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The term "cerebrovascular disease of small vessals" (CDSV) includes neuropathological, clinical and neuroimaging manifestations lesions of small perforating arteries, arterioles, capillaries, venules and small veins. CDSV, according to the pathogenetic classification of L. Pantoni, is divided into 6 types: sporadic non-amyloid microangiopathy (SNAMA); sporadic and hereditary cerebral amyloid angiopathy (CAA); hereditary CDSV (CADASIL, CARASIL, MELAS, Fabry disease, CDSV in mutations of COL4A1 gene and others); CDSV, mediated by inflammation and immune processes; venous collagenosis; other options. In 4 chapters of the review the following are considered: morphological and neuroimaging characteristics of CDSV; cognitive impairment and CDSV: morphological, neuropsychological and neuroimaging comparisons; natural aging of the brain: morphological, neuroimaging and neuropsychological comparisons; the influence of modified risk factors (hypertension, type 2 diabetes mellitus, radiation exposure) on the course of CDSV. Conclusions. Despite the threatening consequences of CDSV, its early clinical and instrumental diagnosis has not attracted proper attention of researchers. The subject of the vast majority of studies were: CDSV of moderate and severe degree, post-stroke conditions; neuroimaging criteria for the prognosis of acute cerebrovascular disease, Alzheimer's disease and dementia in the elderly and senile persons; age differences of CDSV and cognitive impairments (CI) in terms of the overall disease duration, and not in terms of the peculiarities of its manifestation in middle or avanced age. There are objective prerequisites for establishing a methodological framework for early diagnosis of CDSV that takes into account the age of patients and the presence of modifiable risk factors. These include: the existence of consensus on the definition, classification and neuroimaging features of CDSV; availability of effective cognitive scales, which are designed to screen and determine the domain affiliation of non-dementia CD; introduction of new neuroimaging technologies that allow molecular (diffusion) research and obtain images with submillimeter resolution. Two clinical observations serve as convincing evidence of the conclusions reached on the basis of the analysis of the scientific literature.
The term "cerebrovascular disease of small vessals" (CDSV) includes neuropathological, clinical and neuroimaging manifestations lesions of small perforating arteries, arterioles, capillaries, venules and small veins. CDSV, according to the pathogenetic classification of L. Pantoni, is divided into 6 types: sporadic non-amyloid microangiopathy (SNAMA); sporadic and hereditary cerebral amyloid angiopathy (CAA); hereditary CDSV (CADASIL, CARASIL, MELAS, Fabry disease, CDSV in mutations of COL4A1 gene and others); CDSV, mediated by inflammation and immune processes; venous collagenosis; other options. In 4 chapters of the review the following are considered: morphological and neuroimaging characteristics of CDSV; cognitive impairment and CDSV: morphological, neuropsychological and neuroimaging comparisons; natural aging of the brain: morphological, neuroimaging and neuropsychological comparisons; the influence of modified risk factors (hypertension, type 2 diabetes mellitus, radiation exposure) on the course of CDSV. Conclusions. Despite the threatening consequences of CDSV, its early clinical and instrumental diagnosis has not attracted proper attention of researchers. The subject of the vast majority of studies were: CDSV of moderate and severe degree, post-stroke conditions; neuroimaging criteria for the prognosis of acute cerebrovascular disease, Alzheimer's disease and dementia in the elderly and senile persons; age differences of CDSV and cognitive impairments (CI) in terms of the overall disease duration, and not in terms of the peculiarities of its manifestation in middle or avanced age. There are objective prerequisites for establishing a methodological framework for early diagnosis of CDSV that takes into account the age of patients and the presence of modifiable risk factors. These include: the existence of consensus on the definition, classification and neuroimaging features of CDSV; availability of effective cognitive scales, which are designed to screen and determine the domain affiliation of non-dementia CD; introduction of new neuroimaging technologies that allow molecular (diffusion) research and obtain images with submillimeter resolution. Two clinical observations serve as convincing evidence of the conclusions reached on the basis of the analysis of the scientific literature.
Background. The urgency of cerebral small vessel disease (cSVD) in modern neurology is considered mainly in terms of the development of vascular dementia and early diagnosis of Alzheimer’s disease. Minimal changes in MRI images and indistinct cognitive disorders in SNAMA-type cSVD (sporadic non-amyloid microangiopathy) last for a long time until they manifest as acute cerebrovascular disorders and/or significant mental deficits. However, clinical and neuroimaging criteria for early diagnosis of the disease have not been established yet, and the nature of the correlations between the indicators of neuropsychological and multiparametric MRI studies has not been clarified. Purpose – to develop criteria for early diagnosis of SNAMA cerebrovascular disease in middle-aged patients using neuropsychological studies and high-field multiparametric MRI. Materials and methods. The study enrolled 34 middle-aged patients (52.5 ± 10.8) with hypertension of stage 1–2, stage I–II and cSVD (women – 11 (32.4%), men – 23 (67.6%)). The control group (19 healthy individuals) was identical in age, gender and total duration of education. MRI (3T) was performed in the following modes: T1-2WI, DWI, 3D Brain FLAIR SHC, 3D tra, VEN BOLD, DTI medium iso SENSE. Neuropsychological studies were performed using the MoSA questionnaire evaluating the EIS, VIS, AIS, LIS, MIS, OIS domains. Results and discussion. We developed and introduced a modified scoring system for determining the severity of the burden of cerebral small vessels disease (BcSVDearly) in clinical practice. Among the early visual MRI markers, the expansion of the perivascular spaces was dominated in 27 (79.4%) of participants. A minor increase in Σ BcSVDearly to 6–7 points was found in 10 (29.4%) patients. The age norm (0–4 points) corresponded to the indicators of Σ BcSVDearly 23 out of 34 (67.6%) in the main group. Additional evidence of the disease was obtained by DTI MRI. The most significant decrease in FA was recorded in belt fibers (Δ: up to – 31.4%) and semioval centers (Δ: up to – 33.6%), the largest increase in MD was recorded in hooked bundles (Δ: up to 24.4%); right prefrontal, orbitofrontal and parietal areas (Δ up to 28.0%). According to the MoSA scale, moderate cognitive impairment was detected in 29 of 34 (85.3%) patients with a significant decrease in scores in the domains of EIS, VIS, LIS and AIS (p <0.001). The severity of early clinical manifestations of cSVD (non-amnestic polydomain moderate disorders of attention, speech, visual-spatial and executive cognitive functions) has been found to be moderately / markedly correlated with THMS, MD (positive) and FA (negative).Conclusions. We determined early visual signs of cSVD associated with arterial hypertension: dilated perivascular spaces, hyperintensity of the periventricular deep white matter of the brain, decrease by 9–33.6% of FA coefficient and increase by 20.8% – 28.0% MD. Moderate correlations between neuropsychological and neuroimaging studies have been demonstrated.
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