New horizons in cognitive and functional impairment as a consequence of cerebral small vessel disease

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Abstract

Cerebral small vessel disease (cSVD) is a frequent finding in imaging of the brain in older adults, especially in the concomitance of cardiovascular disease risk factors. Despite the well-established link between cSVD and (vascular) cognitive impairment (VCI), it remains uncertain how and when these vascular alterations lead to cognitive decline. The extent of acknowledged markers of cSVD is at best modestly associated with the severity of clinical symptoms, but technological advances increasingly allow to identify and quantify the extent and perhaps also the functional impact of cSVD more accurately. This will facilitate a more accurate diagnosis of VCI, against the backdrop of concomitant other neurodegenerative pathology, and help to identify persons with the greatest risk of cognitive and functional deterioration. In this study, we discuss how better assessment of cSVD using refined neuropsychological and comprehensive geriatric assessment as well as modern image analysis techniques may improve diagnosis and possibly the prognosis of VCI. Finally, we discuss new avenues in the treatment of cSVD and outline how these contemporary insights into cSVD can contribute to optimise screening and treatment strategies in older adults with cognitive impairment and multimorbidity.

Original languageEnglish
Article numberafad148
JournalAge and Ageing
Volume52
Issue number8
DOIs
Publication statusPublished - 1 Aug 2023

Bibliographical note

Funding Information:
M.W. Vernooij received research funding from ZonMw and HealthHolland, outside of this published work. F. Wolters received research funding from the Dutch Research Council (NWO), the Alzheimer’s Association and the Brain & Behaviour Research Foundation, outside of this published work, and has been consultant for the PGGM Pension Fund (fees paid to institution).

Publisher Copyright:
© 2023 The Author(s). Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved.

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