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Subclinical Cerebrovascular Disease: Epidemiology and Treatment

  • Cardiovascular Disease and Stroke (S. Prabhakaran, Section Editor)
  • Published:
Current Atherosclerosis Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Subclinical cerebrovascular disease (sCVD) is highly prevalent in older adults. The main neuroimaging findings of sCVD include white matter hyperintensities and silent brain infarcts on T2-weighted MRI and cerebral microbleeds on gradient echo or susceptibility-weighted MRI. In this paper, we will review the epidemiology of sCVD, the current evidence for best medical management, and future directions for sCVD research.

Recent Findings

Numerous epidemiologic studies show that sCVD, in particular WMH, is an important risk factor for the development of dementia, stroke, worse outcomes after stroke, gait instability, late-life depression, and death. Effective treatment of sCVD could have major consequences for the brain health of a substantial portion of older Americans. Despite the link between sCVD and many vascular risk factors, such as hypertension or hyperlipidemia, the optimal medical treatment of sCVD remains uncertain.

Summary

Given the clinical equipoise about the risk versus benefit of aggressive medical management for sCVD, clinical trials to examine pragmatic, evidence-based approaches to management of sCVD are needed. Such a trial could provide much needed guidance on how to manage a common clinical scenario facing internists and neurologists in practice.

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Funding

Dr. de Havenon, NIH/NINDS K23NS105924.

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Authors and Affiliations

  1. Department of Neurology, University of Utah, Salt Lake City, UT, USA

    Adam de Havenon, Chelsea Meyer & Lee Chung

  2. Department of Radiology, University of Utah, Salt Lake City, UT, USA

    J. Scott McNally & Matthew Alexander

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  1. Adam de Havenon
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  2. Chelsea Meyer
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Correspondence to Adam de Havenon.

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Adam de Havenon, Chelsea Meyer, J. Scott McNally, Matthew Alexander, and Lee Chung declare no conflict of interest.

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de Havenon, A., Meyer, C., McNally, J.S. et al. Subclinical Cerebrovascular Disease: Epidemiology and Treatment. Curr Atheroscler Rep 21, 39 (2019). https://doi.org/10.1007/s11883-019-0799-1

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  • DOI: https://doi.org/10.1007/s11883-019-0799-1

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