Chronic inflammation linking atherosclerosis to cognitive impairment: Multi-target mechanisms and therapeutic advances in chinese herbal medicine

The chronic inflammatory state associated with vascular aging plays a critical role in the pathogenesis of age-related diseases, including occurrence and progression of atherosclerosis (AS) and cognitive impairment (CI). The detrimental impacts of inflammation are multifaceted. On the one hand, inflammation impairs the function of vascular endothelial cells (EC) and contributes to vascular remodeling. On the other hand, it triggers a cascade of events resulting in cerebral small vessel disease (CSVD), which disrupts the blood-brain barrier (BBB), induces neuroinflammation and ultimately impairs cognitive function. Consequently, these processes establish a strong pathological link between atherosclerosis (AS) and cognitive impairment (CI). Chinese Herbal Medicine(CHM) posits that AS and CI share common pathological factors and similar pathogeneses. According to CHM theory, the aging process is associated with a gradual deficiency of healthy qi, which subsequently results in spleen qi deficiency and impaired transportation functions. This dysfunction leads to the accumulation of water-dampness, which can further transform into pathogenic fire, thereby causing damage to the veins and channels. Clinically, such pathological changes may manifest as cardiac pain, dementia, and other symptoms. The treatment of AS in CHM follows principles such as clearing heat, removing toxins, as well as eliminating phlegm and resolving blood stasis. It is notable that numerous studies have demonstrated that Chinese herbs exhibit distinctive therapeutic potential in modulating the progression of CI associated with AS. These herbs have been observed to target multiple pathways intricately involved in AS-related inflammatory processes and cognitive impairment, offering a comprehensive therapeutic approach. In light of the above, this review aims to provide an overview of the evidence supporting the association between AS and CI. It will explore the pathological mechanisms and processes by which AS contributes to the development of CI, and summarize the mechanism of action of Chinese herbs in the treatment of AS-related CI. The findings aim to inform future therapeutic strategies for cognitive disorders and guide research directions in this field.