Cerebral circulation - cognition and behavior最新文献

{"title":"Editorial commentary: The usefulness of the new VasCog-2-WSO criteria for the diagnosis of vascular cognitive impairment and dementia","authors":"Perminder S. Sachdev,&nbsp;Adam C. Bentvelzen","doi":"10.1016/j.cccb.2026.100530","DOIUrl":"10.1016/j.cccb.2026.100530","url":null,"abstract":"<div><div>Cerebrovascular disease has a major role in the development of dementia, contributing to cognitive and functional decline in up to 75 % of all cases, and being the predominant or only cause in 15 to 20 % of cases. The importance of prevention and disease-modifying treatments to minimise the contribution of cerebrovascular disease to dementia has never been more obvious. To maximise the impact of such measures, accurate diagnosis is essential. The VasCog-2-WSO Criteria Consortium recently published diagnostic criteria for vascular cognitive impairment and dementia (VCID), updating the VasCog criteria published in 2014. The key features, strengths and limitations of the VasCog-2-WSO criteria are outlined, which suggest that these criteria have the potential to harmonise the diagnosis of VCID internationally, and infuse new energy into the development of treatment and prevention strategies.</div></div>","PeriodicalId":72549,"journal":{"name":"Cerebral circulation - cognition and behavior","volume":"10 ","pages":"Article 100530"},"PeriodicalIF":2.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148241291","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of cognitive decline rates and risk factors between stroke and non - stroke populations: An analysis of data from the China health and retirement longitudinal study (CHARLS)","authors":"Jiayin Zhang,&nbsp;Zhe Wang,&nbsp;Yuhang Wu,&nbsp;Xiaolong Ren,&nbsp;Ke Li,&nbsp;Taiming Zhang,&nbsp;Long Yan","doi":"10.1016/j.cccb.2026.100554","DOIUrl":"10.1016/j.cccb.2026.100554","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to longitudinally compare cognitive decline trajectories between stroke and non-stroke populations, and identify key risk factors associated with accelerated cognitive deterioration.</div></div><div><h3>Methods</h3><div>Data were extracted from the 2011 baseline and 2020 follow-up waves of the China Health and Retirement Longitudinal Study (CHARLS). After excluding participants with missing cognitive assessment data, stroke status information, or follow-up data, a total of 6810 eligible participants were included. Cognitive function was evaluated using a composite score integrating episodic memory and executive function, ranging from 0 to 21. Univariate and multivariate logistic regression models were used to identify risk factors for cognitive decline, and a nomogram was constructed to visualize the combined effect of key variables.</div></div><div><h3>Results</h3><div>At baseline (2011), there was no significant difference in cognitive function scores between the stroke and non-stroke groups (median: 13 vs. 13.5, P = 0.307). However, after 10 years of follow-up, the stroke group exhibited a significantly faster cognitive decline rate (median change: 6% vs. 3.1%, P = 0.031), with a higher proportion of cognitive decline (62.4%vs. 51.1%, P &lt; 0.05). Multivariate logistic regression analysis revealed that Cystatin C (CysC; β=0.461, OR=1.585, 95% CI: 1.154–2.177, P &lt; 0.05), low-density lipoprotein (LDL; β=0.002, OR=1.002, 95% CI: 1.000–1.004, P &lt; 0.05) and blood urea nitrogen (BUN; β=0.018, OR=1.018, 95% CI: 1.002–1.034, P &lt; 0.05)were independent risk factors for cognitive decline in the total population. In the stroke subgroup, hypertension was associated with cognitive decline (OR = 4.250, 95% CI: 1.169–15.454, P = 0.028).</div></div><div><h3>Conclusion</h3><div>Compared with stroke-free individuals, stroke patients experienced a faster rate of cognitive decline. CysC, LDL, and BUN are reliable risk predictors of cognitive deterioration in the general elderly population, while hypertension correlates with post-stroke cognitive decline.</div></div>","PeriodicalId":72549,"journal":{"name":"Cerebral circulation - cognition and behavior","volume":"11 ","pages":"Article 100554"},"PeriodicalIF":3.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13393735/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148581150","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Automated volume estimate of the brain’s lateral ventricles reveals a persistent association with cognitive performance among stroke survivors","authors":"Bradley J MacIntosh,&nbsp;Pål CW Morberg,&nbsp;Elakkyen Murugesu,&nbsp;Mona K Beyer,&nbsp;Karianne Larsen,&nbsp;Karoline Skogen,&nbsp;Eva B Aamodt,&nbsp;Atle Bjørnerud,&nbsp;Inge R Groote,&nbsp;Matthan WA Caan,&nbsp;Hege Ihle-Hansen,&nbsp;Ingvild Saltvedt,&nbsp;Till Schellhorn","doi":"10.1016/j.cccb.2026.100556","DOIUrl":"10.1016/j.cccb.2026.100556","url":null,"abstract":"<div><h3>Background</h3><div>Post-stroke cognitive impairment (PSCI) is a significant barrier to recovery. While computed tomography (CT) is the dominant modality for acute stroke diagnosis, it can also quantify brain anatomy, such as lateral ventricular volume (LVV). This study investigates whether initial LVV is associated with Montreal Cognitive Assessment (MoCA) scores over long-term follow-up.</div></div><div><h3>Methods</h3><div>Initial head CT, longitudinal MoCA, and functional assessments were collected at sites from the Norwegian COgnitive impairment After STroke (Nor-COAST) study. LVV was estimated using an established deep learning segmentation tool. Associations between initial LVV and repeat MoCA were tested across four timepoints (up to three years) using a linear mixed effects model. To provide context, we explored the independent influence of LVV in relation to National Institutes of Health Stroke Scale (NIHSS), modified Rankin Scale (mRS), and Global Deterioration Scale (GDS).</div></div><div><h3>Results</h3><div>The sample of N = 547 participants were 74 ± 12 years (range: 35–97 years) and 54% female. Log-transformed LVV was inversely associated with longitudinal MoCA scores (t=-3.75, p &lt; 0.001). This relationship was consistent across cross-sectional analyses at individual time points. Secondary analyses revealed significant LVV associations with NIHSS, mRS, and GDS scores (all p &lt; 0.05).</div></div><div><h3>Conclusion</h3><div>LVV was independently associated with lower MoCA scores across the three-year follow-up after stroke. Specifically, a patient with twice the initial LVV scored 0.7 points lower on the MoCA across three years of follow-up. These findings reveal that CT obtained at stroke admission may yield prognostic information about long-term cognitive outcomes, supporting the case for automated LVV estimation.</div></div>","PeriodicalId":72549,"journal":{"name":"Cerebral circulation - cognition and behavior","volume":"11 ","pages":"Article 100556"},"PeriodicalIF":3.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148657717","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Air pollution in relation to brain health indicators and global cognitive functioning in people with cardiovascular disorders along the heart-brain axis","authors":"Erik J. Timmermans ,&nbsp;Esther E. Bron ,&nbsp;Michiel L. Bots ,&nbsp;Anna E. Leeuwis ,&nbsp;Justine E.F. Moonen ,&nbsp;Frank J. Wolters ,&nbsp;Geert Jan Biessels ,&nbsp;Ilonca Vaartjes ,&nbsp;Heart-Brain Connection Consortium","doi":"10.1016/j.cccb.2026.100535","DOIUrl":"10.1016/j.cccb.2026.100535","url":null,"abstract":"<div><div>There is increasing evidence of an inverse relationship between air pollution and cognitive functioning. Yet, the biological mechanisms underlying this relationship remain underexplored in healthy and vulnerable populations. This study examined cross-sectional and longitudinal associations between air pollution and global cognitive functioning in individuals without or with heart failure, carotid occlusive disease, or vascular cognitive impairment. We also assessed whether the cross-sectional associations were mediated by white matter hyperintensities (WMH), total brain volume (TBV), and cerebral blood flow (CBF). The cross-sectional and longitudinal analyses included data from 341 and 180 Heart-Brain Study participants, respectively. Cognitive functioning was measured using neuropsychological tests at baseline and two-year follow-up. Brain Magnetic Resonance Imaging provided WMH and TBV in mL, and CBF in mL/100g/min. WMH and TBV were divided by total intracranial volume. Annual average outdoor concentrations of particulate matter with diameters &lt;2.5 µm and &lt;10.0 µm, and nitrogen dioxide in µg/m³ in residential six-digit postal code areas were linked to participants at baseline. Adjusted multi-level regression analyses showed no significant cross-sectional or longitudinal associations between air pollution and global cognitive functioning. The associations between air pollutants and global cognitive functioning were not significantly mediated by WMH, TBV, and CBF. In this study, air pollution was not associated with global cognitive functioning or brain health indicators in healthy individuals and those with cardiovascular disorders along the heart-brain axis. Larger studies with longer follow-up periods are warranted to extend the present findings and to further elucidate potential associations between air pollution, cognition, and the underlying biological mechanisms.</div></div>","PeriodicalId":72549,"journal":{"name":"Cerebral circulation - cognition and behavior","volume":"10 ","pages":"Article 100535"},"PeriodicalIF":2.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147396219","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response on the commentary on “Relevance of cerebral microbleeds with leaky blood brain barrier in traumatic brain injury and protective role of interferon-gamma: a cohort study”","authors":"Xuan Vinh To ,&nbsp;Fatima Nasrallah","doi":"10.1016/j.cccb.2026.100540","DOIUrl":"10.1016/j.cccb.2026.100540","url":null,"abstract":"","PeriodicalId":72549,"journal":{"name":"Cerebral circulation - cognition and behavior","volume":"10 ","pages":"Article 100540"},"PeriodicalIF":2.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147709809","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pulsatility index is a prognostic marker of cognitive outcome in patients with transient ischemic attack and mild acute stroke","authors":"Nicoletta Brunelli,&nbsp;Claudia Altamura,&nbsp;Marilena Marcosano,&nbsp;Carlo Vico,&nbsp;Marcel Bach-Pages,&nbsp;Luigi d’Onofrio,&nbsp;Sergio Soeren Rossi,&nbsp;Carmelina Maria Costa,&nbsp;Simona Sacco,&nbsp;Mauro Silvestrini,&nbsp;Fabrizio Vernieri","doi":"10.1016/j.cccb.2026.100558","DOIUrl":"10.1016/j.cccb.2026.100558","url":null,"abstract":"<div><h3>Background</h3><div>Pulsatility Index (PI) has been linked to cognitive impairment in patients with lacunar infarcts, but its role in other stroke subtypes remains unclear. We investigated whether PI predicts cognitive outcomes in acute stroke/TIA patients across etiologies.</div></div><div><h3>Methods</h3><div>Patients with TIA or mild ischemic stroke were followed for 12 months, with assessments at T1 (baseline; 48-72 hours from onset), T2 (1 month), T3 (6 months), and T4 (12 months). Cognitive tests were performed at all visits, whereas Middle Cerebral Artery (MCA) and Posterior Cerebral Artery (PCA) PI in the unaffected and affected hemispheres, respectively, was measured at T1 and T3.</div></div><div><h3>Results</h3><div>A total of 124 patients (71% men; median age 66) were enrolled; 69.4% had stroke. MCA/PCA PI remained stable from T1-T3 (p=0.630; p=0.086). MoCA increased significantly from T1-T4 (p&lt;0.001), while MMSE showed a trend (p=0.055). MoCA improvement (T1-T4) was independently associated with MCA PI≤1.1 (p=0.014), MoCA at T1 (p&lt;0.001), and NIHSS at T1 (p=0.037). MMSE change (T1-T4) was associated with MMSE at T1 (p&lt;0.001) and NIHSS at T1 (p=0.042), with a trend for MCA PI≤1.1 at T1 (p=0.073). From T3-T4, MMSE improvement was associated with MCA PI≤1.1 (p=0.004) and MMSE at T3 (p&lt;0.001); MoCA improvement was associated only with MoCA at T3 (p&lt;0.001), with a trend for MCA PI≤1.1 at T3 (p=0.082). Age and diabetes were the main determinants of MCA PI at T1 (p&lt;0.0001), while PCA PI was influenced only by age (p&lt;0.0001).</div></div><div><h3>Conclusion</h3><div>PI is a prognostic marker of cognitive outcome in patients with TIA and mild ischemic stroke.</div></div>","PeriodicalId":72549,"journal":{"name":"Cerebral circulation - cognition and behavior","volume":"11 ","pages":"Article 100558"},"PeriodicalIF":3.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148737413","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vascular cognitive impairment in China: Epidemiology, risk factors, healthcare system, management challenges, therapeutic modalities, and prevention strategies","authors":"Liang Gong,&nbsp;Hongmei Lang,&nbsp;Jie Yang","doi":"10.1016/j.cccb.2026.100563","DOIUrl":"10.1016/j.cccb.2026.100563","url":null,"abstract":"<div><div>Vascular cognitive impairment (VCI) is an increasingly important contributor to cognitive decline in China, where rapid population aging intersects with a substantial burden of stroke, cerebral small vessel disease, and cardiometabolic risk. This narrative review synthesizes Chinese epidemiological, clinical, health-services, and policy literature on VCI, supplemented by key international consensus and interventional evidence when directly relevant. Available evidence indicates that the vascular contribution to cognitive disorders in China is substantial but heterogeneously measured because of differences in case definition, screening tools, study setting, and follow-up design. Post-stroke cognitive impairment is especially important because it is common, clinically recognizable, and reachable through existing stroke follow-up pathways. Across studies, hypertension and cardiometabolic multimorbidity emerge as the most actionable modifiable drivers. China has strengthened its policy response through updated clinical guidance and a national dementia action plan, yet implementation remains constrained by inconsistent screening, uneven specialist capacity, fragmented referral pathways, and limited longitudinal follow-up. Therapeutically, direct evidence for interventions targeting established VCI syndromes remains limited. The strongest available support is indirect and comes from vascular risk reduction, particularly blood pressure lowering for broader dementia or cognitive decline endpoints, while multidomain and symptomatic interventions show phenotype-specific but more heterogeneous signals. A practical China-adapted response is therefore a tiered life-course model linking chronic disease management, post-stroke surveillance, specialist diagnosis, multidomain intervention, and caregiver support. Future priorities include harmonized diagnostics, clearer evidence characterization, biomarker-enabled longitudinal cohorts, and pragmatic implementation-science studies focused on adaptation, cost, and sustainability in community and rural settings.</div></div>","PeriodicalId":72549,"journal":{"name":"Cerebral circulation - cognition and behavior","volume":"11 ","pages":"Article 100563"},"PeriodicalIF":3.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13639685/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149119171","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Insulin resistance increases the risk of conversion to the subcortical small vessel type of dementia","authors":"Elin Axelsson Andrén,&nbsp;Petronella Kettunen,&nbsp;Anders Wallin,&nbsp;Johan Svensson","doi":"10.1016/j.cccb.2026.100561","DOIUrl":"10.1016/j.cccb.2026.100561","url":null,"abstract":"<div><h3>Background</h3><div>Insulin resistance (IR) has been associated with cognitive impairment and white matter hyperintensities (WMHs) on magnetic resonance imaging (MRI) in population-based studies. However, in the clinical setting, the impact of IR on the risk of the subcortical small vessel type of dementia (SSVD) is unknown.</div></div><div><h3>Objective</h3><div>To investigate whether the homeostatic model assessment of insulin resistance (HOMA-IR) was associated with the risk of SSVD or Alzheimer's disease (AD) in a memory clinic cohort.</div></div><div><h3>Methods</h3><div>We included 352 patients from the Gothenburg MCI study with subjective or mild cognitive impairment (SCI or MCI) at baseline. SSVD was diagnosed based on clinical symptomatology, including predominant frontal lobe symptoms, and WMH amount on MRI. Cox regression, adjusted for covariates, assessed the associations between baseline HOMA-IR and incident SSVD or AD.</div></div><div><h3>Results</h3><div>During follow-up (mean 4.1 years), 83 (24%) patients developed dementia (SSVD, n = 28; AD, n = 55). Baseline HOMA-IR (per standard deviation increase) was associated with increased risk of SSVD (adjusted hazard ratio [HR] = 1.41, 95% CI: 1.16–1.73). Patients in the highest HOMA-IR quintile had an almost seven-fold higher risk of SSVD than those in the lowest quintile (adjusted HR = 6.87, 95% CI: 1.09–43.38). These associations remained significant also after excluding patients with diabetes. HOMA-IR was not associated with AD.</div></div><div><h3>Conclusion</h3><div>IR is a strong predictor of SSVD, but not AD, in patients with SCI or MCI. This suggests that IR contributes to SSVD progression and that HOMA-IR may be a useful tool for risk stratification.</div></div>","PeriodicalId":72549,"journal":{"name":"Cerebral circulation - cognition and behavior","volume":"11 ","pages":"Article 100561"},"PeriodicalIF":3.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148951535","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Older adults in more disadvantaged neighborhoods exhibit brain vascular dysfunction","authors":"Kevin W. Law,&nbsp;Allison C. Engstrom,&nbsp;Trevor Lohman,&nbsp;Melanie Quiring,&nbsp;Arunima Kapoor,&nbsp;John Paul M. Alitin,&nbsp;Danny J.J. Wang,&nbsp;Aimée Gaubert,&nbsp;Kathleen Rodgers,&nbsp;Elizabeth Head,&nbsp;Celina I. Valencia,&nbsp;Jillian L. Joyce,&nbsp;Farrah Ferrer,&nbsp;Daniel A. Nation","doi":"10.1016/j.cccb.2026.100562","DOIUrl":"10.1016/j.cccb.2026.100562","url":null,"abstract":"<div><div>Neighborhood disadvantage is a risk factor for dementia, but the mechanisms involved are not well understood. In this study, we explored the relationship between neighborhood deprivation and whole-brain cerebrovascular reactivity (CVR) in 132 older adults without a history of clinical stroke or dementia. Participants underwent brain MRI and venipuncture. Relative neighborhood deprivation was quantified using the Area Deprivation Index. Spontaneous CVR was calculated as the percent change in resting cerebral blood flow per unit change in end-tidal CO₂. Greater neighborhood deprivation was associated with lower whole-brain CVR when adjusted for age and sex (<em>p</em> = 0.027). Further adjustment for <em>APOE</em> ε4 carrier status, vascular risk factors, and plasma Alzheimer’s disease (AD) biomarker p-tau217 did not alter the results. These findings show that older adults in more disadvantaged environments exhibit reduced cerebrovascular function, independent of traditional vascular risk and AD-related pathology. However, further investigation with more diverse samples and a life-course model is warranted to better understand these microvascular differences.</div></div>","PeriodicalId":72549,"journal":{"name":"Cerebral circulation - cognition and behavior","volume":"11 ","pages":"Article 100562"},"PeriodicalIF":3.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149050722","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Arterial spin labeling MRI in CADASIL: Implications for cerebral small vessel disease and therapeutic trials","authors":"Masafumi Ihara ,&nbsp;Satoshi Saito ,&nbsp;Satoru Fujiwara ,&nbsp;Tomotaka Tanaka ,&nbsp;Toshihiko Aso","doi":"10.1016/j.cccb.2026.100542","DOIUrl":"10.1016/j.cccb.2026.100542","url":null,"abstract":"<div><div>Cerebral small vessel disease (CSVD) is a major cause of lacunar stroke, vascular cognitive impairment, and gait disturbance, yet the development of disease-modifying therapies is limited by the lack of robust, non-invasive biomarkers of microvascular pathology. Arterial spin labeling (ASL) MRI enables quantitative, non-invasive, contrast-free measurement of cerebral blood flow (CBF) and is well suited for longitudinal studies. In routine clinical and research practice, single-delay three-dimensional pseudo-continuous ASL (pCASL) with an appropriately long post-labeling delay is the workhorse implementation and has already been applied in several CADASIL (cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy) and hereditary CSVD cohorts, while more advanced approaches such as multi-delay ASL and diffusion-prepared pCASL can additionally probe arterial transit time (ATT) and blood–brain barrier (BBB) water exchange. CADASIL, caused by pathogenic <em>NOTCH3</em> variants, is a prototypical monogenic CSVD with relatively low etiologic heterogeneity, providing a powerful clinical model in which to study microvascular dysfunction and trial-ready imaging markers. In this review, we synthesize data on ASL in CADASIL, including relationships between CBF, cognition, and lesion burden, evidence from acute encephalopathic episodes, and emerging work on ATT and BBB water exchange. We further compare perfusion profiles across monogenic (<em>HTRA1</em>-related CSVD, Fabry disease) and sporadic CSVD, and discuss how ASL-derived measures—CBF, ATT, and BBB water exchange rate—can be incorporated as imaging endpoints in CADASIL therapeutic trials. In particular, standardized single-delay three-dimensional pCASL provides a practical, scalable method to quantify regional CBF as a primary perfusion endpoint.</div></div>","PeriodicalId":72549,"journal":{"name":"Cerebral circulation - cognition and behavior","volume":"10 ","pages":"Article 100542"},"PeriodicalIF":2.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147709808","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}