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Neuromodulation Techniques in Chronic Cerebral Hypoperfusion: Mechanisms and Therapeutic Advances
Chenye Qiao1, Ning Li1, Congxiao Wang1
1Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China.
Insights
Neuromodulation therapies show promise for treating cognitive impairment caused by chronic cerebral hypoperfusion (CCH). These techniques target multiple pathological pathways to improve brain function and recovery.
Area of Science:
- Neuroscience
- Neurology
- Biomedical Engineering
Background:
- Chronic cerebral hypoperfusion (CCH) is a key factor in vascular cognitive impairment and dementia.
- CCH initiates a cascade of neurovascular dysfunction, white matter injury, neuroinflammation, oxidative stress, and synaptic impairment.
- Effective multi-target neuroprotective therapies for CCH are currently limited.
Purpose of the Study:
- To review the pathophysiological mechanisms of CCH.
- To discuss neuromodulation as a therapeutic strategy for CCH.
- To highlight challenges and future directions for clinical translation.
Main Methods:
- Review of central stimulation modalities: repetitive transcranial magnetic stimulation, transcranial electrical stimulation, photobiomodulation, and ultrasound-based neuromodulation.
- Inclusion of peripheral physical modulation approaches and multimodal combination strategies.
- Analysis of evidence supporting neuromodulation's efficacy in mitigating CCH-related brain injury.
Main Results:
- Neuromodulation interventions may counteract hypoperfusion-induced brain injury and cognitive deficits.
- These therapies target multiple pathophysiological mechanisms, promoting synaptic plasticity and network recovery.
- Challenges include limited deep-brain targeting, individualized dosing, and underutilization of rhythm-based biomarkers.
Conclusions:
- Neuromodulation offers a promising, mechanistically-driven, multi-target neuroprotective approach for CCH-related cognitive impairment.
- Further research is needed to address clinical translation challenges.
- Neuromodulation represents a potential advancement in treating vascular cognitive impairment.
Background:
Chronic cerebral hypoperfusion (CCH) is a major hemodynamic substrate of vascular cognitive impairment and vascular dementia, yet effective therapies with multi-target neuroprotective potential remain limited. CCH triggers a complex pathological cascade characterized by neurovascular dysfunction, white matter injury, neuroinflammation, oxidative stress, and synaptic impairment.
Methods:
In this review, we summarize the major pathophysiological mechanisms of CCH and discuss current evidence supporting neuromodulation as a promising therapeutic strategy. We focus primarily on central stimulation modalities, including repetitive transcranial magnetic stimulation, transcranial electrical stimulation, photobiomodulation, and ultrasound-based neuromodulation, while also addressing selected peripheral physical modulation approaches and emerging multimodal combination strategies.
Results:
Available evidence suggests that these interventions may mitigate hypoperfusion-related brain injury and cognitive impairment by targeting multiple pathophysiological mechanisms, ultimately restoring synaptic plasticity and promoting circuit- and network-level recovery. We further discuss current challenges to clinical translation, including limited deep-target engagement, insufficient individualized dosing, and the underuse of rhythm-based biomarkers.
Conclusion:
Neuromodulation holds promise as a mechanistically informed and multi-target neuroprotective strategy for CCH-related cognitive impairment.