Enlarged perivascular spaces and cognitive impairment after stroke and transient ischemic attack

Abstract

Background Previous studies suggested that enlarged perivascular spaces are neuroimaging markers of cerebral small vessel disease. However, it is not clear whether enlarged perivascular spaces are associated with cognitive impairment. We aimed to determine the cross-sectional relationship between enlarged perivascular spaces and small vessel disease, and to investigate the relationship between enlarged perivascular spaces and subsequent cognitive impairment in patients with recent cerebral ischemic event.Methods Anonymized data were accessed from the virtual international stroke trial archive. We rated number of lacunes, white matter hyperintensities, brain atrophy, and enlarged perivascular spaces with validated scales on magnetic resonance brain images after the index stroke. We defined cognitive impairment as a mini mental state examination score of ≤26, recorded at one year post stroke. We examined the associations between enlarged perivascular spaces and clinical and imaging markers of small vessel disease at presentation and clinical evidence of cognitive impairment at one year using linear and logistic regression models.Results We analyzed data on 430 patients with mean (±SD) age 64.7 (±12.7) years, 276 (64%) males. In linear regression analysis, age (β = 0.24; p < 0.001), hypertension (β = 0.09; p = 0.025), and deep white matter hyperintensities (β = 0.31; p < 0.001) were associated with enlarged perivascular spaces. In logistic regression analysis, basal ganglia enlarged perivascular spaces were independently associated with cognitive impairment at one year after adjusting for clinical confounders (OR = 1.72, 95% CI = 1.22-2.42) and for clinical and imaging confounders (OR = 1.54; 95% CI = 1.03-2.31).Conclusions Our data show that in patients with ischemic cerebral events, enlarged perivascular spaces are cross-sectionally associated with age, hypertension, and white matter hyperintensities and suggest that enlarged perivascular spaces in the basal ganglia are associated with cognitive impairment after one year.

Mapping the contribution and strategic distribution patterns of neuroimaging features of small vessel disease in poststroke cognitive impairment

“…In the model with the complete combination of SVD features, we also showed that WMH, lacune, EPVS and atrophy were all involved in the impairment of global cognition and all the cognitive domains (figure 4 and online supplementary figures S3–S7). These findings generally collaborated with previous studies that reported the cognitive impact of individual SVD features in patients with stroke, including WMH,2 3 EPVS6 and atrophy 5. Regarding the lacunes (silent infarcts in our first-ever stroke cohort), researchers have found their strong association with dementia and cognitive decline in patients without stroke,23 24 and it is not surprising that lacunes have additional contribution to cognitive impairment after stroke, as the combination of a clinical stroke (AILs) with subclinical strokes (lacunes as silent infarcts) further increases risk of cognitive deficits 25…”

Enlarged perivascular spaces are associated with health‐related quality of life in patients with acute ischemic stroke

“…We mainly found that EPVS in the basal ganglia were associated with poorer HRQoL. This predictive effect of EPVS in the basal ganglia is consistent with the findings that EPVS in the basal ganglia predict functional disability, cognitive decline, and recurrence in stroke, as well as depression, sleep disorder or movement disorders in stroke‐free populations. In this study, EPVS predicted the HRQoL independently of acute infarct volume and stroke severity, thus it might have direct effects or other paths to affect HRQoL.…”

“…EPVS in the centrum semiovale might reflect cerebral amyloid angiopathy . The association between EPVS and reduced work/productivity was supported by the finding that more severe EPVS in the centrum semiovale were associated with poorer cognition at one year after stroke . This finding is also consistent with the correlation between poor poststroke HRQoL and deep white matter hyperintensities, which was also suggested to be a marker of cerebral amyloid angiopathy .…”

“…In this study, EPVS adversely affected the HRQoL after stroke. Consistently, the extent of EPVS in both the basal ganglia and the centrum seimovale was negatively correlated with cognitive function in stroke or transient ischemic attack . Further, stroke patients with higher degree of EPVS in the basal ganglia had a higher risk of recurrent stroke .…”

“…EPVS are associated with a variety of neuropsychiatric disorders, including multiple sclerosis, dementia, depression, and sleep disorder . EPVS also commonly occur in stroke . Although the presence of numerous EPVS has been showed to be associated with poor physical outcome, cognitive decline and recurrence of stroke in stroke survivors.…”