Blood-Brain Barrier Disruption and Post-Stroke Cognitive Impairment
DOI:
https://doi.org/10.5281/zenodo.22310583Keywords:
Blood-brain barrier, Post-stroke cognitive impairment, Cerebral small vessel disease, Neuroinflammation, Dynamic contrast-enhanced MRIAbstract
Background: Cognitive impairment affects a large proportion of ischaemic stroke survivors, often out of proportion to infarct
size, and mounting evidence implicates disruption of the blood-brain barrier (BBB) as a shared driver.
Objective: To review evidence linking BBB disruption to post-stroke cognitive impairment (PSCI), spanning pathophysiology,
imaging, small vessel disease and therapeutics.
Methods: Narrative synthesis of mechanistic, neuroimaging, longitudinal cohort and therapeutic literature.
Findings: Ischaemia triggers tight-junction breakdown, matrix metalloproteinase activation and neuroinflammatory leukocyte
trafficking, producing measurable permeability on dynamic contrast-enhanced MRI and PET. Elevated BBB leakage correlates
with white matter hyperintensity progression, microbleeds and steeper cognitive decline across multi-year cohorts, independent
of infarct volume. Pericyte loss and endothelial injury sustain chronic leakage, while emerging therapies target junctional repair
and neurovascular inflammation.
Conclusions: BBB integrity is a plausible, imageable and potentially modifiable determinant of PSCI, warranting incorporation
into risk stratification and trial design.
Keywords: Blood-brain barrier; Post-stroke cognitive impairment; Cerebral small vessel disease; Neuroinflammation; Dynamic
contrast-enhanced MRI
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