22 Dec 20. Featured Paper

Clinical management of cerebral small vessel disease: a call for a holistic approach

Link to paper on Chinese Medical Journal

Authors

Clancy, Una; Appleton, Jason P.; Arteaga, Carmen; Doubal, Fergus N.; Bath, Philip M.; Wardlaw, Joanna M.

Abstract

Cerebral small vessel disease (SVD) is a common global brain disease that causes cognitive impairment, ischemic or hemorrhagic stroke, problems with mobility, & neuropsychiatric symptoms.

The brain damage, seen as focal white & deep grey matter lesions on brain magnetic resonance imaging (MRI) or computed tomography (CT), typically accumulates “covertly” & may reach an advanced state before being detected incidentally on brain scanning or causing symptoms.

Patients have typically presented to different clinical services or been recruited into research focused on one clinical manifestation, perhaps explaining a lack of awareness, until recently, of the full range & complexity of SVD.

In this review, we discuss the varied clinical presentations, established & emerging risk factors, relationship to SVD features on MRI or CT, & the current state of knowledge on the effectiveness of a wide range of pharmacological & lifestyle interventions.

The core message is that effective assessment & clinical management of patients with SVD, as well as future advances in diagnosis, care, & treatment, will require a more “joined-up”’ approach.

This approach should integrate clinical expertise in stroke neurology, cognitive, & physical dysfunctions.

It requires more clinical trials in order to improve pharmacological interventions, lifestyle & dietary modifications.

A deeper understanding of the pathophysiology of SVD is required to steer the identification of novel interventions.

An essential prerequisite to accelerating clinical trials is to improve the consistency, & standardization of clinical, cognitive & neuroimaging endpoints.

Keywords

• Dementia

• Magnetic resonance imaging

• Mild cognitive impairment

• Risk factors

• Small vessel disease

• Stroke

• Symptoms

• Treatment