Towards the concept of disease-modifier in post-stroke or vascular cognitive impairment: a consensus report

Abstract

BackgroundVascular cognitive impairment (VCI) is a complex spectrum encompassing post-stroke cognitive impairment (PSCI) and small vessel disease-related cognitive impairment. Despite the growing health, social, and economic burden of VCI, to date, no specific treatment is available, prompting the introduction of the concept of a disease modifier.Consensus and suggestionsWithin this clinical spectrum, VCI and PSCI remain advancing conditions as neurodegenerative diseases with progression of both vascular and degenerative lesions accounting for cognitive decline. Disease-modifying strategies should integrate both pharmacological and non-pharmacological multimodal approaches, with pleiotropic effects targeting (1) endothelial and brain–blood barrier dysfunction; (2) neuronal death and axonal loss; (3) cerebral plasticity and compensatory mechanisms; and (4) degenerative-related protein misfolding. Moreover, pharmacological and non-pharmacological treatment in PSCI or VCI requires valid study designs clearly stating the definition of basic methodological issues, such as the instruments that should be used to measure eventual changes, the biomarker-based stratification of participants to be investigated, and statistical tests, as well as the inclusion and exclusion criteria that should be applied.ConclusionA consensus emerged to propose the development of a disease-modifying strategy in VCI and PSCI based on pleiotropic pharmacological and non-pharmacological approaches.

Association between Pulse Pressure and Onset of Dementia in an Elderly Korean Population: A Cohort Study

“…It can be inferred that high pulse pressure levels are associated with increased brain white matter lesions and the occurrence of dementia through microvessel disorders in the cerebrum [38][39][40][41][42]. Therefore, those diseases are likely to be synergistic effects to developing dementia [43]. Moreover, one study found the possibility that pulse pressure may be also related to increased cerebrospinal fluid and phosphorylated-tau in normal elderly [44].…”

ClinMine: Optimizing the Management of Patients in Hospital

“…memory impairment, attention trouble, executive dysfunction) are related to several pathological conditions: neurodegenerative diseases (in particular Alzheimer's disease), inflammatory diseases (such multiple sclerosis), neurovascular diseases like stroke, vascular risk factors (hypertension, diabetes, hypercholesterolemia), drugs… These cognitive disorders are developing during several years, with consultation or hospitalization in different medical departments. The clustering tools developed in ClinMine would be able to propose a new stratification of cognitive disorders with the possibility to develop specific therapeutic approach in each cluster [Bordet17]. Secondly, the so-called big data is postulated to offer new opportunity to the resourcing of pathophysiological and therapeutic hypothesis in medicine, by identification of new associations between symptoms, paraclinical parameters, drugs, environmental factors, even though these new hypothesis should have to be confirmed or developed through classical translational and clinical research.…”

Update on the Neurobiology of Vascular Cognitive Impairment: From Lab to Clinic

“…Interestingly, TMS findings point out the possibility to predict the progression of mild VCI into VaD, especially in those with concomitant late-onset depression and SIVD (the so-called "vascular depression") [39,50], and to select responders to specific drugs or non-pharmacological treatments [40,41,49,85]. This will be of pivotal importance when designing trials of disease-modifying drugs or approaches based on rTMS or other neuromodulatory interventions [119].…”