Microstructural Predictors of Cognitive Impairment in Cerebral Small Vessel Disease and the Conditions of Their Formation

Abstract

Introduction: Cerebral small vessel disease (CSVD) is the leading cause of vascular and mixed degenerative cognitive impairment (CI). The variability in the rate of progression of CSVD justifies the search for sensitive predictors of CI. Materials: A total of 74 patients (48 women, average age 60.6 ± 6.9 years) with CSVD and CI of varying severity were examined using 3T MRI. The results of diffusion tensor imaging with a region of interest (ROI) analysis were used to construct a predictive model of CI using binary logistic regression, while phase-contrast magnetic resonance imaging and voxel-based morphometry were used to clarify the conditions for the formation of CI predictors. Results: According to the constructed model, the predictors of CI are axial diffusivity (AD) of the posterior frontal periventricular normal-appearing white matter (pvNAWM), right middle cingulum bundle (CB), and mid-posterior corpus callosum (CC). These predictors showed a significant correlation with the volume of white matter hyperintensity; arterial and venous blood flow, pulsatility index, and aqueduct cerebrospinal fluid (CSF) flow; and surface area of the aqueduct, volume of the lateral ventricles and CSF, and gray matter volume. Conclusion: Disturbances in the AD of pvNAWM, CB, and CC, associated with axonal damage, are a predominant factor in the development of CI in CSVD. The relationship between AD predictors and both blood flow and CSF flow indicates a disturbance in their relationship, while their location near the floor of the lateral ventricle and their link with indicators of internal atrophy, CSF volume, and aqueduct CSF flow suggest the importance of transependymal CSF transudation when these regions are damaged.

The Impact of Common Epidemiological Factors on Gray and White Matter Volumes in Magnetic Resonance Imaging–Is Prevention of Brain Degeneration Possible?

“…Brain aging is influenced by many factors including genetic, environmental, or coexisting diseases. Cerebral vascular pathology strongly contributes to acceleration of brain degeneration, especially cerebral small vessel disease (CSVD) causing lacunar infarcts, microbleeds and white matter hyperintensities (WMH) leading to white matter damage (7). Recently, WMH have been of a great interest since they are associated with the increased risk of cognitive impairment and vascular dementia (8).…”

Contrast agent‐free state‐of‐the‐art magnetic resonance imaging on cerebral small vessel disease – Part 2: Diffusion tensor imaging and functional magnetic resonance imaging

“…Such a strong association between executive function and DTI parameters was confirmed by a multimodal MRI model containing age, gender, brain volume, FA, and premorbid intelligence quotient, which explain 74% of the variance of executive function score 43 . Axial diffusivity (AxD) of the posterior frontal periventricular NAWM, right middle cingulum bundle, and midposterior corpus callosum also predicted cognitive impairment in cSVD patients 46 . Besides, the MD of WM lesions (WML) and NAWM correlated with gait disturbances, 47,48 linked to higher morbidity and mortality 49 …”

“…43 Axial diffusivity (AxD) of the posterior frontal periventricular NAWM, right middle cingulum bundle, and midposterior corpus callosum also predicted cognitive impairment in cSVD patients. 46 Besides, the MD of WM lesions (WML) and NAWM correlated with gait disturbances, 47,48 linked to higher morbidity and mortality. 49 In longitudinal studies, FA changes in the thalamus correlated with WMH progression among cSVD patients.…”

Amide Proton Transfer MRI Could Be Used to Evaluate the Pathophysiological Status of White Matter Hyperintensities

“…Studies have shown that DWMH and PWMH may have different mechanisms and lead to different clinical symptoms. [2][3][4][5] This study compared DWMH and PWMH at the same grade separately, significant differences were found only in grade 2 DWMH and grade 2 PWMH in APTw values. We concluded that the pathophysiological mechanism of DWMH and PWMH may be consistent in grade 1 and 3 WMH.…”

“…WMH can be divided into deep WMH (DWMH) and paraventricular WMH (PWMH) according to the site of occurrence. Studies suggested that DWMH and PWMH have different etiologies, different effects, and different pathological changes 2–9 …”