Cerebral Small Vessel Disease in subclinical and clinical stages, role of inflammation for risk prediction and potential treatment targets, and management strategies
Stroke and dementia are the most common neurological disorders worldwide. Cerebrovascular disease, particularly cerebral small vessel disease (CSVD) is implicated in both, and the two main types of CSVD (hypertensive vasculopathy and cerebral amyloid angiopathy) account for the majority of cerebrovascular contributions to stroke and dementia. Current knowledge of CSVD may influence treatment decisions and preventive efforts. Although the causes of CSVD are not entirely elucidated, ongoing research of the pathophysiology of CSVD, such as the role of inflammation, is helping identify potential treatment targets, evaluate prediction models and develop preventive strategies. Given the detectability of CSVD in preclinical stages using brain MRI, a long window of opportunity is presented to implement existent preventive measures. This review considers CSVD including its subclinical manifestations detected using brain MRI, clinical manifestations, use of markers of CSVD as predictors of clinical outcomes such as dementia and stroke, and presents potential management strategies when seeing patients with cerebral small vessel disease to reduce its disease burden and clinical consequences. Clinical trials have evaluated some aspects of CSVD treatment and are beginning to recognize CSVD as endpoint in subclinical stages. Future studies will clarify if this approach is able to delay onset of dementia and prevent stroke occurrence, meanwhile implementation of existent recommendations for the prevention and treatment of stroke and dementia may reduce disability and clinical outcomes related to CSVD.
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