Brain Atrophy and Cerebral Small Vessel Disease

Abstract

Background and Purpose-Cerebral small vessel disease (SVD) is the most common cause of vascular dementia. Interest in the use of surrogate markers is increasing. The aims of this study were to determine if brain volume was different between patients with SVD and control subjects, whether it correlated with cognition in SVD, and whether changes in brain volume could be detected during prospective follow-up. Methods-Thirty-five patients (mean age, 68.8 years) who had a lacunar stroke and radiological evidence of confluent leukoaraiosis and 70 age-and gender-matched control subjects were recruited. Whole-brain T1-weighted imaging and neuropsychological testing were performed after 1 year on all patients and after 2 years for the control subjects. Fully automated software was used to determine brain volume and percentage brain volume change. An executive function score was derived. Results-There was a significant difference in brain volume between the patients with SVD and control subjects (meanϮSD [mL] 1529Ϯ84 versus 1573Ϯ69, Pϭ0.019). In the patients with SVD, there was a significant association between brain volume and executive function (rϭ0.501, PϽ0.05). The meanϮSD yearly brain atrophy rate for patients with SVD and control subjects was significantly different (Ϫ0.914%Ϯ0.8% versus Ϫ0.498%Ϯ0. 4%, respectively, Pϭ0.017). No change in executive function score was detected over this period. Key Words: brain atrophy Ⅲ cerebral small vessel disease Ⅲ cognitive impairment Ⅲ longitudinal study Ⅲ MRI Ⅲ surrogate marker C erebral small vessel disease (SVD) is a major cause of stroke, age-related cognitive decline, and vascular dementia. 1 Despite its importance, few studies have specifically investigated treatment in this stroke subtype. 2,3 This is due to a number of issues that complicate assessment of treatment efficacy: the risk of recurrent stroke is relatively low with an annual rate of 0.25%, 4 the rate of progression to dementia is slow, 4 and repeated cognitive testing is associated with a learning effect that reduces sensitivity to longitudinal decline. Therefore, large sample sizes are required to determine treatment efficacy when using stroke and dementia as end points. This has led to the suggestion that imaging may provide useful surrogate markers for SVD to assess therapeutic approaches at an early stage. 5 A number of criteria have been proposed for the definition of an effective surrogate marker for treatment trials. 6 The first criterion is that the marker must be able to predict the natural course of the disease, that is, it should correlate with relevant clinical features, for example, cognitive function, in both crosssectional and longitudinal studies. Conclusions-Brain volume is reduced in SVD andIn multiple sclerosis, imaging parameters have been demonstrated to have high sensitivity for detection of disease activity, which is better than clinical scores. 7 Brain atrophy has been used as an outcome measure in treatment trials. 8,9 In comparison to multiple sclerosis, there are less data on br...

On the Reproducibility of Inversion Recovery Intravoxel Incoherent Motion Imaging in Cerebrovascular Disease

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Late-Onset Epilepsy and Occult Cerebrovascular Disease

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Brain atrophy accelerates cognitive decline in cerebral small vessel disease

“…16 Longitudinal studies focusing on the consequences of brain atrophy on SVDrelated cognitive decline are still sparse. 5,17,18 Particularly, the mediating effects and the interactions between atrophic changes and vascular pathology are largely unknown. The aims of the present study were to investigate in a sample of older individuals with agerelated WML 1) whether baseline MTA and cortical or subcortical atrophy predict baseline and longitudinal cognitive performance independently of coexisting WML and infarcts, 2) whether these atrophic changes mediate the effect of WML on cognitive impairment, and c) whether the different imaging findings have synergistic effects on cognition.…”