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Cerebral white matter lesions, ageing and vascular cognitive impairment

Daniel Kam Yin Chan, et al.

UNSW Sydney, Sydney, New South Wales, Australia

Extensive cerebral white matter lesions (or hyperintensities) are associated with cognitive decline and ageing. However, the aetiology causing this is not entirely clear. White matter ischaemia associated with small vessel lipohyalinosis was thought to be the cause but recent evidence suggests endothelial dysfunction is the more likely culprit. This may occur subsequent to blood-brain barrier failure, leading to extravasation of plasma, which is potentially toxic to neurocircuits.

In this context, we shall review and present recent work of ours and others in this field, which include the role of biomarkers in blood-brain barrier dysfunction (or disruption of integrity). We shall also examine the role played by cardiovascular risk factors, life-style factors and ageing on vascular cognitive impairment and vascular dementia in the context of white matter lesions and the presence of potential biomarkers. Lastly, we shall discuss future research in ageing which may protect (or repair) blood-brain barrier integrity.