Brain and nerve = Shinkei kenkyū no shinpo
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With the demographic shift in life expectancy inexorably increasing in developed countries, dementia is set to become one of the most important health problems worldwide. In recent years, cerebral small vessel disease (SVD) has received much attention as an important cause of dementia. The reason for this is twofold: firstly, arteriosclerosis (type 1 SVD) is the leading cause of vascular cognitive impairment, and secondly, cerebral amyloid angiopathy (CAA; type 2 SVD) is an almost invariable accompaniment of Alzheimer's disease. ⋯ As arteries stiffen with age or with other co-morbid factors such as life-related diseases, amyloid β (Aβ) synthesis becomes upregulated, resulting in the deposition of insoluble Aβ not only in the parenchyma as senile plaques but also in the perivascular drainage pathways as CAA. Therefore, therapeutic strategies such as vasoactive drugs that enhance the patency of this Aβ drainage pathway may facilitate Aβ removal and help prevent cognitive decline in the elderly. Based on this emerging paradigm, clinical trials are warranted to investigate whether a neurovascular therapeutic approach can effectively halt cognitive decline and act as a preemptive medicine for patients at risk of dementia.
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Antiplatelet therapy is indicated in patients with non-cardioembolic stroke. The clinically used antiplatelet agents for secondary stroke prevention in this group of patients include the cyclooxygenase-1 (COX-1) inhibitor aspirin, the ADP receptor (P2Y12) inhibitors clopidogrel and ticlopidine, and the phosphodiesterase (PDE) inhibitors cilostazol and dipyridamole. Per medical economic data, aspirin is the most widely used antiplatelet agent. ⋯ The CHANCE study conducted in China showed a lower incidence of ischemic stroke in DAPT-treated patients than in those treated with aspirin monotherapy, while the incidence of hemorrhagic stroke was similar between the 2 treatment groups. However, DAPT should be restricted in the acute phase of stroke or TIA in acute settings. Novel antiplatelet agents have been developed for stroke prevention, and large randomized clinical trials should be conducted to evaluate the efficacy and safety of these agents when used singularly or in combination.