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Rethinking Dementia: The Emerging Role of Vascular Factors in Cognitive Decline

A recent multidisciplinary commentary authored by a diverse cross-institute team brings to light the increasingly recognized role of vascular contributions to dementia.  

SVD Workshop members

Dementia is a global health concern that affects millions of individuals, especially older people. While AD has traditionally dominated the conversation, it is now understood that most dementia cases among the elderly result from a mix of factors, usually combining vascular and AD-related brain pathology.  

A recent multidisciplinary commentary authored by a diverse cross-institute team, led by the UK Dementia Research Institute's Vascular Theme in collaboration with the Dementias Platform UK Experimental Medicine Incubator, brings to light the increasingly recognized role of vascular contributions to dementia.  

Published recently in Cerebral Circulation - Cognition and Behavior, this commentary offers valuable insights into the complexities of vascular cognitive impairment (VCI) and the critical need for improved research models and translational efforts. The commentary arose from a workshop held in Manchester in March 2022 funded by the UK DRI, BHF, DPUK and Guarantors of Brain

Vascular cognitive impairment (VCI), encompassing vascular dementia (VaD), is the second most common type of dementia. However, understanding its underlying causes and pathogenesis has presented a formidable challenge. 

The commentary, authored by a diverse team (across metrics of sex, geography, and career stage, including both clinical and preclinical researchers) offers a comprehensive perspective on the limitations of current VCI research models and provides recommendations for enhancing translation and reproducibility. The team delves into various aspects of VCI research, including reproducibility concerns, clinical features of VCI and their alignment with model assessments, human pathology, bioinformatics strategies, and data sharing practices. 

The authors’ recommendations include:  

  • A focus on Small Vessel Disease (SVD) as a key contributing factor to VCI. SVD is a medical condition that primarily affects the small blood vessels in the brain. These tiny blood vessels, also known as arterioles, capillaries and venules, play a crucial role in regulating blood flow to different parts of the brain. When these vessels become damaged or diseased, it can lead to various neurological problems. 
  • The need for diverse models to mirror the various facets of human small vessel disease (SVD). The choice of an appropriate research model is crucial to effectively address specific scientific inquiries in the bid to better understand the complexities of VCI. 
  • Enhanced coordination among researchers. Rigorous, resilient, and comprehensive preclinical assessments of animal models are essential, and the introduction of prospective Randomised Controlled Trials (pRCTs) is proposed as a means to achieve this goal. These trials would help establish a stronger foundation for the translation of research findings into clinical practice. 
  • The UK Dementia Research Institute's Vascular Theme, in partnership with the Dementias Platform UK Experimental Medicine Incubator, is taking active steps to foster a collaborative community dedicated to advancing both preclinical and clinical research in VCI. Their efforts are aimed at creating a more cohesive and effective research environment where the study of VCI can flourish. 

Through highlighting the importance of diverse models, collaborative partnerships, and enhanced coordination, this commentary paves the way for more effective research and, ultimately, improved outcomes for individuals affected by VCI.  

Dr Giovanna Lalli, UK DRI Director of Scientific Affairs, said: “Bringing together pre-clinical and clinical researchers to tackle dementia is integral to the UK DRI’s mission. This is exemplified by our thriving Vascular Theme and our valued partnerships with BHF and DPUK. Building on these activities, we are committed to promote innovative research, reproducibility and translation to ultimately transform lives of those with or at risk of developing dementia.” 

To read the full commentary, click here

 

SVD Workshop members 2