Aging and Cerebrovascular disease

Aging influences cerebrovascular disease expression by a variety of mechanisms. Reduction in CBF creates ischemic changes in brain cells as appreciated by more recent neuroimaging modalities. Age-related changes in cellular metabolism make brain cells more susceptible to injury. The BBB becomes more permeable and susceptible to damage during aging. The elderly often have changes in autoregulation in cerebral vessels and also have impaired collateral circulation. They become more prone to watershed infarction because of these changes in the vasculature. Labile blood pressure with compromised cardiopulmonary function or impaired autonomic function may make the elderly more likely to suffer from ischemic events or cerebral hypoperfusion. Cardioembolic disease from atrial fibrillation is clearly best treated with anticoagulation for appropriate patients. Several clinical studies have provided guidelines for managing carotid artery disease. Transient global amnesia when diagnosed by strict criteria is a benign condition requiring no therapeutic intervention. Vascular dementia and white matter disease are better understood with newer neuroimaging studies, careful neuropsychologic testing, and histopathologic examinations. Atherosclerosis and cerebral amyloid angiopathy may have larger roles than previously understood in Alzheimer's disease. Binswanger's disease may manifest in several types of gait disorders. With further progress, new treatments for vascular dementia and other diseases previously mentioned may become available. Currently, stroke prophylactic measures and careful hypertension control are important initial steps for preventing ischemic CVD. The pathogenesis of cerebral amyloid angiopathy is slowly becoming understood and the relationship to apolipoprotein E needs to be further explored. Older patients suffer from cerebral hemorrhages and subdural hematomas more often for a variety of reasons.