi. Zrozumienie implikacji CSVD dla zdrowia publicznego ma kluczowe znaczenie dla rozwoju skutecznych strategii profilaktyki i leczenia.

Obciążenie chorobowością i śmiertelnością

CSVD powoduje 25% udarów i przyczynia się do 45% przypadków demencji⁶⁷. CSVD odpowiada za około 20% wszystkich udarów, w tym 25% udarów niedokrwiennych i 45% demencji naczyniowych⁶⁸.

Jako wiodąca przyczyna udaru mózgu, pogorszenia funkcji poznawczych i demencji, choroba małych naczyń mózgowych (SVD) stanowi główne źródło chorobowości i śmiertelności w starzejących się populacjach⁶⁹. Obecność markerów CSVD zwiększa ryzyko śmiertelności czterokrotnie w porównaniu ze zdrowymi kohortami⁷⁰.

Strategie prewencji i interwencji

Obecnie zarządzanie VCI koncentruje się na zapobieganiu i kontrolowaniu naczyniowych czynników ryzyka, takich jak nadciśnienie, otyłość, palenie tytoniu i cukrzyca⁷¹.

Europejska Organizacja Udarowa zaleca skupienie się na kontrolowaniu naczyniowych czynników ryzyka, zamiast używania leków przeciwzakrzepowych, które mogą zwiększać ryzyko krwotoczne⁷².

Wyniki z badań klinicznych potwierdzają, że interwencje mogą obniżyć ryzyko progresji VCI⁷³. Strategie zapobiegania udarom niedokrwiennym i krwotocznym mają potencjał do znacznego zmniejszenia obciążenia zaburzeniami funkcji poznawczych w populacji⁷⁴.

Nasze wyniki sugerują, że WMH powinny być uważane za główny cel interwencji prewencyjnych, aby złagodzić nie tylko ryzyko udaru i naczyniowego zaburzenia funkcji poznawczych, ale także demencji typu Alzheimera, i wspierają racjonalność innowacyjnych badań wykorzystujących progresję WMH jako zastępczy lub pośredni punkt końcowy dla pogorszenia funkcji poznawczych i demencji⁷⁵.

Implikacje dla systemów opieki zdrowotnej

Rozpowszechnienie CSVD, szczególnie wśród starzejących się populacji, stawia znaczne wyzwania dla systemów opieki zdrowotnej. Wczesna identyfikacja i interwencja mogą pomóc w zmniejszeniu obciążenia systemów opieki zdrowotnej i poprawie jakości życia pacjentów.

Proponuje się utworzenie specjalistycznych klinik prewencyjnych dla lepszego wykrywania i zarządzania niemą chorobą małych naczyń mózgowych (ccSVD), sugerując, że pacjenci z nadciśnieniem tętniczym i subtelnymi objawami powinni być priorytetowo poddawani badaniom przesiewowym⁷⁶.

Przyszłe kierunki badań

Pomimo znacznego postępu w zrozumieniu CSVD, nadal istnieje wiele luk w wiedzy, które wymagają dalszych badań. Te obszary badań mogą pomóc w rozwinięciu bardziej skutecznych strategii prewencji, diagnostyki i leczenia CSVD.

Rozwój zwierzęcych modeli CSVD

Niepewna patogeneza CSVD utrudnia tworzenie modeli zwierzęcych, które mogłyby prowadzić do skutecznych terapii. Niepewność być może wynika ze złożoności jednostki neuronaczyniowej (NVU) i z mnóstwa patogennych szlaków i chorób, które istnieją pod parasolem CSVD. Zrozumienie sekwencji patogenezy dla każdego typu CSVD jest kluczem do prewencji i leczenia⁷⁷.

Badania genetyczne

Badanie genomiki SVD zapewnia również potężne podejście do odkrywania podstawowych mechanizmów molekularnych i celów w celu przyspieszenia rozwoju przyszłych terapii lub identyfikacji możliwości repozycjonowania leków⁷⁸.

Biologia CSVD jest nadal słabo zrozumiana, a obecnie nie są dostępne żadne leczenia oparte na mechanizmach⁷⁹. Dalsze badania są uzasadnione, aby zbadać genetyczne zróżnicowanie między różnymi grupami etnicznymi i jego ryzyko dla CSVD⁸⁰.

Badania nad wczesnymi markerami CSVD

Identyfikacja tych wczesnych predyktorów mogłaby mieć główne implikacje dla naszego zrozumienia mechanizmów choroby przez całe życie i dla opracowania skutecznych strategii prewencji⁸¹.

Badamy związek lokalizacji ryzyka WMH z wczesnymi zmianami w mikrostrukturze istoty białej na MRI używając obrazowania tensora dyfuzji (DTI) u młodych dorosłych w wieku wczesnych dwudziestu lat⁸². Nasze wyniki dostarczają ważnego wglądu w wpływ genetycznego ryzyka dla SVD przez całe życie⁸³.

Rozwój nowatorskich terapii

Dokładna patogeneza SVD jest niekompletnie zrozumiana, ale najczęstsze nieprawidłowości to rozlana arterioloskleroza, lipohialoza i martwica włóknikowa małych tętniczek⁸⁴⁸⁵. Chociaż nadciśnienie jest kluczowym czynnikiem ryzyka, wielu pacjentów z SVD nie ma nadciśnienia⁸⁶⁸⁷.

Ostatnie badania sugerują bardziej złożone mechanizmy niż arterioloskleroza, które mogą powodować dysfunkcję ściany naczyń włosowatych⁸⁸⁸⁹. Uznanie dysfunkcji śródbłonka i jednostki neuroglionaczyniowej jako głównych podstawowych mechanizmów SVD jest fundamentalne dla rozwijania roli zaawansowanych technik neuroobrazowania⁹⁰⁹¹.

To badanie rzuca bezprecedensowe światło na biologiczne mechanizmy leżące u podstaw choroby małych naczyń mózgowych, sugerując, że mogą być one związane z znacznie wcześniejszymi zjawiskami niż wcześniej podejrzewano. Może to mieć ważne implikacje dla strategii zapobiegania chorobom małych naczyń mózgowych, udarom i związanym z nimi demencji⁹².

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Materiały źródłowe

#1 Small Vessel Disease, a Marker of Brain Health: What the Radiologist Needs to Know | American Journal of Neuroradiology
http://www.ajnr.org/content/early/2021/10/07/ajnr.A7302
SUMMARY: Small vessel disease, a disorder of cerebral microvessels, is an expanding epidemic and a common cause of stroke and dementia. […] In fact, SVD is an enormous health burden, causing about 25% of ischemic strokes and most hemorrhagic strokes, is the most common cause of vascular dementia, and contributes to about half of dementias worldwide. […] Although there is significant variation in the epidemiology of SVD markers, the prevalence of these markers is associated with greater age. […] Several population-based studies have characterized SVD in the healthy population and explored the risk factors for SVD. […] The exact pathogenesis of SVD is incompletely understood, but the most common abnormalities are diffuse arteriolosclerosis, lipohyalinosis, and fibrinoid necrosis of small arterioles.
#2 CNS small vessel disease
https://pmc.ncbi.nlm.nih.gov/articles/PMC6598791/
CNS small vessel disease (CSVD) causes 25% of strokes and contributes to 45% of dementia cases. Prevalence increases with age, affecting about 5% of people aged 50 years to almost 100% of people older than 90 years. […] The prevalence of CSVD increases with age, with no significant sex differences and no currently known differences across racial-ethnic groups or geography. Specifically, the prevalence of WMH increases from about 5% for people aged 50 years to nearly 100% for people aged 90 years. Similarly, the prevalence of CMB increases from 6.5% for people aged 45-50 years to about 36% for people aged 80-89 years. […] The most important modifiable risk factor is arterial hypertension, defined here as blood pressure greater than 140/90 mm Hg. Other risk factors include current and former smoking, diabetes mellitus, obstructive sleep apnea, chronic kidney disease, and branch atheromatous disease with associated subcortical stroke.
#3 Small Vessel Disease, a Marker of Brain Health: What the Radiologist Needs to Know | American Journal of Neuroradiology
https://www.ajnr.org/content/43/5/650
Small vessel disease, a disorder of cerebral microvessels, is an expanding epidemic and a common cause of stroke and dementia. […] Small vessel disease (SVD) is an umbrella term of disease processes affecting the small arteries, arterioles, venules, and capillaries of the brain. […] In fact, SVD is an enormous health burden, causing about 25% of ischemic strokes and most hemorrhagic strokes, is the most common cause of vascular dementia, and contributes to about half of dementias worldwide. […] The spectrum of SVD includes white matter hyperintensities (WMH) of presumed vascular origin, recent small subcortical infarcts, lacunes, microbleeds, superficial siderosis, prominent perivascular spaces, microinfarcts, and brain atrophy. […] Although there is significant variation in the epidemiology of SVD markers, the prevalence of these markers is associated with greater age.
#4 Small Vessel Disease, a Marker of Brain Health: What the Radiologist Needs to Know | American Journal of Neuroradiology
https://www.ajnr.org/content/43/5/650
Small vessel disease, a disorder of cerebral microvessels, is an expanding epidemic and a common cause of stroke and dementia. […] Small vessel disease (SVD) is an umbrella term of disease processes affecting the small arteries, arterioles, venules, and capillaries of the brain. […] In fact, SVD is an enormous health burden, causing about 25% of ischemic strokes and most hemorrhagic strokes, is the most common cause of vascular dementia, and contributes to about half of dementias worldwide. […] The spectrum of SVD includes white matter hyperintensities (WMH) of presumed vascular origin, recent small subcortical infarcts, lacunes, microbleeds, superficial siderosis, prominent perivascular spaces, microinfarcts, and brain atrophy. […] Although there is significant variation in the epidemiology of SVD markers, the prevalence of these markers is associated with greater age.
#5 Cerebral Small Vessel Disease
https://www.mdpi.com/1422-0067/21/24/9729
Cerebral small vessel disease (CSVD) represents a cluster of various vascular disorders with different pathological backgrounds. The disease accounts for 20â30% of cases of ischemic stroke and cerebral hemorrhage. CSVD can be classified according to varied pathological, radiologic and clinical criteria. Most commonly, two types are identified: amyloid and non-amyloid related. The neuroimaging features are white matter hyperintensities (WMH), enlarged perivascular spaces (EPVS), lacunae, subcortical infarcts, microbleeds and brain atrophy. The following review presents the most up-to-date findings on the conditions belonging to the group of CSVD. CSVD can be divided into six groups: Type I: arteriosclerosis/age-related CSVD; Type II: amyloid-related CSVD; Type III: genetic CSVD distinct from amyloid angiopathy; Type IV: inflammatory/immunologically mediated CSVD; Type V: venous collagenosis; Type VI: other CSVD. Of these, the most common in the population is Type I, which is associated with arteriolosclerosis, and Type II, which is caused by amyloid angiopathy. The etiology of CVSD is complex and includes many mechanisms depending on the type of CSVD. The diagnosis of cerebral small vessel disease is based on the detection of neuroimaging markers occurring in the course of its development. They include a number of characteristic lesions that can be observed in imaging tests. This group includes cerebral atrophy, leukoaraiosis, white matter hyperintensities and cerebral microbleeds.
#6 CNS small vessel disease
https://pmc.ncbi.nlm.nih.gov/articles/PMC6598791/
CNS small vessel disease (CSVD) causes 25% of strokes and contributes to 45% of dementia cases. Prevalence increases with age, affecting about 5% of people aged 50 years to almost 100% of people older than 90 years. […] The prevalence of CSVD increases with age, with no significant sex differences and no currently known differences across racial-ethnic groups or geography. Specifically, the prevalence of WMH increases from about 5% for people aged 50 years to nearly 100% for people aged 90 years. Similarly, the prevalence of CMB increases from 6.5% for people aged 45-50 years to about 36% for people aged 80-89 years. […] The most important modifiable risk factor is arterial hypertension, defined here as blood pressure greater than 140/90 mm Hg. Other risk factors include current and former smoking, diabetes mellitus, obstructive sleep apnea, chronic kidney disease, and branch atheromatous disease with associated subcortical stroke.
#7 Neuroimaging in Cerebral Small Vessel Disease
https://www.jneurology.com/articles/neuroimaging-in-cerebral-small-vessel-disease.html
Morphologic imaging indicates the extent and severity of SVD, but the observed changes are not directly related to functional or cognitive impairment and prognosis. […] The unique potentials of PET in localizing and quantifying metabolic changes in gray matter structures responsible for functional/cognitive disturbances and caused by SVD mainly affecting the white matter makes this technique the preferred tool for studying patients with VCI. […] Small vessel disease (SVD) denotes a group of diseases that affect the small vessels of the brain, mostly due to chronic hypertensive damage to small arteries and arterioles. […] SVD is more frequent than previously thought and can now be better detected due to progress in neuroimaging.
#8
https://advances.umw.edu.pl/en/article/2021/30/3/349/
Cerebral small vessel disease (CSVD) is the most common, chronic and progressive vascular disease. […] The CSVD occurs 610 times more often than stroke. […] The prevalence of CSVD increases with age, with no significant sex differences. […] Prevalence of white matter hyperintensities increases from about 5% for people aged 50 years to nearly 100% for people aged 90 years. […] The CSVD is responsible for about 20% of all strokes, including 25% of ischemic strokes and 45% of vascular dementias. […] Silent brain infarcts are the most frequently identified incidental findings on brain scans, especially in older people. […] It has been estimated that for every symptomatic stroke, there are about 10 silent brain changes. […] There is a noticeable population variability: CSVD lesions are more common in the Chinese population, where lacunar strokes account for 46% of ischemic episodes.
#9 Prevalence and Risk Factors of Cerebral Small Vessel Disease from a Population-Based Cohort in China – PubMed
https://pubmed.ncbi.nlm.nih.gov/37734325
Cerebral small vessel disease (CSVD) is a significant burden of morbidity and mortality among elderly people around the world. Epidemiological data with complete CSVD evaluations and a large sample size in the general population are still limited. […] A total of 3,063 participants were enrolled. The mean age was 61.2 years and 46.5% were men. The most prevalent CSVD marker was confluent WMH (16.7%), followed by CMB (10.2%), moderate-severe EPVS in the basal ganglia (BG-EPVS) (9.8%), and lacune (5.6%). 30.5% of the participants have at least one of the four markers (total CSVD score 1 points). The prevalence of CSVD markers increases as age increases. Age and hypertension were independent risk factors for four CSVD markers and the total CSVD score. […] In this Chinese cohort with community-based adults aged 50-75 years, our findings showed a prevalence of 30.5% for CSVD. The most prevalent CSVD marker was confluent WMH, followed by CMB, moderate-severe BG-EPVS, and lacune. The risk factors for CSVD must be strictly screened and controlled in adults living in the community.
#10 Frontiers | Genetic considerations in cerebral small vessel diseases
https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2023.1080168/full
Cerebral small vessel disease (CSVD) encompasses a broad clinical spectrum united by pathology of the small vessels of the brain. […] Epidemiological studies set the stage to understand the relevance of CSVD in population and hospital-based samples. […] In populations of European ancestry, the overall prevalence of SBI has been reported to range between 11â28%. […] In samples of Asian race and ethnicity, the overall prevalence of SBI was 10â16%. […] Lacunes have higher prevalence among Asian individuals (15â25%) than European individuals (7%). […] White matter hyperintensities had the highest prevalence among all CSVD markers, reaching 92% in European elderly samples. […] The overall prevalence of PVS in Asian populations seems higher, reported previously between 17â72%. […] Framingham Heart Study participants had 9% prevalence of CMBs, representing a general population in the United States.
#11 Frontiers | Genetic considerations in cerebral small vessel diseases
https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2023.1080168/full
Cerebral small vessel disease (CSVD) encompasses a broad clinical spectrum united by pathology of the small vessels of the brain. […] Epidemiological studies set the stage to understand the relevance of CSVD in population and hospital-based samples. […] In populations of European ancestry, the overall prevalence of SBI has been reported to range between 11â28%. […] In samples of Asian race and ethnicity, the overall prevalence of SBI was 10â16%. […] Lacunes have higher prevalence among Asian individuals (15â25%) than European individuals (7%). […] White matter hyperintensities had the highest prevalence among all CSVD markers, reaching 92% in European elderly samples. […] The overall prevalence of PVS in Asian populations seems higher, reported previously between 17â72%. […] Framingham Heart Study participants had 9% prevalence of CMBs, representing a general population in the United States.
#12 Frontiers | Genetic considerations in cerebral small vessel diseases
https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2023.1080168/full
Cerebral small vessel disease (CSVD) encompasses a broad clinical spectrum united by pathology of the small vessels of the brain. […] Epidemiological studies set the stage to understand the relevance of CSVD in population and hospital-based samples. […] In populations of European ancestry, the overall prevalence of SBI has been reported to range between 11â28%. […] In samples of Asian race and ethnicity, the overall prevalence of SBI was 10â16%. […] Lacunes have higher prevalence among Asian individuals (15â25%) than European individuals (7%). […] White matter hyperintensities had the highest prevalence among all CSVD markers, reaching 92% in European elderly samples. […] The overall prevalence of PVS in Asian populations seems higher, reported previously between 17â72%. […] Framingham Heart Study participants had 9% prevalence of CMBs, representing a general population in the United States.
#13 Frontiers | Genetic considerations in cerebral small vessel diseases
https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2023.1080168/full
Cerebral small vessel disease (CSVD) encompasses a broad clinical spectrum united by pathology of the small vessels of the brain. […] Epidemiological studies set the stage to understand the relevance of CSVD in population and hospital-based samples. […] In populations of European ancestry, the overall prevalence of SBI has been reported to range between 11â28%. […] In samples of Asian race and ethnicity, the overall prevalence of SBI was 10â16%. […] Lacunes have higher prevalence among Asian individuals (15â25%) than European individuals (7%). […] White matter hyperintensities had the highest prevalence among all CSVD markers, reaching 92% in European elderly samples. […] The overall prevalence of PVS in Asian populations seems higher, reported previously between 17â72%. […] Framingham Heart Study participants had 9% prevalence of CMBs, representing a general population in the United States.
#14 Asymptomatic Cerebral Small Vessel Disease: Insights from Population-Based Studies
https://www.j-stroke.org/journal/view.php?doi=10.5853/jos.2018.03608
Cerebral small vessel disease (CSVD) is a common group of neurological conditions that confer a significant burden of morbidity and mortality worldwide. […] In population-based studies of presumed healthy elderly individuals, CSVD neuroimaging markers including white matter hyperintensities, lacunes, cerebral microbleeds, enlarged perivascular spaces, cortical superficial siderosis, and cerebral microinfarcts are frequently detected. […] While the true burden of CSVD is not known, estimates suggest that at least one-third of healthy-populations have lacunes (the majority of which are due to CSVD), although the actual prevalence of CSVD is likely much higher. […] Several population-based studies have explored the risk factors associated with development of CSVD. […] In healthy populations, the frequency of lacunes ranges from 8% to 31% (owing to differences in the ages of the study populations and variability in spatial resolution of imaging studies).
#15 Asymptomatic Cerebral Small Vessel Disease: Insights from Population-Based Studies
https://www.j-stroke.org/journal/view.php?viewtype=pubreader&number=272
Several population-based studies have explored the risk factors associated with development of CSVD. […] In healthy populations, the frequency of lacunes ranges from 8% to 31% (owing to differences in the ages of the study populations and variability in spatial resolution of imaging studies). […] The presence of CMB almost doubled the risk of ischemic stroke in a 5-year period, with greater CMB count associated with higher stroke risk. […] In one small study, healthy subjects who underwent MRI screening for WMH were given antiplatelet therapy. […] Currently, screening of asymptomatic individuals for CSVD is not recommended. […] However, more cost-effective methods of screening for CSVD may be able to select at-risk patients, especially those in high-risk populations, such as women or African Americans.
#16 CNS small vessel disease
https://pmc.ncbi.nlm.nih.gov/articles/PMC6598791/
CNS small vessel disease (CSVD) causes 25% of strokes and contributes to 45% of dementia cases. Prevalence increases with age, affecting about 5% of people aged 50 years to almost 100% of people older than 90 years. […] The prevalence of CSVD increases with age, with no significant sex differences and no currently known differences across racial-ethnic groups or geography. Specifically, the prevalence of WMH increases from about 5% for people aged 50 years to nearly 100% for people aged 90 years. Similarly, the prevalence of CMB increases from 6.5% for people aged 45-50 years to about 36% for people aged 80-89 years. […] The most important modifiable risk factor is arterial hypertension, defined here as blood pressure greater than 140/90 mm Hg. Other risk factors include current and former smoking, diabetes mellitus, obstructive sleep apnea, chronic kidney disease, and branch atheromatous disease with associated subcortical stroke.
#17
https://advances.umw.edu.pl/en/article/2021/30/3/349/
Cerebral small vessel disease (CSVD) is the most common, chronic and progressive vascular disease. […] The CSVD occurs 610 times more often than stroke. […] The prevalence of CSVD increases with age, with no significant sex differences. […] Prevalence of white matter hyperintensities increases from about 5% for people aged 50 years to nearly 100% for people aged 90 years. […] The CSVD is responsible for about 20% of all strokes, including 25% of ischemic strokes and 45% of vascular dementias. […] Silent brain infarcts are the most frequently identified incidental findings on brain scans, especially in older people. […] It has been estimated that for every symptomatic stroke, there are about 10 silent brain changes. […] There is a noticeable population variability: CSVD lesions are more common in the Chinese population, where lacunar strokes account for 46% of ischemic episodes.
#18 CNS small vessel disease
https://pmc.ncbi.nlm.nih.gov/articles/PMC6598791/
CNS small vessel disease (CSVD) causes 25% of strokes and contributes to 45% of dementia cases. Prevalence increases with age, affecting about 5% of people aged 50 years to almost 100% of people older than 90 years. […] The prevalence of CSVD increases with age, with no significant sex differences and no currently known differences across racial-ethnic groups or geography. Specifically, the prevalence of WMH increases from about 5% for people aged 50 years to nearly 100% for people aged 90 years. Similarly, the prevalence of CMB increases from 6.5% for people aged 45-50 years to about 36% for people aged 80-89 years. […] The most important modifiable risk factor is arterial hypertension, defined here as blood pressure greater than 140/90 mm Hg. Other risk factors include current and former smoking, diabetes mellitus, obstructive sleep apnea, chronic kidney disease, and branch atheromatous disease with associated subcortical stroke.
#19 Cerebral small vessel disease | Radiology Reference Article | Radiopaedia.org
https://radiopaedia.org/articles/cerebral-small-vessel-disease?embed_domain=hackmd.io%2F%40yIPUAFeCSL2JsU8smR5nJQ%2Fbnjhjgjghjghjgh&lang=us
Chronic small vessel disease is more common with increasing age. The prevalence of white matter lesions in the general population is reported to be between 39 to 96% […] Chronic small vessel disease is often an incidental asymptomatic finding on imaging. However, it has been shown to cause vascular dementia and it is more common in patients with dementia (vascular dementia, Alzheimer disease, Lewy body dementia) compared to the general population (100% v. 92% respectively in one study).
#20 Asymptomatic cerebral small vessel disease and silent infarcts | STROKE MANUAL
https://www.stroke-manual.com/asymptomatic-cerebral-small-vessel-disease-and-silent-infarcts/
asymptomatic SVD is common in the elderly, with up to 90% of people over the age of 65 having WMHs […] its prevalence increases with age and is associated with traditional vascular risk factors such as hypertension, diabetes mellitus, hyperlipidemia, smoking, age, and genetic factors.
#21 Update on cerebral small vessel disease: a dynamic whole-brain disease | Stroke and Vascular Neurology
https://svn.bmj.com/content/1/3/83
Cerebral small vessel disease (CSVD) is a very common neurological disease in older people. […] Epidemiology of CSVD might differ in Asian compared with Western populations (where most results and guidelines about CSVD and stroke originate), but more community-based data and clear stratification of stroke types are required to address this. […] The prevalence of lacunar stroke may be higher in patients in China where recent studies have suggested that lacunar infarction accounts for 3846% of ischaemic stroke. […] A systematic review suggests that silent brain infarcts (another term sometimes used for lacune) are more prevalent in the Asian than in the non-Asian population. […] However, it is noteworthy that most of these Asian studies were hospital-based, whereas all non-Asian studies were community-based; therefore, more relevant comparisons are needed to determine if the prevalence of lacunes and other CSVD features does differ between world regions and ethnic groups. […] Risk factor profiles of lacunar stroke seemed different in China, but it might be too early to say so. […] Community-based studies of CSVD prevalence and progression are also needed to determine if prevalence genuinely differs in different world regions or ethnic groups.
#22 Update on cerebral small vessel disease: a dynamic whole-brain disease | Stroke and Vascular Neurology
https://svn.bmj.com/content/1/3/83
Cerebral small vessel disease (CSVD) is a very common neurological disease in older people. […] Epidemiology of CSVD might differ in Asian compared with Western populations (where most results and guidelines about CSVD and stroke originate), but more community-based data and clear stratification of stroke types are required to address this. […] The prevalence of lacunar stroke may be higher in patients in China where recent studies have suggested that lacunar infarction accounts for 3846% of ischaemic stroke. […] A systematic review suggests that silent brain infarcts (another term sometimes used for lacune) are more prevalent in the Asian than in the non-Asian population. […] However, it is noteworthy that most of these Asian studies were hospital-based, whereas all non-Asian studies were community-based; therefore, more relevant comparisons are needed to determine if the prevalence of lacunes and other CSVD features does differ between world regions and ethnic groups. […] Risk factor profiles of lacunar stroke seemed different in China, but it might be too early to say so. […] Community-based studies of CSVD prevalence and progression are also needed to determine if prevalence genuinely differs in different world regions or ethnic groups.
#23 Update on cerebral small vessel disease: a dynamic whole-brain disease | Stroke and Vascular Neurology
https://svn.bmj.com/content/1/3/83
Cerebral small vessel disease (CSVD) is a very common neurological disease in older people. […] Epidemiology of CSVD might differ in Asian compared with Western populations (where most results and guidelines about CSVD and stroke originate), but more community-based data and clear stratification of stroke types are required to address this. […] The prevalence of lacunar stroke may be higher in patients in China where recent studies have suggested that lacunar infarction accounts for 3846% of ischaemic stroke. […] A systematic review suggests that silent brain infarcts (another term sometimes used for lacune) are more prevalent in the Asian than in the non-Asian population. […] However, it is noteworthy that most of these Asian studies were hospital-based, whereas all non-Asian studies were community-based; therefore, more relevant comparisons are needed to determine if the prevalence of lacunes and other CSVD features does differ between world regions and ethnic groups. […] Risk factor profiles of lacunar stroke seemed different in China, but it might be too early to say so. […] Community-based studies of CSVD prevalence and progression are also needed to determine if prevalence genuinely differs in different world regions or ethnic groups.
#24 Update on cerebral small vessel disease: a dynamic whole-brain disease | Stroke and Vascular Neurology
https://svn.bmj.com/content/1/3/83
Cerebral small vessel disease (CSVD) is a very common neurological disease in older people. […] Epidemiology of CSVD might differ in Asian compared with Western populations (where most results and guidelines about CSVD and stroke originate), but more community-based data and clear stratification of stroke types are required to address this. […] The prevalence of lacunar stroke may be higher in patients in China where recent studies have suggested that lacunar infarction accounts for 3846% of ischaemic stroke. […] A systematic review suggests that silent brain infarcts (another term sometimes used for lacune) are more prevalent in the Asian than in the non-Asian population. […] However, it is noteworthy that most of these Asian studies were hospital-based, whereas all non-Asian studies were community-based; therefore, more relevant comparisons are needed to determine if the prevalence of lacunes and other CSVD features does differ between world regions and ethnic groups. […] Risk factor profiles of lacunar stroke seemed different in China, but it might be too early to say so. […] Community-based studies of CSVD prevalence and progression are also needed to determine if prevalence genuinely differs in different world regions or ethnic groups.
#25
https://advances.umw.edu.pl/en/article/2021/30/3/349/
Cerebral small vessel disease (CSVD) is the most common, chronic and progressive vascular disease. […] The CSVD occurs 610 times more often than stroke. […] The prevalence of CSVD increases with age, with no significant sex differences. […] Prevalence of white matter hyperintensities increases from about 5% for people aged 50 years to nearly 100% for people aged 90 years. […] The CSVD is responsible for about 20% of all strokes, including 25% of ischemic strokes and 45% of vascular dementias. […] Silent brain infarcts are the most frequently identified incidental findings on brain scans, especially in older people. […] It has been estimated that for every symptomatic stroke, there are about 10 silent brain changes. […] There is a noticeable population variability: CSVD lesions are more common in the Chinese population, where lacunar strokes account for 46% of ischemic episodes.
#26 Genetic Factors of Cerebral Small Vessel Disease and Their Potential Clinical Outcome
https://www.mdpi.com/1422-0067/20/17/4298
Cerebral small vessel diseases (SVD) have been causally correlated with ischemic strokes, leading to cognitive decline and vascular dementia. […] Cerebral SVD accounts for 15â26% of ischemic strokes in the USA and Europe, whereas this proportion in Asia ranges from 25% to 54%. […] Cerebral SVD has an enormous social and economic impact. […] Several traditional risk factors have been suggested to play important roles in the mechanisms and etiology of cerebral SVD. […] The standard markers of SVD included lacunes, cerebral microbleeds, or white matter hyperintensities (WMHs). […] Until recently, the molecular, cellular, and pathophysiologic mechanisms underlying SVD were largely unknown. […] The estimated heritability for cerebral white matter lesions as a surrogate marker of cerebral SVD ranged between 50% and 80%.
#27 Frontiers | Genetic considerations in cerebral small vessel diseases
https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2023.1080168/full
In contrast to community-based studies, patients attending a hospital or clinic have a higher prevalence of CSVD markers. […] The presence of CSVD markers increases the risk of mortality by four-fold compared to healthy cohorts. […] The above studies indicate that there is a spectrum of manifestations of CSVD with variations across ethnic and racial groups, higher prevalence in clinical samples than population-based samples, but strongly associated with age and hypertension regardless of the sample studied. […] Further studies are warranted to study the genetic variations among different ethnic groups and its risk for the CSVD.
#28
https://advances.umw.edu.pl/en/article/2021/30/3/349/
Cerebral small vessel disease (CSVD) is the most common, chronic and progressive vascular disease. […] The CSVD occurs 610 times more often than stroke. […] The prevalence of CSVD increases with age, with no significant sex differences. […] Prevalence of white matter hyperintensities increases from about 5% for people aged 50 years to nearly 100% for people aged 90 years. […] The CSVD is responsible for about 20% of all strokes, including 25% of ischemic strokes and 45% of vascular dementias. […] Silent brain infarcts are the most frequently identified incidental findings on brain scans, especially in older people. […] It has been estimated that for every symptomatic stroke, there are about 10 silent brain changes. […] There is a noticeable population variability: CSVD lesions are more common in the Chinese population, where lacunar strokes account for 46% of ischemic episodes.
#29
https://advances.umw.edu.pl/en/article/2021/30/3/349/
Cerebral small vessel disease (CSVD) is the most common, chronic and progressive vascular disease. […] The CSVD occurs 610 times more often than stroke. […] The prevalence of CSVD increases with age, with no significant sex differences. […] Prevalence of white matter hyperintensities increases from about 5% for people aged 50 years to nearly 100% for people aged 90 years. […] The CSVD is responsible for about 20% of all strokes, including 25% of ischemic strokes and 45% of vascular dementias. […] Silent brain infarcts are the most frequently identified incidental findings on brain scans, especially in older people. […] It has been estimated that for every symptomatic stroke, there are about 10 silent brain changes. […] There is a noticeable population variability: CSVD lesions are more common in the Chinese population, where lacunar strokes account for 46% of ischemic episodes.
#30 Cerebral small vessel disease | Radiology Reference Article | Radiopaedia.org
https://radiopaedia.org/articles/cerebral-small-vessel-disease?embed_domain=hackmd.io%2F%40yIPUAFeCSL2JsU8smR5nJQ%2Fbnjhjgjghjghjgh&lang=us
Chronic small vessel disease is more common with increasing age. The prevalence of white matter lesions in the general population is reported to be between 39 to 96% […] Chronic small vessel disease is often an incidental asymptomatic finding on imaging. However, it has been shown to cause vascular dementia and it is more common in patients with dementia (vascular dementia, Alzheimer disease, Lewy body dementia) compared to the general population (100% v. 92% respectively in one study).
#31 Asymptomatic Cerebral Small Vessel Disease: Insights from Population-Based Studies
https://www.j-stroke.org/journal/view.php?viewtype=pubreader&number=272
Several population-based studies have explored the risk factors associated with development of CSVD. […] In healthy populations, the frequency of lacunes ranges from 8% to 31% (owing to differences in the ages of the study populations and variability in spatial resolution of imaging studies). […] The presence of CMB almost doubled the risk of ischemic stroke in a 5-year period, with greater CMB count associated with higher stroke risk. […] In one small study, healthy subjects who underwent MRI screening for WMH were given antiplatelet therapy. […] Currently, screening of asymptomatic individuals for CSVD is not recommended. […] However, more cost-effective methods of screening for CSVD may be able to select at-risk patients, especially those in high-risk populations, such as women or African Americans.
#32 Asymptomatic Cerebral Small Vessel Disease: Insights from Population-Based Studies
https://www.j-stroke.org/journal/view.php?doi=10.5853/jos.2018.03608
Although the associated risk factors have varied between studies, hypertension, age, and (to a lesser degree) smoking, seem to be the most replicated. […] The presence of these deep large PVS was associated with silent subcortical infarcts and WMH progression. […] In one small study, higher numbers of basal ganglia and centrum semiovale PVS were associated with poor performance on neuropsychological testing. […] The major reasons MRIs are not performed in healthy populations is cost and lack of intervenable measures if asymptomatic CSVD is identified. […] In cross-sectional population-based studies, numerous biomarkers such as fibrinogen, C-reactive protein (CRP), interleukin-6, neurofilament light chain, homocysteine, and D-dimer have been associated with the presence of CSVD markers such as WMH, lacunes, and PVS. […] It remains unclear how to best identify patients with asymptomatic CSVD.
#33 Asymptomatic Cerebral Small Vessel Disease: Insights from Population-Based Studies
https://www.j-stroke.org/journal/view.php?viewtype=pubreader&number=272
Several population-based studies have explored the risk factors associated with development of CSVD. […] In healthy populations, the frequency of lacunes ranges from 8% to 31% (owing to differences in the ages of the study populations and variability in spatial resolution of imaging studies). […] The presence of CMB almost doubled the risk of ischemic stroke in a 5-year period, with greater CMB count associated with higher stroke risk. […] In one small study, healthy subjects who underwent MRI screening for WMH were given antiplatelet therapy. […] Currently, screening of asymptomatic individuals for CSVD is not recommended. […] However, more cost-effective methods of screening for CSVD may be able to select at-risk patients, especially those in high-risk populations, such as women or African Americans.
#34 Small Vessel Disease, a Marker of Brain Health: What the Radiologist Needs to Know | American Journal of Neuroradiology
https://www.ajnr.org/content/43/5/650
Several population-based studies have characterized SVD in the healthy population and explored the risk factors for SVD. […] The exact pathogenesis of SVD is incompletely understood, but the most common abnormalities are diffuse arteriolosclerosis, lipohyalinosis, and fibrinoid necrosis of small arterioles. […] Although hypertension is a key risk factor, many patients with SVD are not hypertensive. […] Recent studies suggest more complex mechanisms other than arteriolosclerosis that can cause capillary wall dysfunction. […] The recognition of endothelial and neurogliovascular unit dysfunction as the main underlying mechanisms of SVD is fundamental to develop the role of advanced neuroimaging techniques.
#35 CNS small vessel disease
https://pmc.ncbi.nlm.nih.gov/articles/PMC6598791/
CNS small vessel disease (CSVD) causes 25% of strokes and contributes to 45% of dementia cases. Prevalence increases with age, affecting about 5% of people aged 50 years to almost 100% of people older than 90 years. […] The prevalence of CSVD increases with age, with no significant sex differences and no currently known differences across racial-ethnic groups or geography. Specifically, the prevalence of WMH increases from about 5% for people aged 50 years to nearly 100% for people aged 90 years. Similarly, the prevalence of CMB increases from 6.5% for people aged 45-50 years to about 36% for people aged 80-89 years. […] The most important modifiable risk factor is arterial hypertension, defined here as blood pressure greater than 140/90 mm Hg. Other risk factors include current and former smoking, diabetes mellitus, obstructive sleep apnea, chronic kidney disease, and branch atheromatous disease with associated subcortical stroke.
#36 CNS small vessel disease
https://pmc.ncbi.nlm.nih.gov/articles/PMC6598791/
CNS small vessel disease (CSVD) causes 25% of strokes and contributes to 45% of dementia cases. Prevalence increases with age, affecting about 5% of people aged 50 years to almost 100% of people older than 90 years. […] The prevalence of CSVD increases with age, with no significant sex differences and no currently known differences across racial-ethnic groups or geography. Specifically, the prevalence of WMH increases from about 5% for people aged 50 years to nearly 100% for people aged 90 years. Similarly, the prevalence of CMB increases from 6.5% for people aged 45-50 years to about 36% for people aged 80-89 years. […] The most important modifiable risk factor is arterial hypertension, defined here as blood pressure greater than 140/90 mm Hg. Other risk factors include current and former smoking, diabetes mellitus, obstructive sleep apnea, chronic kidney disease, and branch atheromatous disease with associated subcortical stroke.
#37 Asymptomatic Cerebral Small Vessel Disease: Insights from Population-Based Studies
https://www.j-stroke.org/journal/view.php?doi=10.5853/jos.2018.03608
Although the associated risk factors have varied between studies, hypertension, age, and (to a lesser degree) smoking, seem to be the most replicated. […] The presence of these deep large PVS was associated with silent subcortical infarcts and WMH progression. […] In one small study, higher numbers of basal ganglia and centrum semiovale PVS were associated with poor performance on neuropsychological testing. […] The major reasons MRIs are not performed in healthy populations is cost and lack of intervenable measures if asymptomatic CSVD is identified. […] In cross-sectional population-based studies, numerous biomarkers such as fibrinogen, C-reactive protein (CRP), interleukin-6, neurofilament light chain, homocysteine, and D-dimer have been associated with the presence of CSVD markers such as WMH, lacunes, and PVS. […] It remains unclear how to best identify patients with asymptomatic CSVD.
#38 Asymptomatic cerebral small vessel disease and silent infarcts | STROKE MANUAL
https://www.stroke-manual.com/asymptomatic-cerebral-small-vessel-disease-and-silent-infarcts/
asymptomatic SVD is common in the elderly, with up to 90% of people over the age of 65 having WMHs […] its prevalence increases with age and is associated with traditional vascular risk factors such as hypertension, diabetes mellitus, hyperlipidemia, smoking, age, and genetic factors.
#39 Cerebral small vessel disease genomics and its implications across the lifespan | Nature Communications
https://www.nature.com/articles/s41467-020-19111-2
We explore association of WMH risk loci with early changes in white matter microstructure on MRI using diffusion tensor imaging (DTI) in young adults in their early twenties. […] We further demonstrate the importance of higher BP as a risk factor for WMH even below clinical thresholds for HTN. […] Our results suggest that WMH should be considered a major target for preventative interventions, to mitigate not only the risk of stroke and vascular cognitive impairment but also of Alzheimer-type dementia, and support the rationale of innovative trials using WMH progression as a surrogate or intermediate endpoint for cognitive decline and dementia. […] Our findings suggest that these could also be relevant for sporadic forms of SVD. […] Our results provide important insight into the lifetime impact of genetic risk for SVD.
#40
https://journals.lww.com/co-neurology/fulltext/2021/04000/cerebral_small_vessel_disease_and_vascular.15.aspx
Currently, management of VCI is centred on preventing and controlling vascular risk factors such as hypertension, obesity, smoking and diabetes. […] High blood pressure (BP) represents the primary modifiable risk factor involved in SVD progression and VCI. […] Findings from clinical trials support that interventions may lower the risk of VCI progression. […] Strategies to prevent ischaemic and haemorrhagic stroke hold the potential to significantly reduce the burden of cognitive impairment in the population.
#41 Chronic kidney disease and its association with cerebral small vessel disease in the general older hypertensive population | BMC Nephrology | Full Text
https://bmcnephrol.biomedcentral.com/articles/10.1186/s12882-024-03528-8
Cerebral small vessel disease can be identified using magnetic resonance imaging, and includes white matter hyperintensities, lacunar infarcts, cerebral microbleeds, and brain atrophy. […] Chronic kidney disease (CKD) is related to age, and it is like CSVD also prevalent in the older population. […] CKD and CSVD share many of the same risk factors, including hypertension. […] The prevalence of hypertension has been estimated to be as high as 65% in individuals60 years of age. […] We observed that CKD was associated with markers of CSVD (CMBs and cortical atrophy) in the general older hypertensive population. In the general older non-hypertensive population, no associations between CKD and any markers of CSVD were observed. Our findings might indicate that hypertension is a link between CKD and CSVD. Further studies investigating the relationship between CKD, CSVD, and hypertension are warranted.
#42 CNS small vessel disease
https://pmc.ncbi.nlm.nih.gov/articles/PMC6598791/
Single-gene disorders are infrequently the cause of CSVD. Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL), perhaps the most common inherited cause of CSVD, has a population prevalence among working age adults of about 24 per 100,000. […] The uncertain pathogenesis of CSVD hinders the creation of animal models that might lead to effective therapies. The uncertainty perhaps stems from the complexity of the NVU itself and from the multitude of pathogenic pathways and diseases that exist under the CSVD umbrella. Understanding the sequence of the pathogenesis for each CSVD type is the key to prevention and treatments.
#43 Genetic Factors of Cerebral Small Vessel Disease and Their Potential Clinical Outcome
https://www.mdpi.com/1422-0067/20/17/4298
Although the majority of cerebral SVD cases were sporadic, several reports of inherited forms of cerebral SVD pointed to single-gene disorders. […] The recognition of the genetic aspect of cerebral SVD could contribute to the improved diagnosis and treatment of these rare single-gene disorders, as well as sporadic cerebral SVD. […] The clinical features of autosomal-dominant SVD may share several similarities with sporadic SVD, such as arteriopathy, white matter dysfunctions, and infracts in subcortical regions. […] Thus, genetic testing as part of routine diagnosis could identify the potential causative mutations in patients with a family history, suggesting possible connections between gene mutations and clinical symptoms of blood vessel diseases. […] Genetic studies of sporadic cerebral SVD have demonstrated a high degree of heritability, particularly among patients with young-onset stroke.
#44 Genetic Factors of Cerebral Small Vessel Disease and Their Potential Clinical Outcome
https://www.mdpi.com/1422-0067/20/17/4298
Although the majority of cerebral SVD cases were sporadic, several reports of inherited forms of cerebral SVD pointed to single-gene disorders. […] The recognition of the genetic aspect of cerebral SVD could contribute to the improved diagnosis and treatment of these rare single-gene disorders, as well as sporadic cerebral SVD. […] The clinical features of autosomal-dominant SVD may share several similarities with sporadic SVD, such as arteriopathy, white matter dysfunctions, and infracts in subcortical regions. […] Thus, genetic testing as part of routine diagnosis could identify the potential causative mutations in patients with a family history, suggesting possible connections between gene mutations and clinical symptoms of blood vessel diseases. […] Genetic studies of sporadic cerebral SVD have demonstrated a high degree of heritability, particularly among patients with young-onset stroke.
#45 Genetic Factors of Cerebral Small Vessel Disease and Their Potential Clinical Outcome
https://www.mdpi.com/1422-0067/20/17/4298
Although the majority of cerebral SVD cases were sporadic, several reports of inherited forms of cerebral SVD pointed to single-gene disorders. […] The recognition of the genetic aspect of cerebral SVD could contribute to the improved diagnosis and treatment of these rare single-gene disorders, as well as sporadic cerebral SVD. […] The clinical features of autosomal-dominant SVD may share several similarities with sporadic SVD, such as arteriopathy, white matter dysfunctions, and infracts in subcortical regions. […] Thus, genetic testing as part of routine diagnosis could identify the potential causative mutations in patients with a family history, suggesting possible connections between gene mutations and clinical symptoms of blood vessel diseases. […] Genetic studies of sporadic cerebral SVD have demonstrated a high degree of heritability, particularly among patients with young-onset stroke.
#46 Genetic Factors of Cerebral Small Vessel Disease and Their Potential Clinical Outcome
https://www.mdpi.com/1422-0067/20/17/4298
Cerebral small vessel diseases (SVD) have been causally correlated with ischemic strokes, leading to cognitive decline and vascular dementia. […] Cerebral SVD accounts for 15â26% of ischemic strokes in the USA and Europe, whereas this proportion in Asia ranges from 25% to 54%. […] Cerebral SVD has an enormous social and economic impact. […] Several traditional risk factors have been suggested to play important roles in the mechanisms and etiology of cerebral SVD. […] The standard markers of SVD included lacunes, cerebral microbleeds, or white matter hyperintensities (WMHs). […] Until recently, the molecular, cellular, and pathophysiologic mechanisms underlying SVD were largely unknown. […] The estimated heritability for cerebral white matter lesions as a surrogate marker of cerebral SVD ranged between 50% and 80%.
#47 Early life characteristics and late life burden of cerebral small vessel disease in the Lothian Birth Cohort 1936 | Aging
https://www.aging-us.com/article/101043/text
It is unknown whether relations between early-life factors and overall health in later life apply to burden of cerebral small vessel disease (cSVD), a major cause of stroke and dementia. […] Cerebral small vessel disease (cSVD) is common, comprises 20% of ischemic stroke and contributes to 45% of dementias, but there is no effective treatment. […] Several demographic and clinical factors are associated with increased risk of cSVD, including hypertension, diabetes, hypercholesterolemia, obesity, smoking, dietary salt and alcohol intake, but a large proportion of the variance in presence and severity of cSVD is unexplained. […] It is plausible that early-life factors may influence the development and impact of cSVD. […] These same early-life factors have also predicted lower incidence of conditions linked with cSVD in some studies, including cardiovascular disease, stroke, and dementia.
#48 Early life characteristics and late life burden of cerebral small vessel disease in the Lothian Birth Cohort 1936 | Aging
https://www.aging-us.com/article/101043/text
cSVD burden may therefore provide mechanistic links between early-life factors and late-life stroke and dementia incidence. […] In this large sample of generally healthy community-dwelling older members recruited from a single year-of-birth cohort, the total brain burden of cSVD at age 73 was associated with lower age-11 IQ, and showed theory-consistent trends towards association with age-11 deprivation index, own job class and highest qualifying education level. […] The relations between early life factors were more strongly associated with total brain burden of SVD than any one neuroradiological component of WMH, cerebral microbleeds, lacunes or enlarged perivascular spaces. […] Our findings suggest that childhood intelligence may be a risk factor for cSVD in later life.
#49 Early life characteristics and late life burden of cerebral small vessel disease in the Lothian Birth Cohort 1936 | Aging
https://www.aging-us.com/article/101043/text
cSVD burden may therefore provide mechanistic links between early-life factors and late-life stroke and dementia incidence. […] In this large sample of generally healthy community-dwelling older members recruited from a single year-of-birth cohort, the total brain burden of cSVD at age 73 was associated with lower age-11 IQ, and showed theory-consistent trends towards association with age-11 deprivation index, own job class and highest qualifying education level. […] The relations between early life factors were more strongly associated with total brain burden of SVD than any one neuroradiological component of WMH, cerebral microbleeds, lacunes or enlarged perivascular spaces. […] Our findings suggest that childhood intelligence may be a risk factor for cSVD in later life.
#50 Early life characteristics and late life burden of cerebral small vessel disease in the Lothian Birth Cohort 1936 | Aging
https://www.aging-us.com/article/101043/text
cSVD burden may therefore provide mechanistic links between early-life factors and late-life stroke and dementia incidence. […] In this large sample of generally healthy community-dwelling older members recruited from a single year-of-birth cohort, the total brain burden of cSVD at age 73 was associated with lower age-11 IQ, and showed theory-consistent trends towards association with age-11 deprivation index, own job class and highest qualifying education level. […] The relations between early life factors were more strongly associated with total brain burden of SVD than any one neuroradiological component of WMH, cerebral microbleeds, lacunes or enlarged perivascular spaces. […] Our findings suggest that childhood intelligence may be a risk factor for cSVD in later life.
#51 Neuroimaging in Cerebral Small Vessel Disease
https://www.jneurology.com/articles/neuroimaging-in-cerebral-small-vessel-disease.html
Cerebral small vessel disease (SVD) is a condition resulting from damage to the cerebral microcirculation. […] The diagnosis of SVD is difficult because there is no consensus on clinical criteria. […] Neuroimaging plays an important role in the management of patients with impaired cognition. […] Neuroimaging is also relevant for the detection of sporadic SVD. […] MRI remains the key neuroimaging modality in VaD. […] Numerous studies identified MRI markers of small vessel disease (SVD) as determinants of VaD. […] The burden of SVD is increased in systemic lupus erythematosus and as the risk of stroke in type 2 diabetes. […] Small vessel disease identified on MRI in the white matter is called leukoaraiosis. […] The markers of small vessel disease – white matter hyperintensities, lacunes, dilated vascular spaces, microbleeds, and brain volume – are related to decrease in regional cerebral blood flow and must be clearly defined to be reliably used for the diagnosis of this vascular disorder and its progression.
#52 Neuroimaging in Cerebral Small Vessel Disease
https://www.jneurology.com/articles/neuroimaging-in-cerebral-small-vessel-disease.html
Cerebral small vessel disease (SVD) is a condition resulting from damage to the cerebral microcirculation. […] The diagnosis of SVD is difficult because there is no consensus on clinical criteria. […] Neuroimaging plays an important role in the management of patients with impaired cognition. […] Neuroimaging is also relevant for the detection of sporadic SVD. […] MRI remains the key neuroimaging modality in VaD. […] Numerous studies identified MRI markers of small vessel disease (SVD) as determinants of VaD. […] The burden of SVD is increased in systemic lupus erythematosus and as the risk of stroke in type 2 diabetes. […] Small vessel disease identified on MRI in the white matter is called leukoaraiosis. […] The markers of small vessel disease – white matter hyperintensities, lacunes, dilated vascular spaces, microbleeds, and brain volume – are related to decrease in regional cerebral blood flow and must be clearly defined to be reliably used for the diagnosis of this vascular disorder and its progression.
#53 Neuroimaging in Cerebral Small Vessel Disease
https://www.jneurology.com/articles/neuroimaging-in-cerebral-small-vessel-disease.html
Cerebral small vessel disease (SVD) is a condition resulting from damage to the cerebral microcirculation. […] The diagnosis of SVD is difficult because there is no consensus on clinical criteria. […] Neuroimaging plays an important role in the management of patients with impaired cognition. […] Neuroimaging is also relevant for the detection of sporadic SVD. […] MRI remains the key neuroimaging modality in VaD. […] Numerous studies identified MRI markers of small vessel disease (SVD) as determinants of VaD. […] The burden of SVD is increased in systemic lupus erythematosus and as the risk of stroke in type 2 diabetes. […] Small vessel disease identified on MRI in the white matter is called leukoaraiosis. […] The markers of small vessel disease – white matter hyperintensities, lacunes, dilated vascular spaces, microbleeds, and brain volume – are related to decrease in regional cerebral blood flow and must be clearly defined to be reliably used for the diagnosis of this vascular disorder and its progression.
#54 Neuroimaging in Cerebral Small Vessel Disease
https://www.jneurology.com/articles/neuroimaging-in-cerebral-small-vessel-disease.html
Morphologic imaging indicates the extent and severity of SVD, but the observed changes are not directly related to functional or cognitive impairment and prognosis. […] The unique potentials of PET in localizing and quantifying metabolic changes in gray matter structures responsible for functional/cognitive disturbances and caused by SVD mainly affecting the white matter makes this technique the preferred tool for studying patients with VCI. […] Small vessel disease (SVD) denotes a group of diseases that affect the small vessels of the brain, mostly due to chronic hypertensive damage to small arteries and arterioles. […] SVD is more frequent than previously thought and can now be better detected due to progress in neuroimaging.
#55 Neuroimaging in Cerebral Small Vessel Disease
https://www.jneurology.com/articles/neuroimaging-in-cerebral-small-vessel-disease.html
Morphologic imaging indicates the extent and severity of SVD, but the observed changes are not directly related to functional or cognitive impairment and prognosis. […] The unique potentials of PET in localizing and quantifying metabolic changes in gray matter structures responsible for functional/cognitive disturbances and caused by SVD mainly affecting the white matter makes this technique the preferred tool for studying patients with VCI. […] Small vessel disease (SVD) denotes a group of diseases that affect the small vessels of the brain, mostly due to chronic hypertensive damage to small arteries and arterioles. […] SVD is more frequent than previously thought and can now be better detected due to progress in neuroimaging.
#56 Small Vessel Disease, a Marker of Brain Health: What the Radiologist Needs to Know | American Journal of Neuroradiology
http://www.ajnr.org/content/early/2021/10/07/ajnr.A7302
SUMMARY: Small vessel disease, a disorder of cerebral microvessels, is an expanding epidemic and a common cause of stroke and dementia. […] In fact, SVD is an enormous health burden, causing about 25% of ischemic strokes and most hemorrhagic strokes, is the most common cause of vascular dementia, and contributes to about half of dementias worldwide. […] Although there is significant variation in the epidemiology of SVD markers, the prevalence of these markers is associated with greater age. […] Several population-based studies have characterized SVD in the healthy population and explored the risk factors for SVD. […] The exact pathogenesis of SVD is incompletely understood, but the most common abnormalities are diffuse arteriolosclerosis, lipohyalinosis, and fibrinoid necrosis of small arterioles.
#57 Small Vessel Disease, a Marker of Brain Health: What the Radiologist Needs to Know | American Journal of Neuroradiology
https://www.ajnr.org/content/43/5/650
Several population-based studies have characterized SVD in the healthy population and explored the risk factors for SVD. […] The exact pathogenesis of SVD is incompletely understood, but the most common abnormalities are diffuse arteriolosclerosis, lipohyalinosis, and fibrinoid necrosis of small arterioles. […] Although hypertension is a key risk factor, many patients with SVD are not hypertensive. […] Recent studies suggest more complex mechanisms other than arteriolosclerosis that can cause capillary wall dysfunction. […] The recognition of endothelial and neurogliovascular unit dysfunction as the main underlying mechanisms of SVD is fundamental to develop the role of advanced neuroimaging techniques.
#58 Asymptomatic Cerebral Small Vessel Disease: Insights from Population-Based Studies
https://www.j-stroke.org/journal/view.php?doi=10.5853/jos.2018.03608
Cerebral small vessel disease (CSVD) is a common group of neurological conditions that confer a significant burden of morbidity and mortality worldwide. […] In population-based studies of presumed healthy elderly individuals, CSVD neuroimaging markers including white matter hyperintensities, lacunes, cerebral microbleeds, enlarged perivascular spaces, cortical superficial siderosis, and cerebral microinfarcts are frequently detected. […] While the true burden of CSVD is not known, estimates suggest that at least one-third of healthy-populations have lacunes (the majority of which are due to CSVD), although the actual prevalence of CSVD is likely much higher. […] Several population-based studies have explored the risk factors associated with development of CSVD. […] In healthy populations, the frequency of lacunes ranges from 8% to 31% (owing to differences in the ages of the study populations and variability in spatial resolution of imaging studies).
#59 Asymptomatic Cerebral Small Vessel Disease: Insights from Population-Based Studies
https://www.j-stroke.org/journal/view.php?viewtype=pubreader&number=272
Cerebral small vessel disease (CSVD) is a common group of neurological conditions that confer a significant burden of morbidity and mortality worldwide. […] In population-based studies of presumed healthy elderly individuals, CSVD neuroimaging markers including white matter hyperintensities, lacunes, cerebral microbleeds, enlarged perivascular spaces, cortical superficial siderosis, and cerebral microinfarcts are frequently detected. […] Herein, we aim to assess the etiology and significance of these individual biomarkers by focusing in asymptomatic populations at an epidemiological level. […] The implications of this on CSVD is not well understood but may be a balance between small vessel arteriopathy and neural repair processes. Hypertension and other vascular risk factors are believed to be the primary culprits of this entity as we will see from several epidemiological studies.
#60 Asymptomatic Cerebral Small Vessel Disease: Insights from Population-Based Studies
https://www.j-stroke.org/journal/view.php?doi=10.5853/jos.2018.03608
Cerebral small vessel disease (CSVD) is a common group of neurological conditions that confer a significant burden of morbidity and mortality worldwide. […] In population-based studies of presumed healthy elderly individuals, CSVD neuroimaging markers including white matter hyperintensities, lacunes, cerebral microbleeds, enlarged perivascular spaces, cortical superficial siderosis, and cerebral microinfarcts are frequently detected. […] While the true burden of CSVD is not known, estimates suggest that at least one-third of healthy-populations have lacunes (the majority of which are due to CSVD), although the actual prevalence of CSVD is likely much higher. […] Several population-based studies have explored the risk factors associated with development of CSVD. […] In healthy populations, the frequency of lacunes ranges from 8% to 31% (owing to differences in the ages of the study populations and variability in spatial resolution of imaging studies).
#61 Asymptomatic Cerebral Small Vessel Disease: Insights from Population-Based Studies
https://www.j-stroke.org/journal/view.php?doi=10.5853/jos.2018.03608
Although the associated risk factors have varied between studies, hypertension, age, and (to a lesser degree) smoking, seem to be the most replicated. […] The presence of these deep large PVS was associated with silent subcortical infarcts and WMH progression. […] In one small study, higher numbers of basal ganglia and centrum semiovale PVS were associated with poor performance on neuropsychological testing. […] The major reasons MRIs are not performed in healthy populations is cost and lack of intervenable measures if asymptomatic CSVD is identified. […] In cross-sectional population-based studies, numerous biomarkers such as fibrinogen, C-reactive protein (CRP), interleukin-6, neurofilament light chain, homocysteine, and D-dimer have been associated with the presence of CSVD markers such as WMH, lacunes, and PVS. […] It remains unclear how to best identify patients with asymptomatic CSVD.
#62 Asymptomatic Cerebral Small Vessel Disease: Insights from Population-Based Studies
https://www.j-stroke.org/journal/view.php?doi=10.5853/jos.2018.03608
Although the associated risk factors have varied between studies, hypertension, age, and (to a lesser degree) smoking, seem to be the most replicated. […] The presence of these deep large PVS was associated with silent subcortical infarcts and WMH progression. […] In one small study, higher numbers of basal ganglia and centrum semiovale PVS were associated with poor performance on neuropsychological testing. […] The major reasons MRIs are not performed in healthy populations is cost and lack of intervenable measures if asymptomatic CSVD is identified. […] In cross-sectional population-based studies, numerous biomarkers such as fibrinogen, C-reactive protein (CRP), interleukin-6, neurofilament light chain, homocysteine, and D-dimer have been associated with the presence of CSVD markers such as WMH, lacunes, and PVS. […] It remains unclear how to best identify patients with asymptomatic CSVD.
#63 Asymptomatic Cerebral Small Vessel Disease: Insights from Population-Based Studies
https://www.j-stroke.org/journal/view.php?viewtype=pubreader&number=272
Several population-based studies have explored the risk factors associated with development of CSVD. […] In healthy populations, the frequency of lacunes ranges from 8% to 31% (owing to differences in the ages of the study populations and variability in spatial resolution of imaging studies). […] The presence of CMB almost doubled the risk of ischemic stroke in a 5-year period, with greater CMB count associated with higher stroke risk. […] In one small study, healthy subjects who underwent MRI screening for WMH were given antiplatelet therapy. […] Currently, screening of asymptomatic individuals for CSVD is not recommended. […] However, more cost-effective methods of screening for CSVD may be able to select at-risk patients, especially those in high-risk populations, such as women or African Americans.
#64 Asymptomatic Cerebral Small Vessel Disease: Insights from Population-Based Studies
https://www.j-stroke.org/journal/view.php?doi=10.5853/jos.2018.03608
Although the associated risk factors have varied between studies, hypertension, age, and (to a lesser degree) smoking, seem to be the most replicated. […] The presence of these deep large PVS was associated with silent subcortical infarcts and WMH progression. […] In one small study, higher numbers of basal ganglia and centrum semiovale PVS were associated with poor performance on neuropsychological testing. […] The major reasons MRIs are not performed in healthy populations is cost and lack of intervenable measures if asymptomatic CSVD is identified. […] In cross-sectional population-based studies, numerous biomarkers such as fibrinogen, C-reactive protein (CRP), interleukin-6, neurofilament light chain, homocysteine, and D-dimer have been associated with the presence of CSVD markers such as WMH, lacunes, and PVS. […] It remains unclear how to best identify patients with asymptomatic CSVD.
#65 Asymptomatic Cerebral Small Vessel Disease: Insights from Population-Based Studies
https://www.j-stroke.org/journal/view.php?viewtype=pubreader&number=272
Several population-based studies have explored the risk factors associated with development of CSVD. […] In healthy populations, the frequency of lacunes ranges from 8% to 31% (owing to differences in the ages of the study populations and variability in spatial resolution of imaging studies). […] The presence of CMB almost doubled the risk of ischemic stroke in a 5-year period, with greater CMB count associated with higher stroke risk. […] In one small study, healthy subjects who underwent MRI screening for WMH were given antiplatelet therapy. […] Currently, screening of asymptomatic individuals for CSVD is not recommended. […] However, more cost-effective methods of screening for CSVD may be able to select at-risk patients, especially those in high-risk populations, such as women or African Americans.
#66 Detection and management of covert small vessel disease – VJNeurology
https://www.vjneurology.com/video/yoqlsmgy-zs-detection-and-management-of-covert-small-vessel-disease/
Covert cerebral small vessel disease (ccSVD) is a common condition affecting small blood vessels in the brain which increases the risk of future stroke, cognitive impairment, dependency, and death. […] He notes that the European Stroke Organization recommends focusing on controlling vascular risk factors rather than using antithrombotics, which can increase hemorrhagic risk. […] He proposes setting up specialized prevention clinics for better detection and management of ccSVD, suggesting that patients with arterial hypertension and subtle symptoms should be prioritized for screening.
#67 CNS small vessel disease
https://pmc.ncbi.nlm.nih.gov/articles/PMC6598791/
CNS small vessel disease (CSVD) causes 25% of strokes and contributes to 45% of dementia cases. Prevalence increases with age, affecting about 5% of people aged 50 years to almost 100% of people older than 90 years. […] The prevalence of CSVD increases with age, with no significant sex differences and no currently known differences across racial-ethnic groups or geography. Specifically, the prevalence of WMH increases from about 5% for people aged 50 years to nearly 100% for people aged 90 years. Similarly, the prevalence of CMB increases from 6.5% for people aged 45-50 years to about 36% for people aged 80-89 years. […] The most important modifiable risk factor is arterial hypertension, defined here as blood pressure greater than 140/90 mm Hg. Other risk factors include current and former smoking, diabetes mellitus, obstructive sleep apnea, chronic kidney disease, and branch atheromatous disease with associated subcortical stroke.
#68
https://advances.umw.edu.pl/en/article/2021/30/3/349/
Cerebral small vessel disease (CSVD) is the most common, chronic and progressive vascular disease. […] The CSVD occurs 610 times more often than stroke. […] The prevalence of CSVD increases with age, with no significant sex differences. […] Prevalence of white matter hyperintensities increases from about 5% for people aged 50 years to nearly 100% for people aged 90 years. […] The CSVD is responsible for about 20% of all strokes, including 25% of ischemic strokes and 45% of vascular dementias. […] Silent brain infarcts are the most frequently identified incidental findings on brain scans, especially in older people. […] It has been estimated that for every symptomatic stroke, there are about 10 silent brain changes. […] There is a noticeable population variability: CSVD lesions are more common in the Chinese population, where lacunar strokes account for 46% of ischemic episodes.
#69 Cerebral small vessel disease genomics and its implications across the lifespan | Nature Communications
https://www.nature.com/articles/s41467-020-19111-2
White matter hyperintensities (WMH) are the most common brain-imaging feature of cerebral small vessel disease (SVD), hypertension being the main known risk factor. […] As a leading cause of stroke, cognitive decline, and dementia, cerebral small vessel disease (SVD) represents a major source of morbidity and mortality in aging populations. […] The biological underpinnings of SVD are poorly understood and no mechanism-based treatments currently are available. […] Studying the genomics of SVD also provides a powerful approach to discovery of underlying molecular mechanisms and targets in order to accelerate the development of future therapies, or identify drug repositioning opportunities. […] Identifying these early predictors could have major implications for our understanding of disease mechanisms across the lifespan and for devising effective prevention strategies.
#70 Frontiers | Genetic considerations in cerebral small vessel diseases
https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2023.1080168/full
In contrast to community-based studies, patients attending a hospital or clinic have a higher prevalence of CSVD markers. […] The presence of CSVD markers increases the risk of mortality by four-fold compared to healthy cohorts. […] The above studies indicate that there is a spectrum of manifestations of CSVD with variations across ethnic and racial groups, higher prevalence in clinical samples than population-based samples, but strongly associated with age and hypertension regardless of the sample studied. […] Further studies are warranted to study the genetic variations among different ethnic groups and its risk for the CSVD.
#71
https://journals.lww.com/co-neurology/fulltext/2021/04000/cerebral_small_vessel_disease_and_vascular.15.aspx
Currently, management of VCI is centred on preventing and controlling vascular risk factors such as hypertension, obesity, smoking and diabetes. […] High blood pressure (BP) represents the primary modifiable risk factor involved in SVD progression and VCI. […] Findings from clinical trials support that interventions may lower the risk of VCI progression. […] Strategies to prevent ischaemic and haemorrhagic stroke hold the potential to significantly reduce the burden of cognitive impairment in the population.
#72 Detection and management of covert small vessel disease – VJNeurology
https://www.vjneurology.com/video/yoqlsmgy-zs-detection-and-management-of-covert-small-vessel-disease/
Covert cerebral small vessel disease (ccSVD) is a common condition affecting small blood vessels in the brain which increases the risk of future stroke, cognitive impairment, dependency, and death. […] He notes that the European Stroke Organization recommends focusing on controlling vascular risk factors rather than using antithrombotics, which can increase hemorrhagic risk. […] He proposes setting up specialized prevention clinics for better detection and management of ccSVD, suggesting that patients with arterial hypertension and subtle symptoms should be prioritized for screening.
#73
https://journals.lww.com/co-neurology/fulltext/2021/04000/cerebral_small_vessel_disease_and_vascular.15.aspx
Currently, management of VCI is centred on preventing and controlling vascular risk factors such as hypertension, obesity, smoking and diabetes. […] High blood pressure (BP) represents the primary modifiable risk factor involved in SVD progression and VCI. […] Findings from clinical trials support that interventions may lower the risk of VCI progression. […] Strategies to prevent ischaemic and haemorrhagic stroke hold the potential to significantly reduce the burden of cognitive impairment in the population.
#74
https://journals.lww.com/co-neurology/fulltext/2021/04000/cerebral_small_vessel_disease_and_vascular.15.aspx
Currently, management of VCI is centred on preventing and controlling vascular risk factors such as hypertension, obesity, smoking and diabetes. […] High blood pressure (BP) represents the primary modifiable risk factor involved in SVD progression and VCI. […] Findings from clinical trials support that interventions may lower the risk of VCI progression. […] Strategies to prevent ischaemic and haemorrhagic stroke hold the potential to significantly reduce the burden of cognitive impairment in the population.
#75 Cerebral small vessel disease genomics and its implications across the lifespan | Nature Communications
https://www.nature.com/articles/s41467-020-19111-2
We explore association of WMH risk loci with early changes in white matter microstructure on MRI using diffusion tensor imaging (DTI) in young adults in their early twenties. […] We further demonstrate the importance of higher BP as a risk factor for WMH even below clinical thresholds for HTN. […] Our results suggest that WMH should be considered a major target for preventative interventions, to mitigate not only the risk of stroke and vascular cognitive impairment but also of Alzheimer-type dementia, and support the rationale of innovative trials using WMH progression as a surrogate or intermediate endpoint for cognitive decline and dementia. […] Our findings suggest that these could also be relevant for sporadic forms of SVD. […] Our results provide important insight into the lifetime impact of genetic risk for SVD.
#76 Detection and management of covert small vessel disease – VJNeurology
https://www.vjneurology.com/video/yoqlsmgy-zs-detection-and-management-of-covert-small-vessel-disease/
Covert cerebral small vessel disease (ccSVD) is a common condition affecting small blood vessels in the brain which increases the risk of future stroke, cognitive impairment, dependency, and death. […] He notes that the European Stroke Organization recommends focusing on controlling vascular risk factors rather than using antithrombotics, which can increase hemorrhagic risk. […] He proposes setting up specialized prevention clinics for better detection and management of ccSVD, suggesting that patients with arterial hypertension and subtle symptoms should be prioritized for screening.
#77 CNS small vessel disease
https://pmc.ncbi.nlm.nih.gov/articles/PMC6598791/
Single-gene disorders are infrequently the cause of CSVD. Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL), perhaps the most common inherited cause of CSVD, has a population prevalence among working age adults of about 24 per 100,000. […] The uncertain pathogenesis of CSVD hinders the creation of animal models that might lead to effective therapies. The uncertainty perhaps stems from the complexity of the NVU itself and from the multitude of pathogenic pathways and diseases that exist under the CSVD umbrella. Understanding the sequence of the pathogenesis for each CSVD type is the key to prevention and treatments.
#78 Cerebral small vessel disease genomics and its implications across the lifespan | Nature Communications
https://www.nature.com/articles/s41467-020-19111-2
White matter hyperintensities (WMH) are the most common brain-imaging feature of cerebral small vessel disease (SVD), hypertension being the main known risk factor. […] As a leading cause of stroke, cognitive decline, and dementia, cerebral small vessel disease (SVD) represents a major source of morbidity and mortality in aging populations. […] The biological underpinnings of SVD are poorly understood and no mechanism-based treatments currently are available. […] Studying the genomics of SVD also provides a powerful approach to discovery of underlying molecular mechanisms and targets in order to accelerate the development of future therapies, or identify drug repositioning opportunities. […] Identifying these early predictors could have major implications for our understanding of disease mechanisms across the lifespan and for devising effective prevention strategies.
#79 Cerebral small vessel disease genomics and its implications across the lifespan | Nature Communications
https://www.nature.com/articles/s41467-020-19111-2
White matter hyperintensities (WMH) are the most common brain-imaging feature of cerebral small vessel disease (SVD), hypertension being the main known risk factor. […] As a leading cause of stroke, cognitive decline, and dementia, cerebral small vessel disease (SVD) represents a major source of morbidity and mortality in aging populations. […] The biological underpinnings of SVD are poorly understood and no mechanism-based treatments currently are available. […] Studying the genomics of SVD also provides a powerful approach to discovery of underlying molecular mechanisms and targets in order to accelerate the development of future therapies, or identify drug repositioning opportunities. […] Identifying these early predictors could have major implications for our understanding of disease mechanisms across the lifespan and for devising effective prevention strategies.
#80 Frontiers | Genetic considerations in cerebral small vessel diseases
https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2023.1080168/full
In contrast to community-based studies, patients attending a hospital or clinic have a higher prevalence of CSVD markers. […] The presence of CSVD markers increases the risk of mortality by four-fold compared to healthy cohorts. […] The above studies indicate that there is a spectrum of manifestations of CSVD with variations across ethnic and racial groups, higher prevalence in clinical samples than population-based samples, but strongly associated with age and hypertension regardless of the sample studied. […] Further studies are warranted to study the genetic variations among different ethnic groups and its risk for the CSVD.
#81 Cerebral small vessel disease genomics and its implications across the lifespan | Nature Communications
https://www.nature.com/articles/s41467-020-19111-2
White matter hyperintensities (WMH) are the most common brain-imaging feature of cerebral small vessel disease (SVD), hypertension being the main known risk factor. […] As a leading cause of stroke, cognitive decline, and dementia, cerebral small vessel disease (SVD) represents a major source of morbidity and mortality in aging populations. […] The biological underpinnings of SVD are poorly understood and no mechanism-based treatments currently are available. […] Studying the genomics of SVD also provides a powerful approach to discovery of underlying molecular mechanisms and targets in order to accelerate the development of future therapies, or identify drug repositioning opportunities. […] Identifying these early predictors could have major implications for our understanding of disease mechanisms across the lifespan and for devising effective prevention strategies.
#82 Cerebral small vessel disease genomics and its implications across the lifespan | Nature Communications
https://www.nature.com/articles/s41467-020-19111-2
We explore association of WMH risk loci with early changes in white matter microstructure on MRI using diffusion tensor imaging (DTI) in young adults in their early twenties. […] We further demonstrate the importance of higher BP as a risk factor for WMH even below clinical thresholds for HTN. […] Our results suggest that WMH should be considered a major target for preventative interventions, to mitigate not only the risk of stroke and vascular cognitive impairment but also of Alzheimer-type dementia, and support the rationale of innovative trials using WMH progression as a surrogate or intermediate endpoint for cognitive decline and dementia. […] Our findings suggest that these could also be relevant for sporadic forms of SVD. […] Our results provide important insight into the lifetime impact of genetic risk for SVD.
#83 Cerebral small vessel disease genomics and its implications across the lifespan | Nature Communications
https://www.nature.com/articles/s41467-020-19111-2
We explore association of WMH risk loci with early changes in white matter microstructure on MRI using diffusion tensor imaging (DTI) in young adults in their early twenties. […] We further demonstrate the importance of higher BP as a risk factor for WMH even below clinical thresholds for HTN. […] Our results suggest that WMH should be considered a major target for preventative interventions, to mitigate not only the risk of stroke and vascular cognitive impairment but also of Alzheimer-type dementia, and support the rationale of innovative trials using WMH progression as a surrogate or intermediate endpoint for cognitive decline and dementia. […] Our findings suggest that these could also be relevant for sporadic forms of SVD. […] Our results provide important insight into the lifetime impact of genetic risk for SVD.
#84 Small Vessel Disease, a Marker of Brain Health: What the Radiologist Needs to Know | American Journal of Neuroradiology
http://www.ajnr.org/content/early/2021/10/07/ajnr.A7302
Although hypertension is a key risk factor, many patients with SVD are not hypertensive. […] Recent studies suggest more complex mechanisms other than arteriolosclerosis that can cause capillary wall dysfunction. […] The recognition of endothelial and neurogliovascular unit dysfunction as the main underlying mechanisms of SVD is fundamental to develop the role of advanced neuroimaging techniques.
#85 Small Vessel Disease, a Marker of Brain Health: What the Radiologist Needs to Know | American Journal of Neuroradiology
https://www.ajnr.org/content/43/5/650
Several population-based studies have characterized SVD in the healthy population and explored the risk factors for SVD. […] The exact pathogenesis of SVD is incompletely understood, but the most common abnormalities are diffuse arteriolosclerosis, lipohyalinosis, and fibrinoid necrosis of small arterioles. […] Although hypertension is a key risk factor, many patients with SVD are not hypertensive. […] Recent studies suggest more complex mechanisms other than arteriolosclerosis that can cause capillary wall dysfunction. […] The recognition of endothelial and neurogliovascular unit dysfunction as the main underlying mechanisms of SVD is fundamental to develop the role of advanced neuroimaging techniques.
#86 Small Vessel Disease, a Marker of Brain Health: What the Radiologist Needs to Know | American Journal of Neuroradiology
http://www.ajnr.org/content/early/2021/10/07/ajnr.A7302
Although hypertension is a key risk factor, many patients with SVD are not hypertensive. […] Recent studies suggest more complex mechanisms other than arteriolosclerosis that can cause capillary wall dysfunction. […] The recognition of endothelial and neurogliovascular unit dysfunction as the main underlying mechanisms of SVD is fundamental to develop the role of advanced neuroimaging techniques.
#87 Small Vessel Disease, a Marker of Brain Health: What the Radiologist Needs to Know | American Journal of Neuroradiology
https://www.ajnr.org/content/43/5/650
Several population-based studies have characterized SVD in the healthy population and explored the risk factors for SVD. […] The exact pathogenesis of SVD is incompletely understood, but the most common abnormalities are diffuse arteriolosclerosis, lipohyalinosis, and fibrinoid necrosis of small arterioles. […] Although hypertension is a key risk factor, many patients with SVD are not hypertensive. […] Recent studies suggest more complex mechanisms other than arteriolosclerosis that can cause capillary wall dysfunction. […] The recognition of endothelial and neurogliovascular unit dysfunction as the main underlying mechanisms of SVD is fundamental to develop the role of advanced neuroimaging techniques.
#88 Small Vessel Disease, a Marker of Brain Health: What the Radiologist Needs to Know | American Journal of Neuroradiology
http://www.ajnr.org/content/early/2021/10/07/ajnr.A7302
Although hypertension is a key risk factor, many patients with SVD are not hypertensive. […] Recent studies suggest more complex mechanisms other than arteriolosclerosis that can cause capillary wall dysfunction. […] The recognition of endothelial and neurogliovascular unit dysfunction as the main underlying mechanisms of SVD is fundamental to develop the role of advanced neuroimaging techniques.
#89 Small Vessel Disease, a Marker of Brain Health: What the Radiologist Needs to Know | American Journal of Neuroradiology
https://www.ajnr.org/content/43/5/650
Several population-based studies have characterized SVD in the healthy population and explored the risk factors for SVD. […] The exact pathogenesis of SVD is incompletely understood, but the most common abnormalities are diffuse arteriolosclerosis, lipohyalinosis, and fibrinoid necrosis of small arterioles. […] Although hypertension is a key risk factor, many patients with SVD are not hypertensive. […] Recent studies suggest more complex mechanisms other than arteriolosclerosis that can cause capillary wall dysfunction. […] The recognition of endothelial and neurogliovascular unit dysfunction as the main underlying mechanisms of SVD is fundamental to develop the role of advanced neuroimaging techniques.
#90 Small Vessel Disease, a Marker of Brain Health: What the Radiologist Needs to Know | American Journal of Neuroradiology
http://www.ajnr.org/content/early/2021/10/07/ajnr.A7302
Although hypertension is a key risk factor, many patients with SVD are not hypertensive. […] Recent studies suggest more complex mechanisms other than arteriolosclerosis that can cause capillary wall dysfunction. […] The recognition of endothelial and neurogliovascular unit dysfunction as the main underlying mechanisms of SVD is fundamental to develop the role of advanced neuroimaging techniques.
#91 Small Vessel Disease, a Marker of Brain Health: What the Radiologist Needs to Know | American Journal of Neuroradiology
https://www.ajnr.org/content/43/5/650
Several population-based studies have characterized SVD in the healthy population and explored the risk factors for SVD. […] The exact pathogenesis of SVD is incompletely understood, but the most common abnormalities are diffuse arteriolosclerosis, lipohyalinosis, and fibrinoid necrosis of small arterioles. […] Although hypertension is a key risk factor, many patients with SVD are not hypertensive. […] Recent studies suggest more complex mechanisms other than arteriolosclerosis that can cause capillary wall dysfunction. […] The recognition of endothelial and neurogliovascular unit dysfunction as the main underlying mechanisms of SVD is fundamental to develop the role of advanced neuroimaging techniques.
#92 A large study reveals new mechanisms of cerebral small vessel disease – University of Bordeaux
https://www.u-bordeaux.fr/en/news/a-large-study-reveals-new-mechanisms-of-cerebral-small-vessel-disease
A large genomic study of perivascular spaces published in the Nature Medicine journal on April 17th 2023 reveals new biological mechanisms involved in cerebral small vessel disease, a leading cause of stroke and dementia. […] Cerebral small vessel disease is an age-related disease resulting from an alteration in the structure and function of the small arteries responsible for irrigating the brain. It is a major cause of stroke and dementia for which there is currently no specific drug treatment. […] This study sheds unprecedented light on the biological mechanisms underlying cerebral small vessel disease, suggesting that they may be linked to much earlier phenomena than previously suspected. This could have important implications for strategies to prevent cerebral small vessel disease, stroke and related dementia. […] This study provides completely new information on the biology of PVS and their contribution to cerebral small vessel disease, a major cause of stroke and dementia worldwide, providing leads for prioritising preventive drug targets.