Cerebral small vessel disease phenotype and 5-year mortality in asymptomatic middle-to-old aged individuals

Abstract

The present study aimed to determine whether a recently proposed cerebral small vessel disease (CSVD) classification scheme could differentiate the 5-year all-cause mortality in middle-to-old aged asymptomatic CSVD. Stroke-free and non-demented participants recruited from the community-based I-Lan Longitudinal Aging Study underwent baseline brain magnetic resonance imaging (MRI) between 2011 and 2014 and were followed-up between 2018 and 2019. The study population was classified into control (non-CSVD) and CSVD type 1–4 groups based on MRI markers. We determined the association with mortality using Cox regression models, adjusting for the age, sex, and vascular risk factors. A total of 735 participants were included. During a mean follow-up of 5.7 years, 62 (8.4%) died. There were 335 CSVD type 1 (57.9 ± 5.9 years), 249 type 2 (65.6 ± 8.1 years), 52 type 3 (67.8 ± 9.2 years), and 38 type 4 (64.3 ± 9.0 years). Among the four CSVD types, CSVD type 4 individuals had significantly higher all-cause mortality (adjusted hazard ratio = 5.0, 95% confidence interval 1.6–15.3) compared to controls. This novel MRI-based CSVD classification scheme was able to identify individuals at risk of mortality at an asymptomatic, early stage of disease and might be applied for future community-based health research and policy.

Brain structure–function coupling associated with cognitive impairment in cerebral small vessel disease

“…For instance, the mechanisms leading to cognitive impairment are complex and may be the result of a combination of factors other than CSVD alone (Lawrence et al, 2013 ). Second, since each CSVD patient usually has a different combination of MRI markers and severity, each single MRI marker may be difficult to use to predict individual clinical outcome (Lee et al, 2021 ). Disruptions in the brain structure and function have been widely recognized to be associated with cognitive decline in CSVD, but the neural mechanisms remain unclear (Xu et al, 2021 ).…”

Sex Differences in Onset and Progression of Cerebral Amyloid Angiopathy

“…1 It is the cause of >50% of all lobar intracerebral hemorrhage (ICH) in the elderly, with the highest ICH recurrence rate and highest all-cause mortality of all primary ICH etiologies. 1–5 Patients with CAA show a striking variability in clinical symptoms and disease course; some patients present with cognitive decline and have multiple lobar microbleeds on magnetic resonance imaging (MRI), while others suffer from transient neurological episodes or (repeated) lobar located symptomatic ICH (sICH). 2 Even in Dutch-type hereditary CAA (D-CAA), an autosomal dominant variant of sporadic CAA (sCAA), there is a large variation in phenotype.…”