Total Cerebral Small Vessel Disease MRI Score Is Associated with Cognitive Decline in Executive Function in Patients with Hypertension

Abstract

Objectives: Hypertension is a major risk factor for white matter hyperintensities (WMH), lacunes, cerebral microbleeds, and perivascular spaces, which are MRI markers of cerebral small vessel disease (SVD). Studies have shown associations between these individual MRI markers and cognitive functioning and decline. Recently, a “total SVD score” was proposed in which the different MRI markers were combined into one measure of SVD, to capture total SVD-related brain damage. We investigated if this SVD score was associated with cognitive decline over 4 years in patients with hypertension.Methods: In this longitudinal cohort study, 130 hypertensive patients (91 patients with uncomplicated hypertension and 39 hypertensive patients with a lacunar stroke) were included. They underwent a neuropsychological assessment at baseline and after 4 years. The presence of WMH, lacunes, cerebral microbleeds, and perivascular spaces were rated on baseline MRI. Presence of each individual marker was added to calculate the total SVD score (range 0–4) in each patient.Results: Uncorrected linear regression analyses showed associations between SVD score and decline in overall cognition (p = 0.017), executive functioning (p < 0.001) and information processing speed (p = 0.037), but not with memory (p = 0.911). The association between SVD score and decline in overall cognition and executive function remained significant after adjustment for age, sex, education, anxiety and depression score, potential vascular risk factors, patient group, and baseline cognitive performance.Conclusion: Our study shows that a total SVD score can predict cognitive decline, specifically in executive function, over 4 years in hypertensive patients. This emphasizes the importance of considering total brain damage due to SVD.

Intracranial Arterial 4D Flow in Individuals with Mild Cognitive Impairment is Associated with Cognitive Performance and Amyloid Positivity

“…Evidence suggests vascular disease often negatively impacts cognitive performance specifically in the executive functioning domain [30, 31]. In a study of 130 individuals with hypertension, increased small vessel disease was associated with poorer executive functioning performance, but not with memory performance [32], a similar pattern to what we observed in our study. Additionally, in a separate sample (n=94) of cognitively healthy older adults, subcortical ischemic vascular disease significantly predicted worse performance on executive functioning metrics, but not memory measures [33].…”

Framingham Stroke Risk Profile is related to cerebral small vessel disease progression and lower cognitive performance in patients with hypertension

“…Lacunes and cerebral microbleeds were assessed according to international consensus definition . An overall score for the baseline MRI total burden of cSVD was composed, as described earlier …”

Total cerebral small vessel disease score and cognitive performance in community‐dwelling older adults. Results from the Atahualpa Project

“…However, no similar models were constructed after exclusion of the other markers of SVD. More recently, Uiterwijk et al (2016) conducted a longitudinal study involving 130 hypertensive patients (39 with a lacunar stroke) and found that the total SVD score predicted overall cognitive decline in the follow-up. In this study, coefficients of determination (R 2 ) were calculated for the total SVD score and each of its components.…”

“…These MRI findings alone or in combination have been individually related to cognitive decline (Arboix, 2011;Wardlaw et al, 2013;Akoudad et al, 2016;Boyle et al, 2016;Arba et al, 2017). The SVD score was developed to address the combined effect of these imaging markers, and those may be a better prediction of cognitive performance (Huijts et al, 2013;Staals et al, 2015;Uiterwijk et al, 2016).…”