Treatment Of Cerebral Small Vessel Disease Research Articles

Evidence-based evaluation of adjuvant therapy with Chinese medicine for cerebral small vessel disease: A systematic review and meta-analysis

Background: As the population ages, the prevalence of cerebral small vessel disease (CSVD) steadily increases, resulting in a significant economic burden on society. In East Asian nations, Chinese medicine has been used extensively to teat CSVD and has been reported to improve the cognitive function of patients. The present study aimed to comprehensively assess the efficacy and safety of Chinese medicine as adjuvant therapy for CSVD. Methods: A literature search of the CNKI, Wanfang, VIP, SinoMed, Medline, Cochrane Library, and ChiCTR databases were searched for RCTs investigating the use of TCM as an adjuvant in the treatment of CSVD, published up to July 27, 2023, was performed. Based on the Cochrane Collaboration Network bias risk assessment criteria, Review Manager version 5.3 was used to perform a meta-analysis. Results: Meta-analysis of 27 RCTs, including 2554 subjects, revealed that the majority of the RCTs exhibited risk for ambiguous bias. The findings demonstrated that the use of Chinese medicine as an adjuvant treatment for CSVD effectively enhanced the cognitive function, as evidenced by improvements in the MMSE score (mean difference (MD) = 2.42, 95% confidence interval (CI) [1.79,3.17], P < .00001), MoCA score (MD = 2.39, 95% CI [1.78,2.99], P < .00001) and ADL score (MD = 4.13, 95% CI [1.74,6.51], P = .0007). Furthermore, the study also demonstrated the advantages of Chinese medicine adjuvant therapy in enhancing the Chinese medicine syndrome score (MD = −2.57, 95% CI [−3.31, −1.83], P < .00001), CRP (MD = −1.35, 95% CI [−2.27, −0.43], P = .004), Hcy (MD = −3.44,95% CI [−4.05, −2.83], P < .00001), and blood flow velocity (CBV) (MD = 1.37,95% CI [0.24,2.50], P = .02). Moreover, there was no statistical difference in the incidence of adverse reactions between the 2 groups. Conclusion: Findings of the present study indicate that the Chinese medicine, as an adjuvant to conventional treatment, appeared to be efficacious in enhancing cognitive function, reducing Chinese medicine syndrome score, improving blood biochemical markers, and improving cerebral blood flow perfusion in patients with CSVD, without any notable adverse reactions. However, it is imperative to validate these conclusions in future high-quality investigations.

Relationships between intracranial arterial dolichoectasia and small vessel disease in patients with ischaemic stroke: a systematic review and meta-analysis.

Intracranial arterial dolichoectasia (IADE) is a common arterial finding of dilation, elongation, or both, affecting large intracranial vessels, and associated with vascular risk factors, including hypertension. Associations of IADE with neuroimaging cerebral small vessel disease (CSVD) may be relevant for diagnosis and prognosis in patients with stroke. The study aimed to conduct an updated systematic review and meta-analysis of observational studies to investigate the relationships of IADE with well-defined CSVD markers in patients with ischaemic stroke. We systematically searched PubMed, Embase, and Scopus for studies on IADE in ischaemic stroke patients with fulfilling predefined inclusion criteria. We pooled data to conduct a meta-analysis to compare the prevalence of SVD markers between patients with and without IADE groups using risk ratios (RRs) and 95% confidence intervals (CIs). From 157 retrieved abstracts, we included six studies from seven publications comprising 6102 patients with ischaemic stroke. The mean age of patients was 52.8years, and 3691 (60.5%) were male. IADE was diagnosed in 11.4% (95% CI 8.9-13.9) (761) of included patients; 51.8% (3160) had hypertension. Compared to patients without IADE, individuals diagnosed with IADE had a significantly increased prevalence of lacune (RR 1.67, 95% CI 1.36-2.06, P < 0.01, I2 = 0.00%), cerebral microbleeds (CMBs) (RR 2.56, 95% CI 1.53-4.28, P < 0.01, I2 = 84.95%) and white matter hyperintensities (WMHs) (RR 2.17, 95% CI 1.84-2.56, P < 0.01, I2 = 0.00%). In patients with ischaemic stroke, IADE is associated with a higher prevalence of CSVD markers, including lacunes, CMBs, and WMHs. Further studies are needed to clarify the mechanisms underlying these associations and their potential relevance for the understanding, diagnosis, and treatment of CSVD.

Research progress on the correlation between MRI and impairment caused by cerebral small vessel disease: A review.

Cerebral small vessel disease (CSVD) is a chronic global brain disease mainly involving small blood vessels in the brain. The disease can be gradually aggravated with the increase of age, so it is the primary cause of brain dysfunction in the elderly. With the increasing aging of the world population and the high incidence of cerebrovascular risk factors, the incidence of CSVD is increasing day by day. CSVD is characterized by insidious onset, slow progression, diverse clinical manifestations, and difficult early diagnosis. CSVD can lead to cognitive impairment, gait impairment, affective impairment, and so on. however, it has not received enough attention from researchers in the past. In recent years, some studies have shown that CSVD patients have a high proportion of related impairment, which seriously affect patients daily life and social functions. Currently, no clear preventive measures or treatments exist to improve the condition. With the development of magnetic resonance imaging, CSVD has become more and more recognized and the detection rate has gradually improved. This paper reviews the research progress of magnetic resonance imaging and cognitive impairment, gait impairment, affective impairment, urination disorder, swallowing disorder, and other disorders to provide a useful reference for the early diagnosis and treatment of CSVD and expand new ideas.

Progress on Prevention and Treatment of Cerebral Small Vascular Disease Using Integrative Medicine.

Cerebral small vessel disease (CSVD) is a senile brain lesion caused by the abnormal structure and function of arterioles, venules and capillaries in the aging brain. The etiology of CSVD is complex, and disease is often asymptomatic in its early stages. However, as CSVD develops, brain disorders may occur, such as stroke, cognitive dysfunction, dyskinesia and mood disorders, and heart, kidney, eye and systemic disorders. As the population continues to age, the burden of CSVD is increasing. Moreover, there is an urgent need for better screening methods and diagnostic markers for CSVD, in addition to preventive and asymptomatic- and mild-stage treatments. Integrative medicine (IM), which combines the holistic concepts and syndrome differentiations of Chinese medicine with modern medical perspectives, has unique advantages for the prevention and treatment of CSVD. In this review, we summarize the biological markers, ultrasound and imaging features, disease-related genes and risk factors relevant to CSVD diagnosis and screening. Furthermore, we discuss IM-based CSVD prevention and treatment strategies to stimulate further research in this field.

Biomarkers involved in the pathogenesis of cerebral small-vessel disease

Cerebral small-vessel disease (CSVD) has been found to have a strong association with vascular cognitive impairment (VCI) and functional loss in elderly patients. At present, the diagnosis of CSVD mainly relies on brain neuroimaging markers, but they cannot fully reflect the overall picture of the disease. Currently, some biomarkers were found to be related to CSVD, but the underlying mechanisms remain unclear. We aimed to systematically review and summarize studies on the progress of biomarkers related to the pathogenesis of CSVD, which is mainly the relationship between these indicators and neuroimaging markers of CSVD. Concerning the pathophysiological mechanism of CSVD, the biomarkers of CSVD have been described as several categories related to sporadic and genetic factors. Monitoring of biomarkers might contribute to the early diagnosis and progression prediction of CSVD, thus providing ideas for better diagnosis and treatment of CSVD.

Cerebral Small Vessel Disease: Neuroimaging Features, Biochemical Markers, Influencing Factors, Pathological Mechanism and Treatment.

Cerebral small vessel disease (CSVD) is the most common chronic vascular disease involving the whole brain. Great progress has been made in clinical imaging, pathological mechanism, and treatment of CSVD, but many problems remain. Clarifying the current research dilemmas and future development direction of CSVD can provide new ideas for both basic and clinical research. In this review, the risk factors, biological markers, pathological mechanisms, and the treatment of CSVD will be systematically illustrated to provide the current research status of CSVD. The future development direction of CSVD will be elucidated by summarizing the research difficulties.

Exosomal miRNA-223-3p as potential biomarkers in patients with cerebral small vessel disease cognitive impairment.

BackgroundCerebrovascular disease is a common clinical illness. Many patients with cerebrovascular disease can be accompanied by cognitive impairment. The exosomal microRNA (miRNA)-223-3p is related to vascular endothelial injury, synaptic function, inflammatory response, and other mechanisms. In this study, we investigated the levels of plasma exosomal miRNA-223-3p in patients with cerebral small vessel disease (CSVD), in order to determine whether it could be used as a more accessible potential biomarker for the early diagnosis and treatment of CSVD. This study aimed to explore whether the development of cognitive impairment can be explained by differentially expressed miRNA-223-3p by detecting the level of miRNA-223-3p, which is abundant in peripheral blood exosomes related to cognitive impairment in CSVD.MethodsThe three groups of participants included 40 patients with CSVD cognitive impairment (CSVDCI), 38 patients with CSVD, and 35 normal controls (NC). The real-time polymerase chain reaction (RT-PCR) was used to detect the expression level of blood exosomal miRNA-223-3p. In addition, we also studied the relationship between exosomal miRNA-223-3p and blood Hcy and C-reactive protein (CRP). Receiver-operating characteristic (ROC) curve analysis was used to evaluate the diagnostic efficacy of plasma exosomal miRNA-223-3p.ResultsThe expression of exosomal miRNA-223-3p in CSVD increased, and the expression of miRNA-223-3p increased significantly with the occurrence of cognitive impairment. Exosomal miRNA-223-3p was positively correlated with the expression levels of Hcy and CRP in the blood.ConclusionsThe expression of plasma exosomal miRNA-223-3p is associated with the development of cognitive impairment in patients with CSVD. It may be involved in the pathogenesis of CSVD and cognitive impairment, and can be used as a sensitive predictive biomarker.

Update of Immunosenescence in Cerebral Small Vessel Disease.

Aging of the central nervous system (CNS) is closely associated with chronic sterile low-grade inflammation in older organisms and related immune response. As an amplifier for neuro-inflammaging, immunosenescence remodels and deteriorates immune systems gradually with the passage of time, and finally contributes to severe outcomes like stroke, dementia and neurodegeneration in elderly adults. Cerebral small vessel disease (CSVD), one of the major causes of vascular dementia, has an intensive connection with the inflammatory response and immunosenescence plays a crucial role in the pathology of this disorder. In this review, we discuss the impact of immunosenescence on the development of CSVD and its underlying mechanism. Furthermore, the clinical practice significance of immunosenescence management and the diagnosis and treatment of CSVD will be also discussed.

Effect of cerebral small vessel disease on cognitive function and TLR4 expression in hippocampus

The aim of this study was to explore the differences in cognitive and neurological functions between cerebral small vessel disease (CSVD) rats and normal rats, as well as to study the Toll- like receptor 4 (TLR4) expression in the hippocampus of CSVD rats to understand its role in this brain structure. Forty male, 12-week old, specific pathogen-free (SPF), spontaneously hypertensive rats (SHRs) were used as the observation group, while 20 12-week old, SPF, Wistar male rats were used as the control group. After each measurement, 10 rats in the observation group and 5 in the control group were decapitated to collect samples for determining the expression of TLR4 in the hippocampus. At T1, difference in the latency of rats in the observation group showed no statistically significance (p = 0.836), while at T2, T3 and T4, the observation group showed longer latency than did the control group (p < 0.001). In addition, the latency of SHRs at T1 was the shortest (p < 0.05) compared to the follow-ups (T2-T4) and were followed sequentially by T2, T3, and T4 (p < 0.05). The latency was shorter than those at T1 and T2, and the shortest latency was found at T4 (p < 0.05). CSVD rats exhibited poor cognitive and neurological functions compared to normal rats and high expression of TLR4 in the hippocampus. Based on these results, we suggest that TLR4 affects the cognitive function of CSVD rats, and, thus, may be a valuable target in the treatment of CSVD.

The research progress of cerebral microbleeds

Cerebral microbleeds (CMBs ), as an important imaging marker of cerebral small vessel disease ( CSVD), is a subclinical damage caused by small hemosiderin deposits indicative of prior cerebral microscopic hemorrhage. In recent years, CMBs have become an important research issue in the field of neuroimaging with the development of newer magnetic resonance imaging (MRI ) methods for the higher detection rate of the CMBs. It must to be mentioned that CMBs plays a crucial role in the formatting process of vascular cognitive impairment (VCI), which caused researcher’s attention. This review focuses on the research progress in epidemiological status, pathological mechanisms, risk factors, imaging manifestations, clinical features and treatment therapies of CMBs, in order to provide theoretical references for the early detection, prevention and treatment of CSVD and VCI. Key words: Cerebral microbleeds; Cognitive impairment; Susceptibility-weighted imaging

Identification of key signaling pathways in cerebral small vessel disease using differential pathway network analysis.

Cerebral small vessel disease (CSVD) primarily affects the perforating cerebral arterioles and capillaries, and results in injury to subcortical grey and white matter. Despite advances in determining the genetic basis of CSVD, the molecular mechanisms underlying the development and progression of CSVD remain unclear. The present study aimed to identify significant signaling pathways associated with CSVD based on differential pathway network analysis. Combining CSVD microarray data with human protein-protein interaction data and data from the Reactome pathway database, pathway interactions were constructed using the Spearman's correlation coefficient strategy. Pathway interactions with weight values of >0.95 were selected to construct the differential pathway network, which contained 715 differential pathway interactions covering 312 nodes and was visualized using Cytoscape software. A total of 15 hub pathways with a top 5% degree distribution in the differential pathway network were identified. The top 5 hub pathways were associated with the synthesis and metabolism of fatty acids. The results of the present study indicate that the synthesis and metabolism of fatty acids is associated with the occurrence and development of CSVD, and may thus provide insights to improve the early diagnosis and treatment of CSVD.

Sports medicine

Cerebral small vessel disease (CSVD) refers to a type of syndrome caused by lesions in perforating arteries, small veins, small arteries, or capillaries, resulting in clinical, imaging, or pathological alterations. The occurrence and development of CSVD are related to various cerebrovascular risk factors, such as metabolism and genetic factors. CSVD is diagnosed based on brain imaging biomarkers; however, biomarkers capable of predicting and diagnosing CSVD early in its progression have not been found. Exploring biomarkers closely related to disease progression is of great significance for early diagnosis, prognosis, prevention, and treatment of CSVD. This article examines the research progress of CSVD biomarkers, from inflammatory biomarkers, coagulation and fibrinolysis markers, biomarkers of endothelial dysfunction, biomarkers related to cerebrospinal fluid, and gene markers.