title: Cerebral small vessel disease: Capillary pathways to stroke and cognitive decline.
abstract: Cerebral small vessel disease (SVD) gives rise to one in five strokes worldwide and constitutes a major source of cognitive decline in the elderly. SVD is known to occur in relation to hypertension, diabetes, smoking, radiation therapy and in a range of inherited and genetic disorders, autoimmune disorders, connective tissue disorders, and infections. Until recently, changes in capillary patency and blood viscosity have received little attention in the aetiopathogenesis of SVD and the high risk of subsequent stroke and cognitive decline. Capillary flow patterns were, however, recently shown to limit the extraction efficacy of oxygen in tissue and capillary dysfunction therefore proposed as a source of stroke-like symptoms and neurodegeneration, even in the absence of physical flow-limiting vascular pathology. In this review, we examine whether capillary flow disturbances may be a shared feature of conditions that represent risk factors for SVD. We then discuss aspects of capillary dysfunction that could be prevented or alleviated and therefore might be of general benefit to patients at risk of SVD, stroke or cognitive decline.
authors.affiliation: Center of Functionally Integrative Neuroscience and MINDLab, Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark Department of Neuroradiology, Aarhus University Hospital, Aarhus, Denmark leif@cfin.au.dk.
authors.forename: Leif
authors.initials: L
authors.lastname: Østergaard
authors.affiliation: Center of Functionally Integrative Neuroscience and MINDLab, Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark.
authors.forename: Thorbjørn S
authors.initials: TS
authors.lastname: Engedal
authors.affiliation: Institute of Neuroscience and Psychology, University of Glasgow, Glasgow, UK.
authors.forename: Fiona
authors.initials: F
authors.lastname: Moreton
authors.affiliation: Center of Functionally Integrative Neuroscience and MINDLab, Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark.
authors.forename: Mikkel B
authors.initials: MB
authors.lastname: Hansen
authors.affiliation: Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.
authors.forename: Joanna M
authors.initials: JM
authors.lastname: Wardlaw
authors.affiliation: Institute of Neurological Sciences and Psychiatry and Department of Neurology, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
authors.forename: Turgay
authors.initials: T
authors.lastname: Dalkara
authors.affiliation: Department of Clinical Neuroscience, University of Cambridge, Cambridge, UK.
authors.forename: Hugh S
authors.initials: HS
authors.lastname: Markus
authors.affiliation: Institute of Neuroscience and Psychology, University of Glasgow, Glasgow, UK.
authors.forename: Keith W
authors.initials: KW
authors.lastname: Muir
mesh_terms: D002196:Capillaries / Q000473:pathology*; D059345:Cerebral Small Vessel Diseases / Q000150:complications / Q000473:pathology* / Q000523:psychology; D003072:Cognition Disorders / Q000209:etiology*; D018450:Disease Progression; D006801:Humans; D020521:Stroke / Q000209:etiology / Q000473:pathology*
keywords: Cerebral small vessel disease; capillary dysfunction; dementia; oxygenation; stroke