Pharmacologic approaches to cerebral aging and neuroplasticity: insights from the stroke model
- PMID: 23576890
- PMCID: PMC3622470
- DOI: 10.31887/DCNS.2013.15.1/fchollet
Pharmacologic approaches to cerebral aging and neuroplasticity: insights from the stroke model
Abstract
Brain plasticity is an intrinsic characteristic of the nervous system that allows continuous remodeling of brain functions in pathophysiological conditions. Although normal aging is associated with morphological modifications and decline of cerebral functions, brain plasticity is at least partially preserved in elderly individuals. A growing body of evidence supports the notion that cognitive enrichment and aerobic training induce a dynamic reorganization of higher cerebral functions, thereby helping to maintain operational skills in the elderly and reducing the incidence of dementia. The stroke model clearly shows that spontaneous brain plasticity exists after a lesion, even in old patients, and that it can be modulated through external factors like rehabilitation and drugs. Whether drugs can be used with the aim of modulating the effects of physical training or cognitive stimulation in healthy aged people has not been addressed until now. The risk:benefit ratio will be the key question with regard to the ethical aspect of this challenge. We review in this article the main aspects of human brain plasticity as shown in patients with stroke, the drug modulation of brain plasticity and its consequences on recovery, and finally we address the question of the influence of aging on brain plasticity.
La plasticidad cerebral es una característica intrínseca del sistema nervioso que permite una continua remodelación de las funciones cerebrales en situaciones físiopatológicas. Aunque el envejecimiento normal está asociado con cambios morfológicos y una declinación de las funciones cerebrales, en sujetos de edad avanzada la plasticidad del cerebro se mantiene parcialmente, Cada vez hay mayor evidencia que sustenta la noción que el enriquecimiento cognitivo y el entrenamiento aeróbico inducen una reorganización dinámica de las funciones cerebrales superiores, con lo que ayudan a mantener las habilidades operadonales en el anciano y reducen la incidencia de demencia. Claramente el modelo de accidente cerebro vascular muestra que la plasticidad cerebral espontánea se produce después de la lesión, inclusive en pacientes de edad avanzada y que puede ser modulada a través de factores externos como la rehabilitación y los fármacos, Hasta la fecha no se han identificado fármacos que puedan ser empleados con el objetivo de modular los efectos del entrenamiento físico o de la estimulación cognítiva en ancianos sanos, La relación riesgo:benefícío será la pregunta clave respecto a los aspectos éticos de este desafío. En este artículo se revisan los aspectos principales de la plasticidad cerebral humana como se observa en pacientes con accidentes cerebro vasculares, la modulación por fármacos de la plasticidad neuronal y sus consecuencias en la recuperación, y finalmente se aborda la pregunta acerca de la influencia del envejecimiento en la plasticidad cerebral.
La plasticité cérébrale est une caractéristique propre du système nerveux central qui permet un remodelage permanent de son activité à la fois dans des conditions physiologiques et au cours des maladies neurologiques. Bien que le vieillissement s'accompagne de modifications de structure et d'une diminution des performances cognitives, les capacités de plasticité restent au moins partiellement conservées chez le sujet âgé. Un faisceau d'arguments préclinique et clinique plaide pour un rôle majeur des stimulations cognitives et physiques dans le maintien des fonctions cognitives au cours du vieillissement. Le « modèle » de l'accident vasculaire cérébral démontre clairement que le cerveau âgé est capable de se réorganiser après une lésion unique aiguë et focale et que cette réorganisation peut être modulée par des facteurs externes tels que la rééducation et certains médicaments. On ne sait pas encore si les médicaments sont capables de moduler les effets des stimulations physique et cognitive. Les aspects éthiques et le rapport bénéfice-risque seront au coeur du débat. Nous traitons dans cet article les différents aspects de la plasticité cérébrale que l'accident vasculaire cérébral a permis de décrire, nous envisageons l'action des médicaments sur la plasticité cérébrale post-lésionnelle et la récupération fonctionnelle et nous évoquons l'influence du vieillissement sur les capacités du cerveau humain à se reconfigurer lorsqu'il est lésé.
Keywords: aging; brain plasticity; pharmacology; recovery; stroke.
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