Thinking problems after brain blood flow loss and return: a brain system perspective

Post-stroke cognitive impairment (PSCI) is a common consequence of cerebral ischemia-reperfusion injury.

• Traditional views on PSCI focus on neurons but do not account for its delayed onset and diverse pathology.
• A new framework emphasizes the interactions among the neurovascular unit, neuronal networks, and the immune-glial environment.
• Pathological conditions such as neuroinflammation and gut-brain axis dysfunction may indicate a collapse of the neuroecosystem.
• Emerging tools like spatial omics and in vivo dynamic imaging are important for validating this new framework.
• Therapeutic approaches are evolving from protecting individual neurons to restoring the entire neuroecosystem.

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