Cognitive impairment and its severe form dementia are increasingly prevalent in older adults and loom as a public health disaster unless effective interventions are developed. Cognitive impairment is a convergent trait caused by damage from an idiosyncratic mix of four prevalent diseases (Alzheimer disease; vascular brain injury; Lewy body diseases, such as Parkinson disease and dementia with Lewy bodies; and limbic-predominant age-related transactive response DNA-binding protein 43 encephalopathy) that is counterbalanced by individually varying resilience, which is comprised of reserve and compensation. Brain regional damage from each of these four prevalent diseases is generated by the net effect of injury and (mal)adaptive response and is accompanied by characteristic lesions. Existing therapeutics enhance resilience, whereas most agents under development target mechanisms of damage with only suppression of vascular brain injury yet to show therapeutic promise. We hope to anticipate future tailored interventions that target mechanisms of damage and thereby avert the oncoming surge of cognitive impairment and dementia in older adults.

中文翻译：

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老年人的认知障碍和治疗策略


认知障碍及其严重形式的痴呆症在老年人中越来越普遍，除非制定有效的干预措施，否则将成为一场公共卫生灾难。认知障碍是由四种常见疾病（阿尔茨海默病、血管性脑损伤、路易体疾病，如帕金森病和路易体痴呆；以及边缘系统主导的与年龄相关的DNA交互反应）的共同损害引起的趋同性特征。结合蛋白 43 脑病），这是通过个体不同的弹性来平衡的，弹性由储备和补偿组成。这四种常见疾病造成的脑区域损伤是由损伤和（不良）适应性反应的净效应产生的，并伴有特征性病变。现有的治疗方法可以增强恢复力，而大多数正在开发的药物都针对损伤机制，仅抑制血管性脑损伤，尚未显示出治疗前景。我们希望未来能够针对损害机制采取量身定制的干预措施，从而避免老年人认知障碍和痴呆症的激增。