Vascular cognitive impairment (VCI), the second most common cause of dementia in elderly
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to cerebrovascular disease such as manifestations of discrete infarctions, brain
hemorrhages, and white matter lesions. The gut microbiota (GM) has emerged recently as an
essential player in the development of VCI. The GM may affect the brain’s physiological,
behavioral, and cognitive functions through the brain-gut axis via neural, immune,
endocrine, and metabolic pathways. Therefore, microbiota dysbiosis may mediate or affect
atherosclerosis, cerebrovascular disease, and endothelial dysfunction, which are the
predominant risk factors for VCI. Moreover, the composition of the GM includes the
bacterial component lipopolysaccharides and their metabolic products including
trimethylamine-N-oxide and short-chain fatty acids. These products may
increase the permeability of the intestinal epithelium, leading to systemic immune
responses, low-grade inflammation, and altered signaling pathways that are associated with
the pathogenesis of VCI. In this review, we discuss the proposed mechanisms of the GM in
the maintenance of VCI and how it is implicated in acquired metabolic diseases,
particularly in VCI regulation.
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