J Alzheimers Dis. 2026 May 24:13872877261452178. doi: 10.1177/13872877261452178. Online ahead of print.
ABSTRACT
Neurovascular dysfunction is increasingly recognized as a central feature of dementia pathogenesis in the early or even preclinical stage, rather than merely a downstream effect of amyloid-tau neurodegeneration. Based on multimodal clinical evidence showing that cerebrovascular dysregulation can precede amyloid-β accumulation, this commentary emphasizes three converging lines: (1) hippocampal blood-brain barrier breakdown as an early, potentially amyloid-/tau-independent event, (2) vascular-first/parallel two-hit frameworks linking vascular risk factors to subsequent proteinopathy, and (3) early neurovascular coupling failure and chronic hypoperfusion as upstream drivers. Integrating blood-brain barrier and hemodynamic biomarkers may facilitate earlier biological subtyping and prevention.
PMID:42178678 | DOI:10.1177/13872877261452178