Rare inherited coagulation and fibrinolytic defects that challenge diagnostic laboratories

Mild Chronic Small Vessel Disease Ups Risk For DementiaEntertainment ...

What is mild chronic small vessel disease?

Mild chronic small vessel disease, or cerebral small vessel disease (CSVD), is an umbrella term for a range of conditions caused by damage to small blood vessels in the brain. An estimated 11 million Americans are living with CSVD, with a 25% chance of strokes caused by the condition and 45% of dementia cases caused by CSVD.

CSVD usually results from the narrowing or blockage of the brain vessels due to inflammation, hardening of the arteries, plaque buildup or the thickening of the vessel walls. Consistent and ongoing damage to the brain's blood vessels deprives cells of oxygen and can cause permanent deterioration and dysfunction.

Some earlier signs and symptoms of the condition may go unnoticed as symptoms become more severe at later stages of the disease after more significant brain damage has occurred. Such symptoms include stroke, cognitive impairment, movement disorders, nervous system problems and mental health issues. Additionally, individuals with CSVD have an increased risk of developing various forms of dementia, including Alzheimer's disease.

Researchers are still conducting studies to fully understand how CSVD develops and progresses, but they have identified several causes of CSVD-related damage to the brain's small blood vessels. CSVD can be caused by both genetic and lifestyle factors, which include chronic kidney disease, high blood pressure and cholesterol, diabetes and smoking. Genetic diseases and predisposition toward certain conditions are also factors in developing CSVD. CSVD is most common in older adults and about 5% of individuals over 50 have CSVD, with that number increasing with age. Nearly 100% of individuals over 90 have some stage of the disease and according to recent studies, CSVD affects individuals of all genders, ethnic groups and geographical locations equally.

Getting a CSVD diagnosis usually begins after the individual has experienced a stroke, dementia or other serious symptoms. A doctor will initially conduct an MRI scan to start the process. Unlike large vessels of the brain, small vessels are hard to detect through imaging, so doctors will look for biomarkers (measurable disease indicators) that are easier to identify. In cases of CSVD, doctors use areas of damaged tissue, or brain lesions, as biomarkers for the condition, and check for bleeding of the small blood vessels, damage to white matter or evidence of any small strokes.

The primary goal of the treatment of CSVD is to reduce risk factors and prevent or delay complications of the condition. As causes and risk factors vary with each individual, personalized treatments are the most effective. Doctors recommend adopting healthy lifestyles such as regular exercise, a nutrient-rich diet and smoking cessation. More specialized treatments could include speech therapy and counseling for depression.

Cerebral Small Vessel Disease, Hypertension Increase Cognitive ...

Jan. 4 (UPI) -- High blood pressure, in combination with periventricular white matter hyperintensities progression, could bring on cognitive impairment, even with medication to lower blood pressure, a new study says.

New research published in the journal Hypertension showed that, among 345 men and women over age 65 with hypertension, 9 percent developed cerebral small vessel disease, bringing with it a higher risk of developing mild cognitive impairment. This can ultimately lead to dementia.

"The brain is an organ exposed to a high volume of blood flow and it is very vulnerable to sustained high blood pressure levels, and this might be happening silently or with mild symptoms, but that doesn't mean there aren't consequences," Joan Jiménez Balado, a doctoral student at the Institut de Recerca Hospital Vall d'Hebron in Barcelona, Spain, and study lead author, said in a news release.

Cerebral small vessel disease, a common neurological disease that normally strikes older people, causes stroke and dementia, according to the British Medical Journal. To diagnose cerebral small vessel disease, doctors look for signs of white matter hyperintensities progression and visible perivascular spaces, along with other conditions.

Untreated high blood pressure can lead to cerebral small vessel disease.

The Centers for Disease Control and Prevention estimates that about 75 million people in the U.S. Have high blood pressure, which also increases the risk of heart disease and stroke.

Hypertension has already been linked to dementia. But this latest study gets closer to figuring out what small indicators create a link between dementia and high blood pressure.

To figure out that connection, scientists peered into the white matter, which attaches to different areas of the brain. The periventricular white matter sits in the central portion of the brain and serves as a key player in helping cognitive function. So when lesions or irregularities arise in the white matter area, that could point to cognitive impairment.

In the study, researchers discovered that patients with periventricular white matter abnormalities progression displayed a six-fold increased risk of mild cognitive decline. It also showed that these abnormalities were associated with small vessel bleeding within the brain and a decrease in cognitive "global and executive function."

If the lesions go untreated, they can lead to sharper cognitive decline.

"High blood pressure and its consequences are really 'covert' diseases that tend to progress if it is not well managed," Balado said.

Leaky Blood-brain Barrier Linked To Brain Tissue Damage In Brain Aging ...

As people age, changes in the tiniest blood vessels in the brain, a condition called cerebral small vessel disease, can lead to thinking and memory problems and stroke. These changes can also affect the blood-brain barrier, a layer of cells that protect the brain from toxins circulating in the blood. Now a new study has found that people with cerebral small vessel disease who have blood-brain barrier leakage had more brain tissue damage over two years than people with less blood-brain barrier leakage. The study is published in the March 24, 2021, online issue of Neurology®, the medical journal of the American Academy of Neurology.

"Previous research has shown that disruption of the blood-brain barrier is increased in people with cerebral small vessel disease," said study author Danielle Kerkhofs, M.D., of Maastricht University Medical Center in Maastricht, Netherlands. "People with cerebral small vessel disease also may have brain lesions called white matter hyperintensities. Such lesions are visible by MRI and believed to be signs of brain damage and a marker of the severity of disease. For our study, we wanted to see if a leaky blood-brain barrier was linked to degeneration of brain tissue even before these brain lesions appear. We looked at normal brain tissue, surrounding and close to the brain lesions, because we consider this 'tissue at risk.'"

The study involved 43 people with cerebral small vessel disease with an average age of 68. Researchers used MRI at the start of the study to measure the leakiness of the blood-brain barrier for each participant. They then used another brain imaging technique to measure the integrity of the tissue's microstructure surrounding brain lesions. This imaging technique was repeated two years later to see whether the brain tissue integrity has decreased.

Researchers measured the relationship between blood-brain barrier leakage and changes in brain tissue. They found the higher the tissue volume with blood-brain barrier leakage at the start of the study, the greater the loss of brain tissue integrity was around brain lesions two years later. For every 10% increase in leakage volume at the start of the study, after two years the diffusivity of the brain tissue increased by 1.4 %, representing a decrease in brain tissue integrity. They also found a similar relationship involving the leakage rate of the blood-brain barrier -- a higher leakage rate at the start of the study resulted in more loss of tissue microstructure around the brain lesions.

"Our results support the theory that a compromised blood-brain barrier may play an early role in loss of brain tissue integrity as part of the cerebral small vessel disease process, even before brain lesions are visible on MRI," said Kerkhofs. "The change in integrity of brain tissue at risk, close to the brain lesions, could be a promising biomarker in future cerebral small vessel disease studies examining possible prevention strategies and treatment options."

A limitation of the study was that the short follow-up period may have underestimated the associations. Kerkhofs said future studies should measure such changes in larger groups of people over longer periods of time.

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