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Regulation of cerebral blood flow in humans: physiology and clinical implications of autoregulation.

journal contribution
posted on 04.05.2021, 09:44 by Jurgen AHR Claassen, Dick HJ Thijssen, Ronney B Panerai, Frank M Faraci
Brain function critically depends on a close matching between metabolic demands, appropriate delivery of oxygen and nutrients, and removal of cellular waste. This matching requires continuous regulation of cerebral blood flow (CBF), which can be categorized into four broad topics: 1) autoregulation, which describes the response of the cerebrovasculature to changes in perfusion pressure, 2) vascular reactivity to vasoactive stimuli [including carbon dioxide (CO2)], 3) neurovascular coupling (NVC), i.e., the CBF response to local changes in neural activity (often standardized cognitive stimuli in humans), and 4) endothelium-dependent responses. This review focuses primarily on autoregulation and its clinical implications. To place autoregulation in a more precise context, and to better understand integrated approaches in the cerebral circulation, we also briefly address reactivity to CO2 and NVC. In addition to our focus on effects of perfusion pressure (or blood pressure), we describe the impact of select stimuli on regulation of CBF (i.e., arterial blood gases, cerebral metabolism, neural mechanisms, and specific vascular cells), the inter-relationships between these stimuli, and implications for regulation of CBF at the level of large arteries and the microcirculation. We review clinical implications of autoregulation in aging, hypertension, stroke, mild cognitive impairment, anesthesia, and dementias. Finally, we discuss autoregulation in the context of common daily physiological challenges, including changes in posture (e.g., orthostatic hypotension, syncope) and physical activity.

History

Author affiliation

Department of Cardiovascular Sciences

Version

AM (Accepted Manuscript)

Published in

Physiological reviews

Publisher

American Physiological Society

issn

0031-9333

eissn

1522-1210

Acceptance date

17/03/2021

Copyright date

2021

Available date

26/03/2022

Spatial coverage

United States

Language

eng

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