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Staging: relevance for trial design in vascular burden of the brain
Barry Reisberg1, Steven H Ferris, Thet Oo
1William and Sylvia Silberstein Aging and Dementia Research Center, New York University School of Medicine, NY 10016, USA. barry.reisberg@med.nyu.edu
Insights
Cerebrovascular small vessel disease is a major cause of brain vascular burden. Its clinical staging may mirror Alzheimer's disease, but requires further study.
Area of Science:
- Neurology
- Neuroscience
- Vascular Biology
Background:
- Cerebrovascular small vessel disease is increasingly recognized as a primary contributor to the brain's vascular load.
- It shares pathophysiological and clinical similarities with Alzheimer's disease, suggesting overlapping etiopathogenic mechanisms.
Purpose of the Study:
- To explore the applicability of staging procedures used for Alzheimer's disease continua to cerebrovascular small vessel disease.
- To highlight the need for further research into the temporal and prognostic aspects of cerebrovascular small vessel disease staging.
Main Methods:
- Comparative analysis of clinical staging frameworks.
- Review of existing literature on Alzheimer's disease and cerebrovascular small vessel disease progression.
Main Results:
- Alzheimer's disease staging models appear adaptable to cerebrovascular small vessel disease continua.
- Common underlying etiopathogenic mechanisms link these conditions.
Conclusions:
- Staging procedures for age-associated memory impairment, mild cognitive impairment, and Alzheimer's disease dementia are potentially applicable to cerebrovascular small vessel disease.
- Temporal and prognostic aspects of cerebrovascular small vessel disease staging require further investigation.
Abstract:
Cerebrovascular small vessel disease is now believed to be the major source of vascular burden of the brain. Cerebrovascular small vessel disease and Alzheimer's disease appear to represent pathophysiologic and clinical continua, rather than dichotomous entities. It appears that common etiopathologic mechanisms underlie the clinical presentation of both of these conditions. Therefore, the staging procedures that have been developed for the clinical continuum of age-associated memory impairment, mild cognitive impairment, and the progressive dementia of Alzheimer's disease appear to be applicable for the same continua in cerebrovascular small vessel disease. Although temporal and prognostic aspects have been studied for the Alzheimer's-related portions of this clinical staging continuum, they remain to be elucidated for cerebrovascular small vessel disease.