Combined Score of Perivascular Space Dilatation and White Matter Hyperintensities in Patients with Normal Cognition, Mild Cognitive Impairment, and Dementia

Abstract

Background and Objectives: Cerebral perivascular spaces (PVS) are part of the cerebral microvascular structure and play a role in lymphatic drainage and the removal of waste products from the brain. White matter hyperintensities (WMH) are hyperintense lesions on magnetic resonance imaging that are associated with cognitive impairment, dementia, and cerebral vascular disease. WMH and PVS are direct and indirect imaging biomarkers of cerebral microvascular integrity and health. In our research, we evaluated WMH and PVS enlargement in patients with normal cognition (NC), mild cognitive impairment (MCI), and dementia (D). Materials and Methods: In total, 57 participants were included in the study and divided into groups based on neurological evaluation and Montreal Cognitive Assessment results (NC group 16 participants, MCI group 29 participants, D group 12 participants). All participants underwent 3T magnetic resonance imaging. PVS were evaluated in the basal ganglia, centrum semiovale, and midbrain. WMHs were evaluated based on the Fazekas scale and the division between deep white matter (DWM) and periventricular white matter (PVWM). The combined score based on PVS and WMH was evaluated and correlated with the results of the MoCA. Results: We found statistically significant differences between groups on several measures. Centrum semiovale PVS dilatation was more severe in MCI and dementia group and statistically significant differences were found between D-MCI and D-NC pairs. PVWM was more severe in patients with MCI and dementia group, and statistically significant differences were found between D-MCI and D-NC pairs. Furthermore, we found statistically significant differences between the groups by analyzing the combined score of PVS dilatation and WMH. We did not find statistically significant differences between the groups in PVS dilation of the basal ganglia and midbrain and DWM hyperintensities. Conclusions: PVS assessment could become one of neuroimaging biomarkers for patients with cognitive decline. Furthermore, the combined score of WMH and PVS dilatation could facilitate diagnostics of cognitive impairment, but more research is needed with a larger cohort to determine the use of PVS dilatation and the combined score.

Enlarged Perivascular Spaces in Relation to Cumulative Blood Pressure Exposure and Cognitive Impairment

“…They are thought to be drainage pathways of interstitial fluid and waste products in the brain. 5 EPVS in the brain are also closely associated with cognitive impairment 6 and may serve as the pathological basis for cognitive impairment and dementia. 7,8 Hypertension and EPVS are independently associated with cognitive impairment.…”

Combining ADC values in DWI with rCBF values in arterial spin labeling (ASL) for the diagnosis of mild cognitive impairment (MCI)

“…[ 24 ] Several other studies have confirmed this. [ 25 , 26 ] ASL, a nonradioactive blood flow imaging technique, can be applied to assess cerebral blood flow in patients with MCI. It has been shown that MCI patients have more pronounced decreases in cerebral blood flow in prefrontal and temporal regions, which have important roles in cognitive control and memory, compared to normal older adults, and therefore ASL can be used to assess CBF and metabolic changes in these regions to understand cognitive dysfunction in MCI patients.…”

Perivascular spaces and where to find them – MR imaging and evaluation methods

“…Erste Ansätze betrachten beide Parameter gemeinsam mit einem kombinierten Score. Hier werden die Punktzahlen der Ratings für PVS der BG, des CSO und des Mittelhirns sowie der Fazekas-Score [41] addiert [42].…”

“…Initial approaches consider the two parameters together with a combined score. The ratings for perivascular spaces of the BG, the CSO, and the midbrain and the Fazekas score [41] are added [42].…”