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The impact of cardiovascular autonomic failure on cognition: What’s the role of cerebral autoregulation?

      Background: Cerebral autoregulation is a rather complex homeostatic process aimed at ensuring constant blood supply to the brain despite of systemic blood pressure fluctuations. Altered cerebral perfusion, vascular pressure stress, and related damage of the blood brain barrier may also contribute to the development of cognitive deficits in subjects affected by neurocardiovascular instability. Cardiovascular autonomic failure plays a significant negative prognostic role in α-synucleinopathies, including Parkinson’s disease (PD) and multiple system atrophy (MSA). Several studies support the hypothesis that cardiovascular autonomic failure may contribute to the development of white matter lesions and cognitive derangement in α-synucleinopathies. Results: Recent findings suggest a downward shift of the inferior limit of cerebral autoregulation in PD and MSA, consistent with a compensatory mechanisms to the orthostatic hypotension frequently occurring in these disorders. Such shift may be coupled with alterations of the upper limit of cerebral autoregulation, in turn increasing susceptibility to supine hypertensive peaks and cerebral white matter lesions in PD and MSA. Conclusions: Evaluation of cerebral autoregulation behavior may thus represent a novel approach to target simultaneously orthostatic symptoms and silent end-organ damage in α-synucleinopathies, with beneficial effect on cerebrovascular and cognitive outcomes.
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