Possibilities of evaluating vascular risk

RESUMO

MRI and Doppler Sonography allow to study the effects of risk factors on brain parenchyma and vessels walls already in clinically silent stages of cerebrovascular disease and almost one third of normal volunteers reveal minimal to moderate carotid arterioclerosis at the presence of cerevasacular risk factors. However, it is yet unclear whether the detection of such abnormalities will also improve our predictive reliability in respect to the individual risk for stroke or vascular dementia. Basedon the similarity of white matter lesions with the MRI appearance of arteriosclerotic encephalopathy and neuropsychologic test results a tumely evolution of these changes towards dementia seems to be conceivable. Follow-up studies on the fate of white matter lesions will clarify, whether or not the appearence of such changes implies additional risk for vascular dementia than could be expected by the presence of risk factors alone. Serum fibrinogen has been indentified as the major predictor of extracranial arteriosclerosis in normals besides age. Increasing levels correlate with increasing probability of vessels wall damage. These data are of special interest since a previous study demostrate a higher risk for stroke and myocardial infarction in individuals with elevated serum fibrinogen levels than in those without. However. at the moment it can not be decided, if rheologic changes are the cause or sequence of vessels disease. Moreover future research has to determine, if serum fibrinogen increases the risk for stroke per se or may at least help to identify individuals at a high risk