Age-Related Alterations of Cerebral Autoregulation

Intact regulation of cerebral blood flow (CBF) is essential for preserving cognitive function and reducing the risk of cerebrovascular events, particularly in the aging population. Autoregulation of CBF is one of the fundamental mechanisms that ensure constant supply for brain tissue by maintaining relatively stable perfusion despite fluctuations in systemic blood pressure. It also acts as a critical protective mechanism, shielding the fragile cerebral microcirculation from potentially harmful pressure fluctuations and hence excessive pulsatility. The loss or attenuation of this protective mechanism with aging or disease increases the vulnerability of the microvasculature to structural damage, blood-brain barrier (BBB) disruption, and the development of cerebral small vessel disease. This mini-review summarizes current understanding of how aging affects cerebral autoregulation, highlighting underlying mechanisms, clinical consequences, and potential strategies to preserve cerebrovascular health in older adults.