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Towards the concept of disease-modifier in post-stroke or vascular cognitive impairment: a consensus report

BACKGROUND: Vascular cognitive impairment (VCI) is a complex spectrum encompassing post-stroke cognitive impairment (PSCI) and small vessel disease-related cognitive impairment. Despite the growing health, social, and economic burden of VCI, to date, no specific treatment is available, prompting the...

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Autores principales: Bordet, Régis, Ihl, Ralf, Korczyn, Amos D., Lanza, Giuseppe, Jansa, Jelka, Hoerr, Robert, Guekht, Alla
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5444106/
https://www.ncbi.nlm.nih.gov/pubmed/28539119
http://dx.doi.org/10.1186/s12916-017-0869-6
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author Bordet, Régis
Ihl, Ralf
Korczyn, Amos D.
Lanza, Giuseppe
Jansa, Jelka
Hoerr, Robert
Guekht, Alla
author_facet Bordet, Régis
Ihl, Ralf
Korczyn, Amos D.
Lanza, Giuseppe
Jansa, Jelka
Hoerr, Robert
Guekht, Alla
author_sort Bordet, Régis
collection PubMed
description BACKGROUND: Vascular cognitive impairment (VCI) is a complex spectrum encompassing post-stroke cognitive impairment (PSCI) and small vessel disease-related cognitive impairment. Despite the growing health, social, and economic burden of VCI, to date, no specific treatment is available, prompting the introduction of the concept of a disease modifier. CONSENSUS AND SUGGESTIONS: Within this clinical spectrum, VCI and PSCI remain advancing conditions as neurodegenerative diseases with progression of both vascular and degenerative lesions accounting for cognitive decline. Disease-modifying strategies should integrate both pharmacological and non-pharmacological multimodal approaches, with pleiotropic effects targeting (1) endothelial and brain–blood barrier dysfunction; (2) neuronal death and axonal loss; (3) cerebral plasticity and compensatory mechanisms; and (4) degenerative-related protein misfolding. Moreover, pharmacological and non-pharmacological treatment in PSCI or VCI requires valid study designs clearly stating the definition of basic methodological issues, such as the instruments that should be used to measure eventual changes, the biomarker-based stratification of participants to be investigated, and statistical tests, as well as the inclusion and exclusion criteria that should be applied. CONCLUSION: A consensus emerged to propose the development of a disease-modifying strategy in VCI and PSCI based on pleiotropic pharmacological and non-pharmacological approaches.
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spelling pubmed-54441062017-05-25 Towards the concept of disease-modifier in post-stroke or vascular cognitive impairment: a consensus report Bordet, Régis Ihl, Ralf Korczyn, Amos D. Lanza, Giuseppe Jansa, Jelka Hoerr, Robert Guekht, Alla BMC Med Opinion BACKGROUND: Vascular cognitive impairment (VCI) is a complex spectrum encompassing post-stroke cognitive impairment (PSCI) and small vessel disease-related cognitive impairment. Despite the growing health, social, and economic burden of VCI, to date, no specific treatment is available, prompting the introduction of the concept of a disease modifier. CONSENSUS AND SUGGESTIONS: Within this clinical spectrum, VCI and PSCI remain advancing conditions as neurodegenerative diseases with progression of both vascular and degenerative lesions accounting for cognitive decline. Disease-modifying strategies should integrate both pharmacological and non-pharmacological multimodal approaches, with pleiotropic effects targeting (1) endothelial and brain–blood barrier dysfunction; (2) neuronal death and axonal loss; (3) cerebral plasticity and compensatory mechanisms; and (4) degenerative-related protein misfolding. Moreover, pharmacological and non-pharmacological treatment in PSCI or VCI requires valid study designs clearly stating the definition of basic methodological issues, such as the instruments that should be used to measure eventual changes, the biomarker-based stratification of participants to be investigated, and statistical tests, as well as the inclusion and exclusion criteria that should be applied. CONCLUSION: A consensus emerged to propose the development of a disease-modifying strategy in VCI and PSCI based on pleiotropic pharmacological and non-pharmacological approaches. BioMed Central 2017-05-24 /pmc/articles/PMC5444106/ /pubmed/28539119 http://dx.doi.org/10.1186/s12916-017-0869-6 Text en © The Author(s). 2017 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Opinion
Bordet, Régis
Ihl, Ralf
Korczyn, Amos D.
Lanza, Giuseppe
Jansa, Jelka
Hoerr, Robert
Guekht, Alla
Towards the concept of disease-modifier in post-stroke or vascular cognitive impairment: a consensus report
title Towards the concept of disease-modifier in post-stroke or vascular cognitive impairment: a consensus report
title_full Towards the concept of disease-modifier in post-stroke or vascular cognitive impairment: a consensus report
title_fullStr Towards the concept of disease-modifier in post-stroke or vascular cognitive impairment: a consensus report
title_full_unstemmed Towards the concept of disease-modifier in post-stroke or vascular cognitive impairment: a consensus report
title_short Towards the concept of disease-modifier in post-stroke or vascular cognitive impairment: a consensus report
title_sort towards the concept of disease-modifier in post-stroke or vascular cognitive impairment: a consensus report
topic Opinion
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5444106/
https://www.ncbi.nlm.nih.gov/pubmed/28539119
http://dx.doi.org/10.1186/s12916-017-0869-6
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