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Dean of Clinical Medicine Head of Edinburgh Medical School Director of Edinburgh Neuroscience Euan MacDonald Centre and Anne Rowling Regenerative Neurology Clinic Bachelor of Medicine Southampton University Neurology training National Hospital for Neurology and Neurosurgery University College London and University of Cambridge PhD in developmental neurobiology University of Cambridge 2000 Consultant Neurologist University Lecturer Fellow of King s College University of Cambridge MacDonald Professor of Neurology University of Edinburgh 2009present Fellow of the Academy of Medical Sciences 2022
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American Journal of Biomedical Science Research www biomedgrid com ISSN 2642 1747 Mini Review Copy Right Jin Zhang Hyperbaric Oxygen Therapy for Vascular Dementia Shuwen Ge2 Chengyun Tang1 Kuo Chen3 Cuiping Zhao4 Vladimir N Nikolenko1 5 and Jin Zhang1 1 I M Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation Sechenov University Russia 2 Shengjing Hospital of China Medical University China 3 The First Affiliated Hospital of Zhengzhou University China 4 The 80th Army Hospital of the Chinese people s Liberation Army Weifang China Department of Normal and Topographic Anatomy Faculty of Fundamental Medicine MV Lomonosov Moscow State University MSU 31 5 Lomonosovsky Prospect Russia 5 Corresponding author Jin Zhang I M Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation Sechenov University Russia To Cite This Article Shuwen Ge Chengyun Tang Kuo Chen Cuiping Zhao Vladimir N Nikolenko Jin Zhang Hyperbaric Oxygen Therapy for Vascular Dementia Am J Biomed Sci Res 2021 14 4 AJBSR MS ID 002006 DOI 10 34297 AJBSR 2021 14 002006 Received June 23 2021 Published October 20 2021 Introduction Diabetic vascular complications are a combination of specific abnormalities and vascular disease found in people with diabetes Chronic and long term metabolic and hormone imbalances are the pathogenesis of diabetic vascular disease 1 Studies have shown that cerebrovascular diseases may cause Mild Cognitive Impairment MCI or vascular dementia Vascular dementia VD In addition in the elderly with normal cognition it is also found that due to vascular risk factors and changes in cerebral blood flow vascular disorders there is a risk of subjective self perceived cognitive decline Therefore improving cerebral blood perfusion reducing intracranial pressure alleviating brain edema increasing tissue oxygen partial pressure promoting brain tissue healing and neovascularization are important methods for the treatment of patients with MCI or VD Due to the limitations and side effects of conventional therapies studies have proposed a complementary therapy that can significantly improve this disease Hyperbaric Oxygen Therapy HBOT This article will discuss the additional effects limitations or side effects of HBOT by increasing cerebral blood flow to assist in the treatment of cognitive impairment Due to decreased cerebral blood flow cerebrovascular dysfunction type 2 diabetes has a risk of mild cognitive impairment and dementia Dementia is a disease characterized by memory loss confusion language and comprehension personality and behavior changes and increased dependence on others in daily activities Vascular dementia is the second most common form of dementia and its clinical manifestations are mainly cognitive impairment cerebrovascular disease and progressive memory decline The risk factors are hypertension obesity diabetes hyperlipidemia metabolic syndrome etc 2 Stroke or acute cerebral infarction caused by transient ischemic attack and large scale cerebral vascular damage are the main pathogenic factors of VD 3 Vascular dementia not only reduces the quality of life of patients and suffers psychological and physical damage but also causes significant medical and economic burdens on the family and society Therefore research on effective treatment of VD has important social and clinical significance The brain depends on the normal function of the vascular neural network to maintain cognitive function This network includes neurovascular units endothelial cells pericytes glial cells and neurons upstream arteries and arterioles which provide nutrients for the microcirculation of the brain Studies have shown that vascular neural network dysfunction can lead to neuronal damage and degeneration of Cerebral Blood Flow CBF The rate at which arterial blood is transported to the capillary bed of a specific tissue is a functional measure of the vascular neural network and is related to normal aging and This work is licensed under Creative Commons Attribution 4 0 License AJBSR MS ID 002006 331
Am J Biomed Sci Res Copy Jin Zhang cognitive decline During normal and pathological aging there is a reliable correlation between cerebral blood flow and cognitive ability Studies have shown that in patients with no decline in subjective function higher CBF supports memory function but in patients with reduced subjective cognitive ability higher CBF no longer supports memory function which reflects the cognitive dysfunction The patient has neurovascular disorders 4 In addition in patients with type 2 diabetes who may develop cognitive impairment lower CBF is associated with poor memory executive function and processing speed When adjusting for diabetes a significant association between lower regional CBF and poor executive function and processing speed still exists At present the Conventional Treatment of VD CT including anticoagulant drugs dilation of cerebrovascular reducing blood viscosity correcting electrolyte disturbances controlling cerebral edema etc mostly focuses on symptomatic management and reducing potential risk factors for cerebrovascular diseases 5 Cholinesterase inhibitors donepezil ristamine and galantamine and non cholinergic drugs memantine nimodipine and hydrobase have been considered effective drugs for the treatment of VD 6 However due to its many contraindications many side effects and unclear pathological mechanisms the role of CT is still limited At present studies have proposed a complementary therapy that can significantly improve this disease Hyperbaric Oxygen Therapy HBOT Regarding The Improvement Exercise on Cerebral Blood Flow of Aerobic For the elderly with a sedentary lifestyle Cerebral Blood Flow CBF is a sensitive physiological marker of cerebrovascular function Physical activity can improve cerebrovascular function and reduce age related cognitive decline A randomized controlled crossover trial of 17 apparently healthy men aged 60 70 years with BMI between 25 and 35kg m2 Study participants were randomly assigned to an 8 week period of fully supervised progressive aerobic exercise or no exercise control with a 12 week clearance period in between Measurements at the end of each period include aerobic fitness assessed using peak oxygen consumption during incremental exercise VO2peak CBF measured using pseudocontinuous arterial spin labeled magnetic resonance imaging and Oral Glucose Tolerance Test OGTT Glucose response after a determined load In addition cognitive performance in areas such as executive function memory and psychomotor speed were also evaluated Experimental results show that compared with non exercise control VO2peak after aerobic exercise training increased significantly by 262 236mL P
Am J Biomed Sci Res Copy Jin Zhang physiological data is scarce In a recent experimental study the authors used a burn model to observe that compared with the control group the area of secondary hyperalgesia was reduced in the HBOT group Surprisingly a lasting neuroplasticity effect was observed in the HBOT pretreatment group to reduce the regional response of secondary hyperalgesia induced by burns 18 19 In addition HBOT also plays a role in delaying cellular senescence Aging is characterized by the gradual loss of physiological capacity At the cellular level two key signs of the aging process include shortened Telomere Length TL and cellular senescence The use of HBOT for repeated intermittent hyperoxia exposure during hypoxia can induce a regenerative effect A study evaluated whether HBOT affects the concentration of TL and senescent cells in normal nonpathological and aging adults The final study confirmed that HBOT may delay the effects of aging including a significant increase in telomere length and the elimination of senescent cells in the aging population 20 Conclusion The available evidence in this review shows that adding HBOT to the standard conventional treatment of VD significantly improves mental status scales activities of daily living hemorheology and clinical efficacy In view of the effectiveness and safety of HBOT it is reasonable to recommend HBOT as an adjuvant therapy for the treatment of VD Acknowledgement None 5 Sorrentino G Migliaccio R Bonavita V 2008 Treatment of vascular dementia the route of prevention Eur Neurol 60 5 217 223 6 Chen LP Fa Wei W Fang Zuo Jian Jun J Wei Guo J 2011 Clinical research on comprehensive treatment of senile vascular dementia J Tradit Chin Med 31 3 178 181 7 Kleinloog J Ronald PM Dimo Ivanov Jos JA Kamil U et al 2019 Aerobic Exercise Training Improves Cerebral Blood Flow and Executive Function A Randomized Controlled Cross Over Trial in Sedentary Older Men Front Aging Neurosci 11 333 8 Garc a CL Cuauht moc S 2000 Hyperbaric oxygenation therapy basic concepts Gac Med Mex 136 1 45 56 9 You Q Lan Li Su Qin X Yu Fen Y Dan Li et al 2019 Meta Analysis on the Efficacy and Safety of Hyperbaric Oxygen as Adjunctive Therapy for Vascular Dementia Front Aging Neurosci 11 86 10 Robertson PW BB Hart 1999 Assessment of tissue oxygenation Respir Care Clin N Am 5 2 221 263 11 Wang F Yong Wang Tao Sun Hua Lin Y 2016 Hyperbaric oxygen therapy for the treatment of traumatic brain injury a meta analysis Neurol Sci 37 5 693 701 12 Yin W Ahmed E George M John H 2002 Down regulation of COX 2 is involved in hyperbaric oxygen treatment in a rat transient focal cerebral ischemia model Brain Res 926 1 2 165 171 13 Yin D Changman Z Ikuyo K John WC Andrew D 2003 Inhibition of apoptosis by hyperbaric oxygen in a rat focal cerebral ischemic model J Cereb Blood Flow Metab 23 7 855 864 14 Calvert JW Changman Z Anil Nanda John HZ 2003 Effect of hyperbaric oxygen on apoptosis in neonatal hypoxia ischemia rat model J Appl Physiol 1985 95 5 2072 2080 15 Zhang T Qin WY Shu NW Jing ZW Qiang W et al 2010 Hyperbaric oxygen therapy improves neurogenesis and brain blood supply in piriform cortex in rats with vascular dementia Brain Inj 24 11 13501357 16 Cui HJ Hao Y A Li Yang Hua Tao et al 2017 Hyperbaric oxygen for experimental intracerebral haemorrhage Systematic review and stratified meta analysis Brain Inj 31 4 456 465 Conflict of Interest No conflict of interest References 1 Feener E GL King 1997 Vascular dysfunction in diabetes mellitus Lancet 350 1 9 13 2 Levine DA KM Langa 2011 Vascular cognitive impairment disease mechanisms and therapeutic implications Neurotherapeutics 8 3 361 373 3 Kalaria RN R Akinyemi M Ihara 2016 Stroke injury cognitive impairment and vascular dementia Biochim Biophys Acta 1862 5 915 925 4 Hays C Zlatar Z Laura Meloy Christina 2018 Subjective Cognitive Decline Modifies the Relationship Between Cerebral Blood Flow and Memory Function in Cognitively Normal Older Adults J Int Neuropsychol Soc 24 3 213 223 17 Tibbles PM Edelsberg JS 1996 Hyperbaric oxygen therapy N Engl J Med 334 25 1642 1648 18 Heyboer Deepali S William S Norman McCulloch 2017 Hyperbaric Oxygen Therapy Side Effects Defined and Quantified Adv Wound Care New Rochelle 6 6 210 224 19 Wahl AM Daniel B Isabel G Mads U Ole H et al 2019 A single session of hyperbaric oxygen therapy demonstrates acute and long lasting neuroplasticity effects in humans a replicated randomized controlled clinical trial J Pain Res 12 2337 2348 20 Hachmo Y Amir H Ramzia A Malka D Merav C et al 2020 Hyperbaric oxygen therapy increases telomere length and decreases immunosenrescence in isolated blood cells a prospective trial Aging Albany NY 12 22 22445 22456 American Journal of Biomedical Science Research 333