Cognitive and affective repercussions of vascular burden in the elderly

Abstract

Initial investigations of the impact of cerebrovascular pathology on cognition and mood predominantly focused on macrovascular lesions. Progressively, however, the role of a chronic accumulation of small vascular and microvascular lesions on both cognitive status and mood regulation came to light. Recent contributions have pointed to the main role of cortical microinfarcts and subcortical lacunes in dementia, providing the first pathological substrates of mixed dementia. With respect to mood regulation, the research focus has equally shifted from the localisation of macrovascular infarcts to the impact of a chronic cerebrovascular lesion burden. However, empirical results from the wider field of the “vascular depression hypothesis” remain contradictory and the relative contributions of biological and psychosocial factors are still a matter of debate. We review here the currently available datasets and theories regarding the cognitive and affective repercussions of cerebrovascular lesions while considering the methodological limitations of neuroimaging and neuropathological studies. In contrast to the initial neuroanatomically inspired lesion models, the current conception of the clinical expression of vascular burden is based on a vulnerability model. This encourages a multidimensional approach that takes into account not only lesions and risk factors but also the possibilities of early detection and intervention, thus integrating the emergent concepts of healthy aging and cognitive reserve and emphasising the role of psychosocial factors.