报告摘要

The cross-tal between arterial and brain aging

Angelo Scuteri

UOC Geriatria  INRCA IRCCS Rome (Italy)

The world population is getting older and older. In 2000，there were 600 million  people aged 60 and over; who will become 1.2 billion by 2025 and 2 billion by 2050. Loss of cognitive function is a common condition in the elderly population and significantly impacts on loss of personal independency. Dementia，whose prevalence increases with advancing age (7% of subjects over 65 years and 30% of those over 80)，is usually preceded by a progressive cognitive impairment progressively affecting memory，executive functions，and other cognitive domains.

The aim of this presentation will be:

• to define the clinical presentation of arterial aging;
• to show that arterial aging is the main risk factor for cardiovascular events in older subjects;
• to describe the relationships between arterial aging and  cognitive impairment and dementia;
• to provide a rationale for promoting routinely arterial aging measurements for potential prevention of cognitive impairment;
• to explore potential mechanisms linking accelerated arterial aging or cognitive decline，that may represent possible targets for effective therapeutic strategies aimed to slow arterial aging and to prevent dementia.

Arterial aging is mainly characterized by changes in large artery structure and function

leading  to arterial stiffening and thickening ，and to a lower extent by changes in small artery structure and function .

In spite of marked heterogeneity across studies for the study population (small groups; gender composition; inclusion of subjects with dementia，etc)，the specific methodology adopted to measure arterial structure and function，and the neuropsychological test adopted to evaluate cognition (single or repeated measures of Mini Mental State Examination，neuropsychological battery，specific tests for  selected cognitive domains)，a significant inverse relationship between arterial stiffness or thickness  and cognitive performance  was reported cross-sectionally  and longitudinally. A greater arterial stiffness or thickness was also associated with larger cerebral white matter lesions (WML) at neuroimaging.

Possible pathophsyiological pathways linking arterial and brain aging will be discussed. Specific attention will be devoted to the role of arterial aging in the onset of hypotension / hypoperfusion in the context of the dominant “the lower the better” paradigm to control CV risk factors.

Additionally，we will focus on therapeutical strategies to reduce arterial stiffness (and possibly cognitive dysfunction) independently of blood pressure lowering.