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BMC Medicine
Published in: BMC Medicine 1/2017

Open Access 01-12-2017 | Opinion

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

Authors: Régis Bordet, Ralf Ihl, Amos D. Korczyn, Giuseppe Lanza, Jelka Jansa, Robert Hoerr, Alla Guekht

Published in: BMC Medicine | Issue 1/2017

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Abstract

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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Metadata
Title
Towards the concept of disease-modifier in post-stroke or vascular cognitive impairment: a consensus report
Authors
Régis Bordet
Ralf Ihl
Amos D. Korczyn
Giuseppe Lanza
Jelka Jansa
Robert Hoerr
Alla Guekht
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Medicine / Issue 1/2017
Electronic ISSN: 1741-7015
DOI
https://doi.org/10.1186/s12916-017-0869-6

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