Cerebral small vessel disease: A review

Abstract

Cerebral small vessel disease (CSVD) is the most common, chronic and progressive vascular disease. The changes affect arterioles, capillaries and small veins supplying the white matter and deep structures of the brain. It is the most common incidental finding on brain scans, especially in people over 80 years of age. Magnetic resonance imaging (MRI) plays a key role in the diagnosis of CSVD. The nomenclature and radiological phenotypes of CSVD were published in 2013 based on the unified position of the so-called Centres of Excellence in Neurodegeneration. The disease is characterized by a diverse clinical and radiological picture. It is primarily responsible for stroke incidents, gait disturbances, depression, cognitive impairment, and dementia in the elderly. The CSVD contributes to about 20% of strokes, including 25% of ischemic strokes and 45% of dementias. Common causes of CSVD include arteriosclerosis, cerebral amyloid angiopathy (CAA), genetic small vessel angiopathy, inflammation and immune-mediated small vessel diseases, and venous collagenosis. There is no causal treatment and management is mainly based on combating known risk factors for cardiovascular disease (CVD).

White matter hyperintensities volume and cognition: A meta-analysis

“…The incidence of CSVD is related to the slow accumulation of tissue damage, which primarily manifests as static focal cerebrovascular diseases such as static lacunar infarction (LI), cerebral microbleeds (CMBs), local leukoaraiosis, and progressive cognitive dysfunction (Zhang et al, 2010 ), which are the leading causes of both the cognitive impairment and vascular dementia (VD) (Cipollini et al, 2019 ). The identification of CSVD most commonly relies on MRI markers, including white matter hyperintensities (WMHs), LI, enlarged perivascular spaces (EPVSs), CMBs, and brain atrophy (Pantoni, 2010 ), all of which have variably been associated with cognitive performance (Chojdak-Łukasiewicz et al, 2021 ). White matter is comprised of the structural connections between areas of the brain's gray matter.…”

Potential of brain age in identifying early cognitive impairment in subcortical small-vessel disease patients

“…Subcortical small-vessel disease (SSVD) is the most common cause of vascular cognitive impairment in elderly people and shows visible radiological biomarkers on magnetic resonance imaging (MRI), i.e., lacunar, white matter hyperintensity (WMH), cerebral microbleeds (CMBs), or brain atrophy ( Chojdak-Łukasiewicz et al, 2021 ; Hamilton et al, 2021 ). Although the pathological mechanisms of SSVD remain unclear, there is strong evidence that potential pathophysiological mechanisms, including oxidative stress, inflammatory response, and endothelial dysfunction, can impair the structure and function of cerebral small vessels ( Ungvari et al, 2021 ).…”

Should Slowing Be Considered a Distinct Geriatric Syndrome?

“…39e41 Indeed, these and possibly other symptoms have been previously described together as manifestations of subcortical vascular disease. 40 One study alone does not, however, establish a scientific truth, and the article by van de Schraaf et al 12 has a number of limitations.…”