Chapter 19 - Cerebral Vascular Dysfunction with Aging

Abstract

This chapter summarizes select changes in blood vessels during aging. Because the impact of these vascular changes and the subsequent end-organ damage is great in the brain, the discussion focuses much of its attention on alterations in the cerebral circulation. Aging produces diverse effects on blood vessels throughout the circulation. These changes are particularly prominent in the brain, where aging produces structural changes in the vessel wall, reductions in resting blood flow, and impairment of vasodilator responses. Impairment of the normal function of the blood–brain barrier also occurs with increasing age. Both oxidative stress and local inflammation appear to be key mechanisms that promote vascular disease during aging. Activation of the renin–angiotensin system plays a key role in producing vascular abnormalities by promoting oxidative stress and inflammation. In contrast, molecules including superoxide dismutases and peroxisome proliferator-activated receptor Lambda protect vascular cells by limiting these changes. A better understanding of the mechanisms that promote vascular dysfunction or protect against these changes may result in targeted approaches that could prevent or delay the progression of cerebrovascular disease that occurs with normal aging.