# Targeting the Biology of Aging in Cerebrovascular Disease: Inflammation, Metabolism, Senescence, and Regeneration

## TL;DR

This paper explores new therapies targeting aging-related cerebrovascular diseases by focusing on inflammation, metabolism, and regeneration.

## Contribution

The paper introduces novel therapeutic strategies tailored to the aging brain's unique biology.

## Key findings

- Aging is a major risk factor for cerebrovascular disease, affecting vascular and immune functions.
- Emerging therapies include senescence targeting, stem cell regeneration, and RNA-based interventions.
- Precision medicine and chronobiology are highlighted for personalized treatment of elderly patients.

## Abstract

Aging is the strongest independent risk factor for cerebrovascular diseases, profoundly influencing vascular structure, immune responses, and regenerative capacity of the brain. Traditional therapeutic strategies, largely developed in younger populations, often show reduced efficacy and increased risk in elderly patients, underscoring the need for age-adapted interventions. Advances in the understanding of cerebrovascular aging have revealed key mechanisms such as vascular senescence, chronic low-grade inflammation, blood–brain barrier dysfunction, mitochondrial impairment, and circadian dysregulation as central drivers of disease progression and poor recovery. This narrative review summarizes emerging therapeutic strategies targeting the molecular and cellular hallmarks of aging-related cerebrovascular disease. These include immunomodulatory and anti-inflammatory approaches, senescence-targeted therapies, stem cell and extracellular vesicle-based regenerative strategies, RNA-based interventions, and metabolic and mitochondrial modulation. Particular emphasis is placed on therapies aimed at restoring neurovascular unit integrity and promoting brain repair in the aged microenvironment. Additionally, this review highlights the growing role of chronobiology and precision medicine, integrating biomarkers and multi-omics approaches to tailor treatments for elderly patients. Collectively, these emerging therapies represent a paradigm shift from symptom-oriented management toward mechanism-based and personalized interventions. Addressing age-specific pathophysiology will be critical for improving outcomes in cerebrovascular diseases in the aging population and for translating experimental advances into effective clinical therapies.