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Regulation of cerebral blood flow in humans: physiology and clinical implications of autoregulation

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Claassen, Jurgen A. H. R., Thijssen, Dick H. J., Panerai, Ronney B., Faraci, Frank M.·2021·Physiological Reviews

DOI 10.1152/physrev.00022.2020

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Abstract

Brain function critically depends on a close matching between metabolic demands, appropriate delivery of oxygen and nutrients, and removal of cellular waste. This matching requires continuous regulation of cerebral blood flow (CBF), which can be categorized into four broad topics: 1) autoregulation, which describes the response of the cerebrovasculature to changes in perfusion pressure; 2) vascular reactivity to vasoactive stimuli [including carbon dioxide (CO 2)]; 3) neurovascular coupling (NVC), i.e., the CBF response to local changes in neural activity (often standardized cognitive stimuli in humans); and 4) endothelium-dependent responses. This review focuses primarily on autoregulation and its clinical implications. To place autoregulation in a more precise context, and to better understand integrated approaches in the cerebral circulation, we also briefly address reactivity to CO 2 and NVC. In addition to our focus on effects of perfusion pressure (or blood pressure), we describe the impact of select stimuli on regulation of CBF (i.e., arterial blood gases, cerebral metabolism, neural mechanisms, and specific vascular cells), the interrelationships between these stimuli, and implications for regulation of CBF at the level of large arteries and the microcirculation. We review clinical implications of autoregulation in aging, hypertension, stroke, mild cognitive impairment, anesthesia, and dementias. Finally, we discuss autoregulation in the context of common daily physiological challenges, including changes in posture (e.g., orthostatic hypotension, syncope) and physical activity.

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Authors: Claassen, J. A. H. R., Thijssen, D. H. J., Panerai, R. B., & Faraci, F. M.
Venue: Physiological Reviews
Publisher: American Physiological Society
Published: 2021-10-01
Volume: 101
Issue: 4
Pages: 1487-1559
ISSN: 0031-9333 (ISSN-L)
1522-1210
DOI: 10.1152/physrev.00022.2020
OpenAlex: W3139496128
Cited by: 915
References: 41
FWCI: 18.94
Type: journal article
Language: en
Open access: green
Funders: Alzheimer Nederland (WE.03-2015-15040)
Foundation for the National Institutes of Health (NS-096465, NS-108409)

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Regulation of cerebral blood flow in humans: physiology and clinical implications of autoregulation

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