Abstract
Rationale. This paper describes the rationale and design of the SHEF-CSVD Study, which aims to determine the long-term clinical and radiological course of cerebral small vessel disease (CSVD) and to evaluate haemostatic and haemodynamic prognostic factors of the condition. Design. This single-centre, prospective, non-interventional cohort study will follow 150 consecutive patients with different clinical manifestations of CSVD (lacunar ischaemic stroke, vascular dementia, vascular parkinsonism or spontaneous deep, intracerebral haemorrhage) and 50 age- and sex-matched controls over a period of 24 months. The clinical and radiological course will be evaluated basing on a detailed neurological, neuropsychological and MRI examinations. Haemodynamic (cerebral vasoreactivity, 24 h blood pressure control) and haemostatic factors (markers of endothelial and platelet dysfunction, brachial artery flow-mediated dilatation test) will be determined. Discussion. The scheduled study will specifically address the issue of haemodynamic and haemostatic prognostic factors and their course over time in various clinical manifestations of CSVD. The findings may aid the development of prophylactic strategies and individualised treatment plans, which are critical during the early stages of the disease.
Highlights
Effective therapeutic and preventive strategies in neurological diseases of the elderly are lacking
Vascular risk factor pro les, which include information related to hypertension, diabetes mellitus, coronary artery disease, hypercholesterolemia, peripheral vascular disease, smoking, T 1: Diagnostic criteria for lacunar stroke, deep intracerebral haemorrhage, chronic vascular parkinsonism, and vascular dementia
Numerous studies have shown that white-matter lesions (WMLs) are related to vascular risk factors. e exact diagnosis of Cerebral small vessel disease (CSVD) is, still not well known and requires systematic evaluation of potentially relevant clinical and other phenotypic features
Summary
Effective therapeutic and preventive strategies in neurological diseases of the elderly are lacking. Cerebral small vessel disease (CSVD) is one of the most important and common vascular diseases of the brain. High morbidity rates are associated with CSVD; this disease leads to recurrent ischaemic and haemorrhagic strokes, gait disturbances, vascular dementia, and vascular parkinsonism [1, 2]. CSVD is related to vascular risk factors like hypertension, advanced age, and smoking; the direct pathophysiological mechanisms of the disease remain unclear [3]. Potential mechanisms include cerebrovascular risk factor-induced ischaemic cerebral changes and other nonspeci c cerebral processes, such as generalised vascular disease or normal ageing [4]. Lacunar strokes represent the focal manifestation of a diffuse abnormality of the small cerebral arterioles resulting in a state of chronic hypoperfusion of the white-matter, eventually resulting in degeneration of myelinated bres as a consequence of repeated selective oligodendrocyte death. Subcortical vascular cognitive impairment is recognized to be the commonest form of vascular cognitive impairment, and it is recognized as subcortical vascular dementia in the International Classi cation of Diseases, 10th revision [9]
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