Pathogenesis of chronic disorders of cerebral circulation

Kamchatnov P.R.; Chugunov A.V.; Tyazhelnikov A.A.; Pyshkina L.I.

doi:https://doi.org/10.17116/jnevro201711712270-77

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Abstract:

Chronic disorders of cerebral circulation are a common syndrome, in the pathogenesis of which the important role play structural and functional alterations in large and small arteries, autoregulation of cerebral circulation and the level of systemic arterial pressure. Drugs that increase cerebral blood flow and restore the ability to its autoregulation are used, among others, in treatment of patients with CRMC. The possibility of using nicergoline (sermion) for the treatment of patients with CRMK is considered.

Keywords:

chronic cerebral ischemia

microangiopathy

autoregulation of cerebral circulation

nicergoline

sermion

Authors:

Kamchatnov P.R.

Kafedra nevrologii i neĭrokhirurgii Rossiĭskogo gosudarstvennogo meditsinskogo universiteta im. N.I. Pirogova, Moskva

SPIN RSCI: 9240-6754
Scopus AuthorID: 6602401209
ORCID: 0000-0001-6747-3476

Chugunov A.V.

Kafedra nevrologii i neĭrokhirurgii Rossiĭskogo gosudarstvennogo meditsinskogo universiteta im. N.I. Pirogova, Moskva

Scopus AuthorID: 7004437778

Tyazhelnikov A.A.

City Consultative and Diagnostic Polyclinic №121 of the Moscow City Health Department, Moscow, Russia

Pyshkina L.I.

kafedra nevrologii i neĭrokhirurgii lechebnogo fakul'teta

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References:

Gusev EI, Skvorcova VI. Ishemiya golovnogo mozga. M: Medicina; 2001. (In Russ.)
Zhetishev RR, Mihajlova NA, Kamchatnov PR, Ivashchenko RA. Asimptomnye infarkty golovnogo mozga: faktory riska i kognitivnye narusheniya. Zhurnal nevroljgii i psihiatrii im. S.S. Korsakova (Insul’t). 2014;3(2):3-7. (In Russ.)
Lammie GA, Brannan F, Slattery J, Warlow C. Nonhypertensive cerebral small-vessel disease. An autopsy study. Stroke. 1997;28(11):2222-2229.
Pantoni L. Cerebral small vessel disease: from pathogenesis and clinical characteristics to therapeutic challenges. Lancet Neurol. 2010;9(7):689-701. https://doi.org/10.1016/S1474-4422(10)70104-6
Zhang M, Chen M, Wang Q, Yun W, Zhang Z, Yin Q, Huang Q, Zhu W. Relationship between cerebral microbleeds and cognitive function in lacunar infarct. J Int Med Res. 2013;41(2):347-355. https://doi.org/10.1177/0300060513476448
de la Torre JC. Cardiovascular risk factors promote brain hypoperfusion leading to cognitive decline and dementia. Cardiovasc Psychiatry Neurol. 2012;2012:367516. https://doi.org/10.1155/2012/367516
Palacio S, McClure LA, Benavente OR, Bazan C 3rd, Pergola P, Hart RG. Lacunar strokes in patients with diabetes mellitus: risk factors, infarct location, and prognosis: the secondary prevention of small subcortical strokes study. Stroke. 2014;45(9):2689-2694. https://doi.org/10.1161/STROKEAHA.114.005018
Blinder P, Tsai PS, Kaufhold JP, Knutsen PM, Suhl H, Kleinfeld D. The cortical angiome: an interconnected vascular network with noncolumnar patterns of blood flow. Nat Neurosci. 2013;16:889-897. https://doi.org/10.1038/nn.3426
Nishimura N, Rosidi NL, Iadecola C, Schaffer CB. Limitations of collateral flow after occlusion of a single cortical penetrating arteriole. J Cereb Blood Flow Metab. 2010;30:1914-1927. https://doi.org/10.1038/jcbfm.2010.157
Sörös P, Whitehead S, Spence JD, Hachinski V. Antihypertensive treatment can prevent stroke and cognitive decline. Nat Rev Neurol. 2013;9:174-178. https://doi.org/10.1038/nrneurol.2012.255
Gulevskaya TS, Morgunov VA. Patologicheskaya anatomiya narushenij mozgovogo krovoobrashcheniya pri ateroskleroze i arterial’noj gipertenzii. M.: Medicina; 2009. (In Russ.)
Riba-Llena I, Nafría C, Mundet X, López-Rueda A, Fernández-Cortiñas I, Jarca CI, Jiménez-Balado J, Domingo M, Tovar JL, Orfila F, Pujadas F, Álvarez-Sabín J, Maisterra O, Montaner J, Delgado P. Assessment of enlarged perivascular spaces and their relation to target organ damage and mild cognitive impairment in patients with hypertension. Eur J of Neurol. 2016;23:1044-1050. https://doi.org/10.1111/ene.12979
Derosa G, Maffioli Р. A review about biomarkers for the investigation of vascular function and impairment in diabetes mellitus. Vascular Health and Risk Manag. 2016;12:415-419. https://doi.org/10.2147/VHRM.564460
Kampoli AM, Tousoulis D, Briasoulis A, Latsios G, Papageorgiou N, Stefanadis C. Potential pathogenic inflammatory mechanisms of endothelial dysfunction induced by type 2 diabetes mellitus. Curr Pharm Des. 2011;17(37):4147-4158.
Zwanenburg JJM, van Osch MJP. Targeting Cerebral Small Vessel Disease With MRI. Stroke. 2017;48:3175-3182. https://doi.org/10.1161/STROKEAHA.117.016996
Ding J, Sigurðsson S, Jónsson PV, Eiriksdottir G, Charidimou A, Lopez OL, van Buchem MA, Guðnason V, Launer LJ. Large Perivascular Spaces Visible on Magnetic Resonance Imaging, Cerebral Small Vessel Disease Progression, and Risk of DementiaThe Age, Gene/Environment Susceptibility—Reykjavik Study. JAMA Neurol. 2017;74(9):1105-1112. https://doi.org/10.1001/jamaneurol.2017.1397
McLauchlan D, Malik GA, Robertson NP. Cerebral amyloid angiopathy: subtypes, treatment and role in cognitive impairment. J Neurol. 2017;264:2184-2186. https://doi.org/10.1007/s00415-017-8608-7
Hilal S, Mok V, Youn YC, Wong A, Ikram MK, Chen CL. Prevalence, risk factors and consequences of cerebral small vessel diseases: data from three Asian countries. J of Neurol Neurosurg and Psychiatr. 2017;88(8):45-49. https://doi.org/10.1136/jnnp-2016-315324
Iadecola C. The pathobiology of vascular dementia. Neuron. 2013;80(4):844-866. https://doi.org/10.1016/j.neuron.2013.10.008
Cooper L, Woodard T, Sigurdsson S, van Buchem M, Torjesen A, Inker L, Aspelund T, Eiriksdottir G. Cerebrovascular Damage Mediates Relations Between Aortic Stiffness and Memory. Hypertension. 2016;67:176-182. https://doi.org/10.1161/HYPERTENSIONAHA.115.06398
Nichols WW, O’Rourke MF. McDonalds’s blood flow in arteries: theoretical, experimental and clinical principles, 5th edn., London: Hodder Arnold Publishing; 2005.
Kollias A, Lagou S, Zeniodi ME, Boubouchairopoulou N, Stergiou GS. Association of central versus brachial blood pressure with target-organ damage: systematic review and meta-analysis. Hypertension. 2016;67(1):183-190. https://doi.org/10.1161/HYPERTENSIONAHA.115.06066
Barnes JN, Harvey RE, Zuk SM, Lundt ES, Lesnick TG, Gunter JL, Senjem ML, Shuster LT, Miller VM, Jack Jr CR, Joyner MJ, Kantarci K. Aortic hemodynamics and white matter hyperintensities in normotensive postmenopausal women. J Neurol. 2017;264:938. https://doi.org/10.1007/s00415-017-8476-1
Townsend RR, Black HR, Chirinos JA, Feig PU, Ferdinand KC, Germain M, Rosendorff C, Steigerwalt SP, Stepanek JA. Clinical use of pulse wave analysis: proceedings from a symposium sponsored by North American artery. J Clin Hypertens (Greenwich). 2015;17(7):503-513. https://doi.org/10.1111/jch.12574
Webb AJ, Simoni M, Mazzucco S, Kuker W, Schulz U, Rothwell PM. Increased cerebral arterial pulsatility in patients with leukoaraiosis: arterial stiffness enhances transmission of aortic pulsatility. Stroke. 2012;43(10):2631-2636. https://doi.org/10.1161/STROKEAHA.112.655837
Pase MP, Himali JJ, Mitchell GF, Beiser A, Maillard P, Tsao C, Larson MG, DeCarli C, Vasan RS, Seshadri S. Association of aortic stiffness with cognition and brain aging in young and middle-aged adults: the Framingham third generation cohort study. Hypertension. 2016;67(3):513-519. https://doi.org/10.1161/HYPERTENSIONAHA.115.06610
Davis KR, Pearson H, Moat S, Bonham JR, Donnelly R. Acute hyperhomocysteinaemia affects pulse pressure but not microvascular vasodilator function. Br J Clin Pharmacol. 2001;52(3):327-332. https://doi.org/10.1046/j.0306-5251.2001.01447.x
Jennings JR, Mendelson DN, Muldoon MF, Ryan CM, Gianaros PJ, Raz N, Aizenstein H. Regional grey matter shrinks in hypertensive individuals despite successful lowering of blood pressure. Journal of Human Hypertension. 2012;26:295-305. https://doi.org/10.1038/jhh.2011.31
Keenan W, Power M, Hoogeveen R, Folsom A, Ballantyne C, Knopman D, Windham G, Selvin E, Jack C, Gottesman R. The Atherosclerosis Risk in Communities Study. Midlife Systemic Inflammation, Late-Life White Matter Integrity, and Cerebral Small Vessel Disease. Stroke. 2017;48(12). https://doi.org/10.1161/STROKEAHA.117.018675
Moonga I, Niccolini F, Wilson H, Pagano G, Politis M. Hypertension is associated with worse cognitive function and hippocampal hypometabolism in Alzheimer’s disease. Eur J of Neurol. 2017;24(9):1173-1182. https://doi.org/10.1111/ene.13374
Moretti R, Torre P, Antonello RM, Manganaro D, Vilotti C, Pizzolato G. Risk factors for vascular dementia: hypotension as a key point. Vasc Health Risk Manag. 2008;4(2):395-402.
Muller M, van der Graaf Y, Visseren F, Vlek A, Mali W, Geerlings M. for the SMART Study Group. Blood pressure, cerebral blood flow, and brain volumes. The SMART-MR study. Journal of Hypertension. 2010;28(7):1498-1505. https://doi.org/10.1097/HJH.0b013e32833951ef
Drake CT, Iadecola C. The role of neuronal signaling in controlling cerebral blood flow. Brain Lang. 2007;102:141-152. https://doi.org/10.1016/j.bandl.2006.08.002
Cipolla M. The Cerebral Circulation. University of Vermont College of Medicine. San Rafael (CA): Morgan & Claypool Life Sciences; 2009. 201010.4199/C00005ED1V01Y200912ISP002
Harris JJ, Attwell D. The energetics of CNS white matter. J Neurosci. 2012;32:356-371. https://doi.org/10.1523/JNEUROSCI.3430-11.2012
Quaegebeur A, Lange C, Carmeliet P. The neurovascular link in health and disease: molecular mechanisms and therapeutic implications. Neuron. 2011;71:406-424. https://doi.org/10.1016/j.neuron.2011.07.013
Bell RD, Winkler EA, Sagare AP, Singh I, Larue B, Deane R, Zlokovic BV. Pericytes Control Key Neurovascular Functions and Neuronal Phenotype in the Adult Brain and during Brain Aging. Neuron. 2010;68:409-427. https://doi.org/10.1016/j.neuron.2010.09.043
Lin J, Wang D, Lan L, Fan Y. Multiple Factors Involved in the Pathogenesis of White Matter Lesions. Biomed Res Int. 2017;2017:9372050. https://doi.org/10.1155/2017/9372050
Hossmann KA, Heiss WD. History of the Letzte Wiese/Last Meadow Concept of Brain Ischemia. Stroke. 2016;47:46-50. https://doi.org/10.1161/STROKEAHA.115.010976
Tönnis W, Schiefer W. Physiologie und Pathophysiologie der Hirndurchblutung. Zirkulationsstörungen des Gehirns im Serienangiogramm. Springer. 1959:49-65.
Mangla R, Kolar B, Almast J, Ekholm SE. Border zone infarcts: pathophysiologic and imaging characteristics. Radiographics. 2011;31:1201-1214. https://doi.org/10.1148/rg.315105014.
Gupta A, Chazen L, Hartman M, Delgado D, Anumula N, Shao H, Mazumdar M, Segal A, Kamel H, Leifer D, Sanelli P. Cerebrovascular Reserve and Stroke Risk in Patients With Carotid Stenosis or Occlusion. A Systematic Review and Meta-Analysis. Stroke. 2012;43:2884-2891. https://doi.org/10.1161/STROKEAHA.112.663716
Xu X, Wang B, Ren C, Hu J, Greenberg DA, Chen T, Xie L, Jin K. Recent Progress in Vascular Aging: Mechanisms and Its Role in Age-related Diseases. Aging Dis. 2017;8(4):486-505. https://doi.org/10.14336/AD.2017.0507
Chen PL, Wang PY, Sheu WH, Chen YT, Ho YP, Hu HH, Hsu HY. Changes of brachial flow-mediated vasodilation in different ischemic stroke subtypes. Neurology. 2006;67(6):1056-1058. https://doi.org/10.1212/01.wnl.0000237526.32692.67
Knottnerus IL, Ten Cate H, Lodder J, Kessels F, van Oostenbrugge RJ. Endothelial dysfunction in lacunar stroke: a systematic review. Cerebrovasc Dis. 2009;27(5):519-526. https://doi.org/10.1159/000212672
Moody DM, Bell MA, Challa VR. Features of the cerebral vascular pattern that predict vulnerability to perfusion or oxygenation deficiency: an anatomic study. Am J Neuroradiol. 1990;11(3):431-439.
Bereczki D, Fekete I. Vinpocetine for acute ischaemic stroke. Cochrane Database Syst Rev. 2008;1:CD000480. https://doi.org/10.1002/14651858.CD000480.pub2
Pantoni L. Treatment of vascular dementia: evidence from trials with non-cholinergic drugs. J Neurol Sci. 2004;226(1-2):67-70. https://doi.org/10.1016/j.jns.2004.09.014
Nishimura N, Schaffer CB, Friedman B, Tsai PS, Lyden PD, Kleinfeld D. Targeted insult to subsurface cortical blood vessels using ultrashort laser pulses: three models of stroke. Nat Methods. 2006;3(2):99-108. https://doi.org/10.1038/nmeth844
Wang P, Wang Y, Feng T, Zhao X, Zhou Y, Wang Y, Shi W, Ju Y. on behalf of the NICE Study Investigators. Rationale and design of a double-blind, placebo-controlled, randomized trial to evaluate the safety and efficacy of nimodipine in preventing cognitive impairment in ischemic cerebrovascular events (NICE). BMC Neurol. 2012;12:88. https://doi.org/10.1186/1471-2377-12-88
Davis LA, Smeda JS. Captopril treatment temporarily restores cerebral blood flow autoregulation in spontaneously hypertensive rats after hemorrhagic stroke. J Cardiovasc Pharmacol. 2010;56(3):255-262. https://doi.org/10.1097/FJC.0b013e3181e8af62
Smeda JS, Daneshtalab N. The effects of poststroke captopril and losartan treatment on cerebral blood flow autoregulation in SHRsp with hemorrhagic stroke. J Cereb Blood Flow Metab. 2011;31(2):476-485. https://doi.org/10.1038/jcbfm.2010.110
Kuo IY, Ellis A, Seymour VAL, Sandow SL, Hill CE. Dihydropyridine-insensitive calcium currents contribute to function of small cerebral arteries. J Cereb Blood Flow Metab. 2010;30(6):1226-1239. https://doi.org/10.1038/jcbfm.2010.11
Fioravanti M, Flicker L. Efficacy of nicergoline in dementia and other age associated forms of cognitive impairment. Cochrane Database Syst Rev. 2001;(4):CD003159. https://doi.org/10.1002/14651858.CD003159
Weinstein JD. A unique and promising combination of medications for the treatment of Alzheimer’s disease. Med Hypotheses. 2017;109:53-56. https://doi.org/10.1016/j.mehy.2017.09.021
Saletu B, Garg A, Shoeb A. Safety of Nicergoline as an Agent for Management of Cognitive Function Disorders. Biomed Res Int. 2014;2014:610103. https://doi.org/10.1155/2014/610103
Iliff LD, Du Boulay GH, Marshall J, Russell RW, Symon L. Effect of nicergoline on cerebral blood flow. J Neurol Neurosurg Psychiatry. 1977;40(8):746-747.