Cerebral blood flow control in small vessel disease

In normal conditions CBF is maintained over a wide range of perfusion pressures (ca. 60~150 mm Hg) by two main control systems, i.e. mechanoregulation, referring to CA, and chemoregulation, also known as cerebrovascular CO2 responsiveness reflecting the vasodilatory capacity of the cerebral vasculature. Cerebral microangiopathy, i.e. SVD, is associated with hypertension and other vascular risk factors, being a major cause of stroke and vascular dementia. Previous studies reported affected mechano- and chemoregulation in longstanding diabetes mellitus with both microvascular complications and CAN. Also dynamic CA has been demonstrated to be affected bilaterally in patients suffering from lacunar infarction, strongly suggesting a link between impaired autoregulatory capacity and SVD. In this thesis we focused on T2DM and SCD representing two different forms of SVD, both associated with diffuse vasculopathy of the small arteries, resulting in multiple lacunar infarctions and generalized white matter lesions. Cerebral autoregulatory capacity and CO2 responsiveness were studied in both diseases and compared with control subjects.