The brain is the most active part of the body, so it needs a large blood supply to work properly. The brain's blood supply depends on a very complex network of small blood vessels that reach individual nerve cells. Damage to the brain’s small blood vessels is called 'cerebral small vessel disease' (SVD). People with cerebral small vessel disease may be prone to strokes and dementia. Surprisingly, many people only discover they have small vessel disease after a brain scan for an unrelated issue. When the small blood vessels in the brain are damaged, blood supply to small areas of the brain is impaired. This leads to changes on brain scans, and in a small number of people it also leads to symptoms. The brain scan changes are often called 'white matter hyperintensities' and 'lacunar infarcts' by doctors. Some people are more susceptible to developing SVD. Rarely, SVD can run in families due to rare genetic abnormalities. What are some symptoms of cerebral Small Vessel Disease?Small vessel disease is commonly seen on brain scans. At the age of 50, some people have some evidence of small vessel disease, and at the age of 80, most people have it. Most people do not have symptoms from cerebral small vessel disease, but some do. The symptoms it can lead to include: Ischaemic stroke: A blocked small blood vessel leads to a small area of brain damage. This is called a ‘lacunar stroke'. Lacunar stroke can lead to sudden weakness or loss of sensation down one side of the body, clumsiness, double vision and speech disturbance. Most people with SVD do not develop a stroke.Intracerebral haemorrhage: A burst small blood vessel causes bleeding in the brain and results in symptoms. This is called a ‘haemorrhagic stroke’. Intracerebral haemorrhage (or stroke due to bleeding) can lead to sudden weakness, speech, and vision problems. They can be very severe but are rare and most people with SVD do not develop a haemorrhage.Mild cognitive impairment or dementia: Brain damage associated with small vessel disease can lead to progressive slowness of thought and memory problems. This can range from mild cognitive impairment, i.e. cognitive problems that do not impact on day-to-day activities, to dementia, which affects activities of daily living. Most people with SVD do not develop mild cognitive impairment. If small vessel disease is the only change leading to dementia, it is called ‘vascular dementia’; if small vessel disease coexists with other brain changes, it is called ‘mixed dementia’. Most people with small vessel disease do not develop dementia. People who have mild cognitive impairment do not always develop dementia. Other symptoms: Some people have symptoms that can be due to small vessel disease that are hard to diagnose and often have other causes, like slowness of walking, poor balance, problems with mood, and poor bladder control. What causes cerebral Small Vessel Disease?The cause of small vessel disease is not precisely understood. We do know that people who are older, have higher blood pressure, or have diabetes are more likely to develop small vessel disease. Sometimes (although rarely) small vessel disease has a genetic cause, which usually runs in families. How is cerebral Small Vessel Disease detected?Small vessel disease is usually detected on a brain scan performed for reasons unrelated to small vessel disease symptoms, although sometimes it is detected on scans performed to investigate stroke or memory problems. Brain scans are either done with Magnetic Resonance Imaging (MRI), which uses magnetic fields, or Computed Tomography (CT), which uses X-rays. Can cerebral Small Vessel Disease be prevented?Researchers are working to find the best ways to prevent small vessel disease. Lifestyle changes such as maintaining a healthy diet, regular exercise, controlling blood pressure and diabetes, and not smoking can reduce the risk. To learn more, here are some recommendations from the British Heart Foundation on: SmokingHigh cholesterolHigh blood pressureDiabetesObesityPhysical inactivityLead a healthy lifestyle: keep your weight down, take regular exercise, avoid smoking and eat a healthy diet without adding salt. Get your blood pressure and blood sugar checked regularly, and if you think you may have high blood pressure or symptoms of diabetes. The brain and body are very closely connected, so improvements in your general health are likely to improve your brain health.Professor Joanna Wardlaw, Chair of Applied Neuroimaging; Head of Neuroimaging Sciences and Edinburgh Imaging; Row Fogo Centre Director, co-lead of the European Stroke Organisation Guidelines on Cerebral Small vessel Disease What are the available treatments for cerebral Small Vessel Disease?Treatment focuses on addressing underlying risk factors and managing any symptoms that may arise. Medications to control blood pressure, cholesterol if high, and lifestyle modifications are important and common. It is particularly important to make sure that your blood pressure is well controlled – after smoking cessation, it is possibly the single most important thing you can do. You and your doctor should be aiming for blood pressure levels of no higher than 130/80. Sticking to your medications helps reduce damage to the small blood vessels, helps to prevent strokes and heart attacks and may help to prevent dementia. Research is ongoing at the Row Fogo Centre to find new targeted treatments for SVD, including repurposing well-known medications that are used for other diseases. Click here to learn more about our current research projects. Resources and Support The following organisations, charities, and advocacy groups provide a number of resources for people experiencing cerebral small vessel disease, stroke, and other age-related brain conditions. Stroke-Related Eye Conditions Vision issues are frequently experienced after a stroke. Our eyes relay visual information along a network of brain regions essential for sight, referred to as the visual pathway. At the Row Fogo Centre for Research into Ageing and the Brain, we bring together scientific specialties and advanced brain imaging methods from clinical and pre-clinical research, to accelerate discoveries about mechanisms of SVD and other common brain disorders, their causes and treatment. Our work has led to important advances in understanding of the causes and factors influencing the progression of small vessel disease, imaging methods, image analysis computational mapping and rating tools, and image databanks. These allow for faster image processing and disease quantification. Therapeutic approaches developed in our Centre are now being tested in clinical trials. You can support the Row Fogo Centre research by making a donation or fundraising. Our research depends not only on research grants, but also on generous donations from supporters like you. You can also support small vessel disease research by taking part in our trials and studies. Click here to learn more about our current research projects. This article was published on 2024-08-27
