Opinion in 2012

Hypertension is highly prevalent, particularly in individuals over 60 years of age, and constitutes a major risk factor for stroke and dementia. Antihypertensive therapy in elderly individuals has, however, been limited owing to concerns over adverse effects of such therapies. In this Perspectives article, Sörös et al. emphasize that treatment of hypertension can markedly reduce stroke and dementia risk, and argue that antihypertensive therapy should be considered in all patients, irrespective of age.

Pathological changes underlying Alzheimer disease (AD) begin more than 10 years before clinical presentation, and the need for early therapeutic intervention is becoming increasingly recognized. Reisa Sperling and colleagues consider challenges to such an approach—including the difficulty of defining preclinical AD, and ethical issues associated with disclosing information on AD biomarker status to healthy individuals—and discuss possible ways to overcome these hurdles.

The neurovascular unit is a key concept in stroke medicine that for many years has been defined as the endothelial cells, neurons and glia surrounding cerebral capillaries. In this Perspectives article, the authors expand this concept to encompass more-distant circulation, smooth muscle cells and perivascular innervation. This 'neural vascular network' in turn points to new strategies for stroke therapy.

Immunotherapy targeting amyloid-β showed promise for treatment of Alzheimer disease (AD) in preclinical studies, but trials in humans have yielded disappointing results. In their Perspectives article, Liu and colleagues discuss adverse effects of amyloid-targeted therapies, which have limited treatment efficacy, and propose strategies to optimize the design of future therapeutic antibodies for AD.