Impaired dynamic cerebral autoregulation is associated with the severity of neuroimaging features of cerebral small vessel disease

Abstract

Aims Cerebral small vessel disease (CSVD) is characterized by functional and structural changes in small vessels. We aimed to elucidate the relationship between dynamic cerebral autoregulation (dCA) and neuroimaging characteristics of CSVD. Methods A case‐control study was performed. Cerebral blood flow velocity (CBFV) of bilateral middle cerebral arteries and spontaneous arterial blood pressure were simultaneously recorded. Transfer function analysis was used to calculate dCA parameters (phase, gain, and the rate of recovery of CBFV [RoRc]). Neuroimaging characteristics of CSVD patients were evaluated, including lacunes, white matter hyperintensities (WMH), cerebral microbleeds (CMBs), perivascular spaces (PVS), and the total CSVD burden. Results Overall, 113 patients and 83 controls were enrolled. Compared with the control group, the phase at low frequency and the RoRc in CSVD patients were lower, and the gain at very low and low frequencies were higher, indicating bilaterally impaired dCA. Total CSVD burden, WMH (total, periventricular and deep), severe PVS, and lobar CMBs were independently correlated with the phase at low frequency. Conclusions Our findings suggested that dCA was compromised in CSVD patients, and some specific neuroimaging characteristics (the total CSVD burden, WMH, severe PVS and lobar CMBs) might indicate more severe dCA impairment in CSVD patients.

Effects of cognitive reserve proxies on cognitive function and frontoparietal control network in subjects with white matter hyperintensities: A cross‐sectional functional magnetic resonance imaging study

“…White matter hyperintensities (WMH), the most common morphologic feature on brain magnetic resonance imaging (MRI) in cerebral small vessel disease, is common among older people 1–3 . There is increasing evidence suggesting that WMH can cause cognitive decline and plays a significant role in the etiology of vascular cognitive impairment (CI) 4,5 .…”

“…White matter hyperintensities (WMH), the most common morphologic feature on brain magnetic resonance imaging (MRI) in cerebral small vessel disease, is common among older people. [1][2][3] There is increasing evidence suggesting that WMH can cause cognitive decline and plays a significant role in the etiology of vascular cognitive impairment (CI). 4,5 However, individuals with WMH exhibit high levels of heterogeneity in cognitive performance, and a portion of these individuals even maintain normal cognitive function.…”

Implication of heart rate variability on cerebral small vessel disease: A potential therapeutic target

“…The underlying mechanisms of the association between CSVD and ANS were not well‐elucidated; however, several possibilities were put forth as follows. Firstly, increased mechanical stress on the endothelium and subsequent endothelial injury induced by the imbalance between sympathetic and parasympathetic tones were presumed to contribute to the failure of dynamic cerebral autoregulation and blood–brain barrier disruption 50–52 . Secondly, the cerebrovascular architecture in the deep brain parenchyma lacked anastomoses; as a result, these regions were more susceptible to vasodilatory disturbances in rigid vessels caused by abnormal autonomic function 53 .…”

“…Firstly, increased mechanical stress on the endothelium and subsequent endothelial injury induced by the imbalance between sympathetic and parasympathetic tones were presumed to contribute to the failure of dynamic cerebral autoregulation and blood–brain barrier disruption. 50 , 51 , 52 Secondly, the cerebrovascular architecture in the deep brain parenchyma lacked anastomoses; as a result, these regions were more susceptible to vasodilatory disturbances in rigid vessels caused by abnormal autonomic function. 53 Thirdly, many risk factors and mechanisms which were reported to be associated with HRV, such as diabetes and inflammation, were deemed to exert interactive effects that enhance the link between HRV and CSVD.…”

Clinical factors associated with cerebral autoregulation in ischemic stroke related to small artery occlusion

“…CSVD is associated with changes in cerebral small vessels and consequent brain damage in the white and grey matter [ 18 ]. A recent study in patients with CSVD demonstrated that CA was compromised, and some specific neuroimaging characteristics (total CSVD burden, white matter hyperintensities, severe PVS, and lobar cerebral microbleeds) might indicate more severe CA impairment [ 19 ]. Another study in patients with Alzheimer’s disease demonstrated an interrelationship between Alzheimer’s disease pathology, CSVD, and CA [ 20 ].…”