Cognitive Impact of Cerebral Small Vessel Disease Changes in Patients With Hypertension

Abstract

Hypertension is one of the principal risk factors for cerebral small vessel disease progression and cognitive impairment. We aimed to investigate how changes in cerebral small vessel disease lesions relate to cognitive decline and incident mild cognitive impairment in hypertensive patients. Data were obtained from the ISSYS cohort (Investigating Silent Strokes in Hypertensives: a Magnetic Resonance Imaging Study)—a longitudinal population-based study on hypertensive patients aged 50 to 70 years without dementia and stroke at baseline. Patients underwent a brain magnetic resonance imaging, a cognitive screening test, and cognitive diagnosis (normal aging or mild cognitive impairment) at baseline and follow-up. We evaluated incident lacunar infarcts and cerebral microbleeds. Changes in the periventricular and deep white matter hyperintensities (WMH) were qualitatively defined as none, minor, or marked. We followed up 345 patients (median age, 65 [61–68]; 55.4% men) for 3.95 (3.83–4.34) years. Incident mild cognitive impairment was diagnosed in 9.1% of the sample. Considering the progression of cerebral small vessel disease, the prevalence of incident infarcts was 6.1% and that of incident cerebral microbleeds was 5.5%; progression of periventricular WMH was 22% and that of deep WMH was 48%. Patients with marked progression of periventricular WMH showed a significant decrease in global cognition compared with patients without progression (adjusted mean [SE], −0.519 [0.176] versus 0.057 [0.044], respectively; P value=0.004) and a higher risk of incident mild cognitive impairment (OR, 6.184; 95% CI, 1.506–25.370; P value=0.011). Therefore, our results indicate that hypertensive patients with progression of periventricular WMH have higher odds of cognitive impairment, even in the early stages of cognitive decline.

Association of Low Blood Pressure with White Matter Hyperintensities in Elderly Individuals with Controlled Hypertension

“…3 Periventricular and deep WMHs have been associated with different etiologies; periventricular WMH is due to hemodynamic insufficiency (hypoperfusion), 2,[4][5][6][7] whereas deep WMH is due to small vessel diseases. 2,[8][9][10] Hypertension can cause both cerebral hypoperfusion [11][12][13] and small vessel disease 14,15 and has been associated with the presence and amount of both periventricular WMH 16,17 and deep WMH. 18,19 In hypertension, cerebral hypoperfusion is known to result from the increased vascular resistance and disturbed hemodynamic flow patterns, [11][12][13]20,21 whereas the small vessel disease results from endothelial dysfunction of the blood-brain barrier.…”

Ambulatory Blood Pressure Levels in the Prediction of Progression of Cerebral Small Vessel Disease

“…The follow-up visit was conducted between 2014 and 2016 in a sample of 361 individuals at high risk of cSVD progression, defined by the presence of extensive WMH or silent brain infarcts. 3 In this study we selected 233 patients who underwent baseline and follow-up MRIs and had at least ABPM recordings at the baseline visit ( Figure 1).…”

Remote Ischemic Conditioning Improves Cognition in Patients with Subcortical Ischemic Vascular Dementia

“…Cerebral small vessel disease is associated with cognitive impairment, due to the decreased microvascular perfusion and microstructural integrity [8,20,21]. SIVD is characterized by cerebral small vessel incomplete occlusion or lacunar infarction, and accompanied by destruction of bloodbrain barrier and invasion of inflammation [2].…”