Cerebral autoregulation: an overview of current concepts and methodology with special focus on the elderly

• Published in: Journal of Cerebral Blood Flow & Metabolism 2008-06, Vol.28 (6), p.1071-1085
• Main Authors: van Beek, Arenda HEA, Claassen, Jurgen AHR, Rikkert, Marcel GM Olde, Jansen, René WMM
• Format: Article
• Language: English
• Subjects: Aged; Aging - physiology; Biological and medical sciences; Brain - blood supply; Brain - physiology; Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy; Homeostasis - physiology; Humans; Medical sciences; Nervous system (semeiology, syndromes); Neurology; Time Factors; Vascular diseases and vascular malformations of the nervous system
• ISSN: 0271-678X; 1559-7016
• DOI: 10.1038/jcbfm.2008.13

Cerebral autoregulation (CA) refers to the properties of the brain vascular bed to maintain cerebral perfusion despite changes in blood pressure (BP). Whereas classic studies have assessed CA during changes in BP that have a gradual onset, dynamic studies quantify the fast modifications in cerebral blood flow (CBF) in relation to rapid alterations in BP. There is a lack of standardization in the assessment of dynamic CA. This review provides an overview of the methods that have been applied, with special focus on the elderly. We will discuss the relative merits and shortcomings of these methods with regard to the aged population. Furthermore, we summarize the effects of variability in BP on CBF in older people. Of the various dynamic assessments of CA, a single sit-to-stand procedure is a feasible and physiologic method in the elderly. The collection of spontaneous beat-to-beat changes in BP and CBF allows estimation of CA using the technique of transfer function analysis. A thorough search of the literature yielded eight studies that have measured dynamic CA in the elderly aged