Core Viewpoint - A recent clinical study from China published in the Journal of Stroke and Cerebrovascular Diseases indicates that NSKSD nattokinase can effectively reduce the risk of cognitive decline in asymptomatic patients with intracranial/ carotid artery stenosis [1][2]. Group 1: Study Overview - The study, led by Professor Lou Min from Zhejiang University School of Medicine, involved a randomized double-blind placebo-controlled trial assessing the impact of NSKSD nattokinase on brain blood flow and cognitive function in patients with at least 50% stenosis [1][2]. - A total of 120 asymptomatic patients were enrolled, with 60 receiving NSKSD nattokinase (8000 FU daily) and 60 receiving a placebo for six months [2]. Group 2: Key Findings - The study found that the NSKSD nattokinase group showed a 65% reduction in the risk of cognitive decline in visual-spatial function compared to the placebo group [2]. - The average Z-score for visual-spatial function improved by 0.254 in the NSKSD group, while it decreased by 0.094 in the placebo group, resulting in a significant inter-group difference of 0.350 [2]. Group 3: Importance of Visual-Spatial Function - Visual-spatial ability is crucial for daily activities and its decline can lead to significant negative impacts on patients' lives, including difficulties in navigation and increased safety risks at home [3]. - Early intervention targeting visual function decline is essential for preventing vascular dementia, as it reflects the severity of cerebrovascular disease [3]. Group 4: Broader Implications - The study highlights the growing challenge of cerebrovascular and cognitive disorders in China, with a reported prevalence of mild cognitive impairment (MCI) at 20.8% among individuals aged 65 and older, with a significant portion attributed to cerebrovascular diseases [3]. - Traditional drug treatments face challenges such as adherence issues and side effects, making non-drug nutritional interventions like NSKSD nattokinase an important complementary approach in chronic disease prevention [4].

Core Viewpoint - The study reveals that exosomes derived from macrophage-derived foam cells in atherosclerotic plaques exacerbate ischemic white matter injury and vascular cognitive impairment by transmitting metabolic defects to microglia [2][5][10]. Group 1: Research Findings - Atherosclerosis (AS) is identified as an independent risk factor for vascular cognitive impairment (VCI), with unclear mechanisms [2]. - The research team discovered that exosomes in the circulation of AS patients worsen ischemic white matter injury and VCI [5]. - Foam cells produce exosomes that target microglia in the central nervous system, transmitting oxidative stress imbalance and metabolic defects through the miR-101-3p-Nrf2-Slc2a1 signaling axis [5][7]. Group 2: Potential Therapeutic Targets - The study confirms that inhibiting miR-101-3p or activating Nrf2 can counteract the effects of atherosclerotic exosomes and improve vascular cognitive impairment [6][7]. - The findings suggest a long-distance connection between peripheral macrophages and microglia, providing new insights and potential therapeutic targets for atherosclerosis-induced vascular cognitive impairment [3][10].