Fig. 7
From: Arterial stiffness and vascular aging: mechanisms, prevention, and therapy
a Microscopic and macroscopic consequences of arterial stiffness and altered vessel pulsation on the brain parenchyma. The increased pressure peaks cause a remodeling process in the arterial wall structure; thus, pulsation is not transmitted into the peripheral microvasculature. This leads to a decrease in CSF influx, the deposition of amyloid proteins and the emergence of enlarged perivascular spaces. In addition, the remodeling process includes decreases in cerebral perfusion and small vessel disease, which can be visualized as microbleeds, white matter hyperintensities, and lacunar infarctions.162,271 b Impaired glymphatic clearance is presented on a microscopic scale. The altered pulsation caused by vessel remodeling and arterial stiffness leads to decreased CSF influx into the brain parenchyma and subsequent waste deposition, such as that of amyloid proteins. Stored amyloids cause inflammation and reactive astrogliosis, which promote neurodegenerative diseases. Additionally, we depicted the ongoing process in young individuals versus Alzheimer’s disease patients with enlarged perivascular spaces.276 CSF cerebrospinal fluid, ISF interstitial fluid, EPVS enlarged perivascular space, pp pulse pressure. Created with BioRender.com
