Cerebrovascular disease is increasingly recognized to have a substantial influence on cognition in aging, Alzheimer dementia (AD), and other dementias.1,2 Biomarkers are urgently needed for the diagnosis, prevention, and treatment of vascular contributions to cognitive impairment. Several magnetic resonance vascular imaging markers have been proposed for cerebrovascular disease, including white matter hyperintensities (WMH), microbleeds, and lacunes, but these have variable sensitivity and specificity. Enlarged perivascular spaces (EPVS), a marker long recognized in radiologic and pathologic studies in association with cerebrovascular disease, have received less attention. Perivascular spaces are pia-lined channels that follow arterioles deep within the gray and white matter. Perivascular and related cells and fluid are implicated in the new and expanding field of glymphatics, which is the brain transport system involved in waste clearance, perivascular transport, and other physiologic functions.3 Alterations to glymphatic function could be mechanistically involved in cerebrovascular disease, AD, and other neurologic conditions. EPVS denote morphologic changes to this interface and are associated with age, hypertension, cerebrovascular disease, and dementia. EPVS and other vascular imaging abnormalities are commonly evident on MRIs of older persons without known cerebrovascular disease or dementia. There is a critical need, therefore, to determine whether EPVS and other vascular imaging abnormalities can be used as biomarkers of current and future vascular brain health.
from Neurology recent issues https://ift.tt/2HG70Qf
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