Cerebral small vessel disease (SVD), present in 80-94% of adults over age 65 years, increases the risk of stroke by 2-fold, and dementia by 2.3-fold. There is currently no treatment to slow SVD progression. This study aims to test whether impaired cerebral and retinal vasoreactivity may serve as biomarker for SVD progression, and to evaluate the safety and efficacy of cilostazol (antiplatelet agent with vasodilatory and anti-inflammatory properties) for the treatment of SVD.
Age ≥18 yo.
Diagnosis of CADASIL, sporadic WMD or lobar CMB and age-matched healthy controls (eg. patient's spouse or unrelated friends without SVD)
Age<18yo
Pregnant
Breast feeding
Unable to follow commands
Parallel
Cilostazol
DrugCilostazol 100mg BID
white matter disease volume
change in total white matter disease volume
cognition
global Z-score and by cognitive domain
stroke
ischemic stroke or hemorrhagic stroke
cerebrovasoreactivity
change in blood oxygen level dependence (BOLD) per unit of end tidal PCO2 mmHg
retinal vasoreactivity
change in retinal vessel density pre/post CO2 challenge
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