Title : Cervical stenosis-induced chronic cerebrospinal fluid flow restriction as a contributing cause of dementia
Abstract:
Statement of the Problem: Obvious CSF flow obstruction is a well-established cause of acute and subacute dementia, as well as a host of other neurological dysfunction processes. Unfortunately, the less-obvious vagaries of CSF production and absorption remain relatively unexplored and, logically, could play a role in neuronal destruction.
The Purpose of this Study: The complexity and multitude of neuronal feedback mechanisms, as well as the difficulty in measuring subtle neurological defects, makes probing the etiology of cognitive decline a vexing process. The purpose of our inquiry is to demarcate processes (particularly cervical stenosis) by which restricted (often episodic), CSF circulation subtly damages neuronal tissue, and to propose studies and arrangements to track and prevent the onset of such difficulties.
Methodology and Theoretical Orientation: To assess the impact of recent new understandings of CSF flow dynamics, and on the possible etiology of dementia, a substantial literature review was conducted, and new suggestions proposed.
Findings: A systematic literature review suggests the elevated prevalence of cervical stenosis, concomitant CSF flow obstruction and dementia, in an elderly population. The literature further suggests that cervical stenosis can significantly, often discreetly, chronically compromise CSF circulation, thereby injuring neuronal tissue by direct untoward pressure, by restriction of cerebral CSF bulk flow retarding beta-amyloid clearance, and by ventricular ependymal cell damage allowing transependymal flow neuronal damage. Moreover, such restriction could contribute to the development of sleep apnea, thereby causing concomitant respiratory and circulatory dysfunction, promoting the development of a vicious cycle in which widespread direct neuronal injury as well as further increase in ICP occurs.
Conclusion & Significance: We conclude that, among other obstructive possibilities, cervical stenosis could play a largely unappreciated role in the development of dementia. Recognition of subtle, chronic CSF alterations (in some ways comparable to chronically abnormal blood pressure) calls for the development of, preferably non-invasive, technology to measure CSF circulation on a 24-hour basis. If the parameters of episodic abnormalities could be better adjudicated, optimistically, prevention of such events could reasonably be effectuated by cervical decompression, therapeutic drug regimen, and altered sleep position. Such hopeful interventions could be instituted in the large, identified cohort of elderly patients presently undergoing evaluation and treatment for traditional cervical stenosis-engendered clinical problems. Patients in this established population could easily be assessed for the impact of dementia.
