Prevalence Of Vascular Cognitive Impairment Research Articles

A serum metabolomics study of vascular cognitive impairment patients based on Traditional Chinese medicine syndrome differentiation.

Objective: Vascular cognitive impairment (VCI) accounts for approximately 50%-70% of all dementia cases and poses a significant burden on existing medical systems. Identifying an optimal strategy for preventing VCI and developing efficient symptomatic treatments remains a significant challenge. Syndrome differentiation represents a fundamental approach for personalized diagnosis and treatment in Traditional Chinese Medicine (TCM) and aligns with the principles of precision medicine. The objective of this study was to elucidate the metabolic characteristics of VCI based on TCM syndrome differentiation, thus providing novel insights into the diagnosis and treatment of VCI. Methods: A 2-year cross-sectional cognitive survey was conducted in four communities in Beijing between September 2020 and November 2022. The syndrome differentiation of participants was based on the Kidney-Yang Deficiency Syndrome Scale (KYDSS), which was originally developed by Delphi expert consultation. The identification of serum metabolites was performed by Ultra performance liquid chromatography (UPLC) analysis coupled with an electrospray ionization quadruple time-of-flight mass spectrometer (ESI-QTOF MS). Multivariate, univariate, and pathway analyses were used to investigate metabolic changes. Logistic regression models were also used to construct metabolite panels that were capable of discerning distinct groups. Phospholipase A2 (PLA2) levels were measured by a commercial ELISA kit. Results: A total of 2,337 residents completed the survey, and the prevalence of VCI was 9.84%. Of the patients with VCI, those with Kidney-Yang deficiency syndrome (VCIS) accounted for 70.87% of cases and exhibited more severe cognitive impairments. A total of 80 participants were included in metabolomics study, including 30 with VCIS, 20 without Kidney-Yang deficiency syndrome (VCINS), and 30 healthy control participants (C). Ultimately, 45 differential metabolites were identified when comparing the VCIS group with group C, 65 differential metabolites between the VCINS group and group C, and 27 differential metabolites between the VCIS group and the VCINS group. The downregulation of phosphatidylethanolamine (PE), and phosphatidylcholine (PC) along with the upregulation of lysophosphatidylethanolamine (LPE), lysophosphatidylcholine (LPC), phosphatidic acid (PA) and phospholipase A2 (PLA2) can be considered as the general metabolic characteristics associated with VCI. Dysfunction of glycerophospholipids, particularly LPEs and PCs, was identified as a key metabolic characteristic of VCIS. In particular Glycerophospho-N-Arachidonoyl Ethanolamine (GP-NArE) was discovered for the first time in VCI patients and is considered to represent a potential biomarker for VCIS. The upregulation of PLA2 expression was implicated in the induction of alterations in glycerophospholipid metabolism in both VCIS and VCINS. Moreover, robust diagnostic models were established based on these metabolites, achieving high AUC values of 0.9322, 0.9550, and 0.9450, respectively. Conclusion: These findings contribute valuable information relating to the intricate relationship between metabolic disorders in VCI, neurodegeneration and vascular/neuroinflammation. Our findings also provide a TCM perspective for the precise diagnosis and treatment of VCI in the context of precision medicine.

Cognitive-exercise dual-task attenuates chronic cerebral ischemia-induced cognitive impairment by activating cAMP/PKA pathway through inhibiting EphrinA3/EphA4

BackgroundThe prevalence of vascular cognitive impairment induced by chronic cerebral ischemia (CCI) is increasing year by year. Cognitive-exercise dual-task intervention has shown beneficial effects on improving cognitive performance in ischemic patients. It is well known that the tyrosine kinase ligand-receptor (Ephrin-Eph) system plays an important role in synaptic transmission and that the cAMP/PKA pathway is associated with cognitive function. However, it is unclear whether they are responsible for the dual-task improving cognitive impairment in CCI. MethodsBilateral common carotid artery occlusion (BCCAO) in SD rats was used to establish the CCI model. The effects of dual-task and single-task on cognitive function and the expressions of EphrinA3, EphA4, cAMP, and PKA in rats were detected by the novel object recognition (NOR) test, immunofluorescence staining, quantitative real-time polymerase chain reaction (qPCR), and Western blotting (WB), respectively. Overexpression or knockdown of EphrinA3 in astrocytes or rats were constructed by lentivirus infection to verify the effects of EphrinA3/EphA4 on the cAMP/PKA pathway. ResultsAfter dual-task intervention, the discrimination index of rats increased significantly compared with the rats in the CCI group. The expressions of EphrinA3 and EphA4 were decreased, while the expressions of cAMP and PKA were increased. Furthermore, knockdown of EphrinA3 alleviated the trend of CCI-induced cognitive decline in rats and OGD-stimulated cellular damage. It also increased cAMP/PKA expression in hippocampal neurons. ConclusionCognitive-exercise dual-task can significantly improve the cognitive impairment induced by CCI, and this effect may be better than that of the cognitive or exercise single-task intervention. The improvement may be related to the inhibition of EphrinA3/EphA4, followed by activation of the cAMP/PKA pathway.

The Role of Methionine-Rich Diet in Unhealthy Cerebrovascular and Brain Aging: Mechanisms and Implications for Cognitive Impairment.

As aging societies in the western world face a growing prevalence of vascular cognitive impairment and Alzheimer's disease (AD), understanding their underlying causes and associated risk factors becomes increasingly critical. A salient concern in the western dietary context is the high consumption of methionine-rich foods such as red meat. The present review delves into the impact of this methionine-heavy diet and the resultant hyperhomocysteinemia on accelerated cerebrovascular and brain aging, emphasizing their potential roles in cognitive impairment. Through a comprehensive exploration of existing evidence, a link between high methionine intake and hyperhomocysteinemia and oxidative stress, mitochondrial dysfunction, inflammation, and accelerated epigenetic aging is drawn. Moreover, the microvascular determinants of cognitive deterioration, including endothelial dysfunction, reduced cerebral blood flow, microvascular rarefaction, impaired neurovascular coupling, and blood-brain barrier (BBB) disruption, are explored. The mechanisms by which excessive methionine consumption and hyperhomocysteinemia might drive cerebromicrovascular and brain aging processes are elucidated. By presenting an intricate understanding of the relationships among methionine-rich diets, hyperhomocysteinemia, cerebrovascular and brain aging, and cognitive impairment, avenues for future research and potential therapeutic interventions are suggested.

The Underlying Role of the Glymphatic System and Meningeal Lymphatic Vessels in Cerebral Small Vessel Disease.

There is a growing prevalence of vascular cognitive impairment (VCI) worldwide, and most research has suggested that cerebral small vessel disease (CSVD) is the main contributor to VCI. Several potential physiopathologic mechanisms have been proven to be involved in the process of CSVD, such as blood-brain barrier damage, small vessels stiffening, venous collagenosis, cerebral blood flow reduction, white matter rarefaction, chronic ischaemia, neuroinflammation, myelin damage, and subsequent neurodegeneration. However, there still is a limited overall understanding of the sequence and the relative importance of these mechanisms. The glymphatic system (GS) and meningeal lymphatic vessels (mLVs) are the analogs of the lymphatic system in the central nervous system (CNS). As such, these systems play critical roles in regulating cerebrospinal fluid (CSF) and interstitial fluid (ISF) transport, waste clearance, and, potentially, neuroinflammation. Accumulating evidence has suggested that the glymphatic and meningeal lymphatic vessels played vital roles in animal models of CSVD and patients with CSVD. Given the complexity of CSVD, it was significant to understand the underlying interaction between glymphatic and meningeal lymphatic transport with CSVD. Here, we provide a novel framework based on new advances in main four aspects, including vascular risk factors, potential mechanisms, clinical subtypes, and cognition, which aims to explain how the glymphatic system and meningeal lymphatic vessels contribute to the progression of CSVD and proposes a comprehensive insight into the novel therapeutic strategy of CSVD.

Prevalence and Predictors of Vascular Cognitive Impairment in Patients With CADASIL.

Background and ObjectivesCerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is the most common monogenic form of stroke and early-onset dementia. We determined the prevalence of vascular cognitive impairment (VCI) in a group of patients with CADASIL and investigated which factors were associated with VCI risk, including clinical, genetic, and MRI parameters.MethodsCognition was assessed in patients with genetically confirmed CADASIL (n = 176) and healthy controls (n = 265) (mean [SD] age 50.95 [11.35] vs 52.37 [7.93] years) using the Brief Memory and Executive Test (BMET) and the Montreal Cognitive Assessment (MoCA). VCI was defined according to previously validated cutoffs. We determined the prevalence of VCI and its associations with clinical risk factors, mutation location (epidermal growth factor–like repeats [EGFr] 1–6 vs EGFr 7–34), and MRI markers of small vessel disease.ResultsVCI was more common in patients with CADASIL than in controls; 39.8 vs 10.2% on the BMET and 47.7% vs 19.6% on the MOCA. Patients with CADASIL had worse performance across all cognitive domains. A history of stroke was associated with VCI on the BMET (OR 2.12, 95% CI [1.05, 4.27] p = 0.04) and MoCA (OR 2.55 [1.21, 5.41] p = 0.01), after controlling for age and sex. There was no association of VCI with mutation site. Lacune count was the only MRI parameter independently associated with VCI on the BMET (OR: 1.63, 95% CI [1.10, 2.41], p = 0.014), after controlling for other MRI parameters. These associations persisted after controlling for education in the sensitivity analyses.DiscussionVCI is present in almost half of the patients with CADASIL with a mean age of 50 years. Stroke and lacune count on MRI were both independent predictors of VCI on the BMET.

Vascular cognitive impairment risk among Mongolian adults: An overview

Cognitive impairment is commonly associated with older people. It can also occur in middle-aged people due to non-communicable diseases. The prevalence of lifestyle-related diseases (non-communicable diseases) has been rapidly increasing in Mongolia. Therefore, we aimed to overview these studies to identify whether the increasing prevalence of non-communicable disease is associated with the risks of cognitive impairment in Mongolians. Published literature between 01 January 1980 and 20 June 2021 were included in the study. We searched articles published in journals registered to PubMed and doctoral and master's dissertations registered in the Central Medical Library of Mongolia using the following keywords: "cognitive impairment", "dementia", "mild cognitive impairment", "Alzheimer", "vascular dementia", “diabetes", "Mongolia", "obesity", "stroke", "hypertension". While there were no internationally published articles in this field, seven studies were either published in local research journals or as doctoral or master’s dissertations. Although few studies have been conducted in Mongolia, people with lifestyle-related conditions such as hypertension and diabetes are strongly associated with a higher risk of cognitive impairment. The increasing prevalence of non-communicable diseases may be one of the factors contributing to the prevalence of vascular cognitive impairment.

Cognitive Impairment in Patients with Stroke.

Despite substantial advances in stroke care, vascular cognitive impairment remains a prominent source of disability. Unlike sensorimotor impairments, cognition often continues to decline after stroke. An aging population will increase the prevalence of vascular cognitive impairment, with stroke playing an important role. Ten percent of patients presenting with stroke have pre-stroke dementia; an additional 10% will develop incident dementia with a first stroke, and 30% with a recurrent stroke. While stroke increases the risk of cognitive impairment, the presence of cognitive impairment also impacts acute stroke treatment and increases risk of poor outcome by nearly twofold. There is substantial overlap in the clinical and pathological aspects of vascular and degenerative dementias in many patients. How they relate to one another is controversial. The treatment of vascular cognitive impairment remains supportive, focusing on treating vascular risk factors. Cognitive rehabilitation after stroke is an area of active research, and existing pharmacologic treatments have limited benefit. Heightened awareness of cognitive impairment in the setting of stroke is imperative for prognostication and management, impetus for research and, ultimately, the discovery of efficacious treatments.

Study on epidemiology of cognitive dysfunction after stroke in the population over the age of 45 in Inner Mongolia

ABSTRACTObjective: To analyze the prevalence of different degrees vascular cognitive impairment (VCI) in stroke and the characteristics of demography distribution in Inner Mongolia. In order to provide reference data and theoretical guidance for the prevention and treatment of VCI after stroke in the area.Methods: Stratified multi-stage random sampling was used to extract six regions of Inner Mongolia as the first sampling cluster; and then the corresponding banners (counties) were selected randomly as the secondary sampling cluster; according to the number of patient required to investigation, the corresponding number of communities was randomly selected from the secondary sampling cluster. According to the diagnostic criteria of ‘Guidelines for the diagnosis and treatment of vascular cognitive impairment’ and National Institute of Neurological Disorders and Stroke convened an International Workshop with support from the Association Internationale pour la Recherche et l'Enseignement en Neurosciences (NINDS-AIREN), we screened all stroke patients aged 45 or older from each community, a total of 444 patients participated in the questionnaire and various scale assessments.Results: The prevalence of VCI, vascular cognitive impairment no dementia and vascular dementia was 80.41%, 34.46% and 45.95% respectively. The prevalence of VCI in stroke was significantly different in different nationality, age and education level (P < 0.05), and there was no significant difference in gender, occupation, marital status and family structure (P > 0.05).Conclusion: The prevalence of VCI after stroke was higher in Inner Mongolia, and VCI had a relatively high morbidity in old age people and person with less education in Chinese Han population.

RISK FACTOR PROFILES PREDICTING DELAYED VASCULAR COGNITIVE IMPAIRMENT IN YOUNG AND OLD ISCHEMIC STROKE SURVIVORS

Vascular cognitive impairment (VCI) can affect both young (<60 years old at onset) and old ischemic stroke survivors. Elucidating the specific risk profiles for delayed VCI in young and old patients will be useful in risk stratification and intervention with pharmacological and non-pharmacological measures. 854 ischemic stroke survivors from Singapore and Hong Kong with no pre-stroke decline were studied. Risk factor and MRI data from time of stroke was collected. Subjects were reviewed at 6 months post-stroke for cognitive assessment. A subcohort of 637 subjects was additionally reviewed 18 months post-stroke. Prevalence of VCI at both time-points was compared between old and young subjects. Stepwise logistic regression models predicting VCI and 6 months and 18 months for old and young subjects were used to describe specific risk profiles. 206 subjects (24.12%) were <60 years old at time of stroke. Overall prevalence of VCI was 44.6% at 6 months, and 49.3% at 18 months. Older subjects had less education and more risk factors, such as hypertension, prior stroke, atrial fibrillation, cortical atrophy, white matter hyperintensities, and chronic lacunes. VCI at 6 months was 18.9% for young subjects and 52.8% for old subjects.[Table 1] Increase of VCI between 6 months and 18 months was greater among the older stroke subjects (51.2% to 56.8%) as seen in the follow-up subcohort.[Figure 1] Education and chronic lacunes were significant predictors of VCI at both time-points for young subjects. Age, education, diabetes mellitus, and chronic lacunes were significant predictors for VCI for older subjects, with acute cortical large infarcts being an additional risk factor only at 6 months.[Table 2]. Older stroke survivors have a greater prevalence of VCI and continue to have higher increase in prevalence from months 6 to months 18 compared to younger patients. Low education and burden of chronic lacunes are common risk factors for VCI at all age and chronicity levels. Acute infarct characteristics are salient only for VCI in older subjects at months 6, but not for VCI at month 18. Chronic risk factors, not acute, are more predictive of long-term cognitive status in ischemic stroke survivors. Prevalence of VCI in young and old stroke survivors at 6 months and 18 months post-stroke in the follow-up subcohort

Vascular Cognitive Impairment

The term vascular cognitive impairment (VCI) has been proposed to encompass all people with cognitive impairment of cerebrovascular origin. VCI is not a single condition, but has several clinical presentations, etiologies, and treatment. VCI forms a spectrum that includes vascular dementia, mixed Alzheimer's disease with a vascular component, and VCI that does not meet dementia criteria. Multiple pathophysiological mechanisms contribute to VCI, accounting for its heterogeneity. Although main changes in the brain in VCI include cerebral infarcts, vascular cognitive impairment is thought to be due to factors beyond acute infarcts. Cerebral white matter lesions and silent brain infarcts are considered to be risk factors for VCI. The prevalence of VCI is high and this entity is poised to become the silent epidemic of the 21st century. Cognitive impairment due to cerebrovascular disease can to some extent be improved, and VCI prevented, if vascular risk factors are brought under control and strokes do not recur. Therefore, strategies that focus on the prevention and treatment of the cognitive impairment associated with cerebrovascular disease are high priority healthcare objectives.

Prevalence of vascular cognitive impairment in acute transient ischemic attack and minor stroke

Prevalence of vascular cognitive impairment in acute transient ischemic attack and minor stroke

VASCULAR COGNITIVE IMPAIRMENT: POSSIBLE MECHANISMS OF DEVELOPMENT

The prevalence of vascular cognitive impairment increases with the population ageing. Given the growing medical, social and economic signiicance of vascular cognitive impairment, its prevention and treatment are important priorities nowadays. Understanding the mechanisms of vascular cognitive impairment contributes to the effective primary and secondary prevention, as well as to proper treatment.

The prevalence of vascular cognitive impairment and its subtypes in Korean elders

The prevalence of vascular cognitive impairment and its subtypes in Korean elders

Prevalence of dementia and mild cognitive impairment in a Bulgarian urban population.

Prevalence of cognitive impairment and dementia has not been studied in Bulgaria up to date. A 2-phase cross-sectional study was designed in order to determine the prevalence of dementia, its subtypes, and mild cognitive impairment in a Bulgarian population. The study sample consisted of 605 participants over the age of 65, residents of the city of Varna. A total of 540 participants (89%) completed the screening phase of the study. All positive screens and a control group were included in the diagnostic phase of the study, where comprehensive neuropsychological, clinical, and imaging assessments were performed. Dementia was diagnosed in 39 persons (7.2%) and 36 had mild cognitive impairment (6.7%). Alzheimer's disease was the most frequent type of dementia (3.1%), followed by vascular dementia (2.0%). Our results support the hypothesis that prevalence of vascular cognitive impairment may be higher in Bulgaria than in most European countries.

Vascular cognitive impairment: disease mechanisms and therapeutic implications.

The prevalence of vascular cognitive impairment (VCI) is likely to increase as the population ages and cardiovascular disease survival improves. We provide an overview of the definition and disease mechanisms of VCI and present a systematic literature review of the current evidence for the pharmacologic and nonpharmacologic therapies used to treat the VCI symptoms of cognitive dysfunction or to modify VCI through primary and secondary prevention. The Cochrane Database of Systematic Reviews was searched from 2005 to October 2010 using the keywords "vascular dementia" or "vascular cognitive impairment and therapy." MEDLINE was searched for English-language articles published within the last 10years using the combined Medical Subject Headings (MeSH) "therapeutics and dementia," "vascular" or "vascular cognitive impairment." Although cholinesterase inhibitors and memantine produce small cognitive improvements in patients with VCI, these drugs do not improve global clinical outcomes and have adverse effects and costs. Selective serotonin reuptake inhibitors and dihydropyridine calcium channel blockers may improve short-term cognitive function in patients with VCI. Anti-hypertensive therapy with an ACE inhibitor-based regimen and statins may prevent the major subtype of VCI known as poststroke cognitive decline. Clinical and effectiveness studies with long-term follow-up are needed to determine the benefits and risks of pharmacologic and nonpharmacologic therapies to prevent and treat VCI. Given its growing health, social, and economic burden, the prevention and treatment of VCI are critical priorities for clinical care and research.