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Published on: April 23, 2021
Cerebral small-vessel disease and progression of brain atrophy: the SMART-MR study
R P Kloppenborg1, P J Nederkoorn, A M Grool
1Department of Neurology, University Medical Center Utrecht, Utrecht, the Netherlands.
Objectives:
To investigate whether severity and progression of periventricular and deep white matter lesions (WML) and lacunar infarcts were associated with progression of brain atrophy.
Methods:
Within the SMART-MR study, a prospective cohort on MRI changes in patients with symptomatic atherosclerotic disease, 565 patients (57 ± 9 years) without large infarcts had vascular screening and 1.5 T MRI at baseline and after a mean follow-up of 3.9 years. With automated brain segmentation, total brain, cortical gray matter, ventricular, and WML volumes were estimated and expressed relative to intracranial volume (%). Lacunar infarcts were rated manually.
Results:
Using linear regression analyses adjusted for demographics and vascular risk factors, periventricular WML volume at baseline was associated with greater decrease in cortical gray matter volume (B = -1.73%, 95% confidence interval [CI] -3.15% to -0.30%, per 1% WML volume increase) and greater increase in ventricular volume (B = 0.12%, 95% CI 0.04% to 0.20%). Progression of periventricular WML volume corresponded with a greater decrease in cortical gray matter volume (B = -0.45%, 95% CI -0.9% to 0%) and greater increase in ventricular volume (B = 0.15%, 95% CI 0.1% to 0.2%). Presence of lacunar infarcts was associated with greater decline in total brain volume (B = -0.25%, 95% CI -0.49% to -0.01%) and progression of lacunar infarcts with a greater decrease of total brain (B = -0.30%, 95% CI -0.59% to 0.01%) and cortical gray matter volume (B = -0.81%, 95% CI -1.43% to -0.20%).
Conclusions:
In patients with symptomatic atherosclerotic disease, presence and progression of periventricular WML and lacunar infarcts is associated with greater progression of brain atrophy independent of vascular risk factors.
Insights
White matter lesions and lacunar infarcts in patients with symptomatic atherosclerotic disease are linked to increased brain atrophy. This progression occurs independently of common vascular risk factors, highlighting their significance.
Area of Science:
- Neurology
- Radiology
- Cardiovascular Disease Research
Background:
- Brain atrophy, characterized by the loss of brain tissue, is a significant concern in patients with symptomatic atherosclerotic disease.
- White matter lesions (WML) and lacunar infarcts are common findings in this patient population and may contribute to neurodegeneration.
- Understanding the relationship between these cerebrovascular changes and brain atrophy is crucial for predicting disease progression and developing targeted interventions.
Purpose of the Study:
- To determine if the severity and progression of white matter lesions (WML) and lacunar infarcts correlate with the advancement of brain atrophy.
- To investigate this association in patients diagnosed with symptomatic atherosclerotic disease.
Main Methods:
- A prospective cohort study (SMART-MR) involving 565 patients with symptomatic atherosclerotic disease and no large infarcts.
- Baseline and follow-up MRI scans (mean 3.9 years) were used to assess total brain, cortical gray matter, ventricular, and WML volumes via automated segmentation.
- Lacunar infarcts were manually rated, and analyses were adjusted for demographics and vascular risk factors.
Main Results:
- Baseline periventricular WML volume correlated with decreased cortical gray matter and increased ventricular volumes.
- Progression of periventricular WML was associated with greater cortical gray matter loss and ventricular expansion.
- The presence and progression of lacunar infarcts were linked to a decline in total brain volume and cortical gray matter.
Conclusions:
- Both the presence and progression of periventricular WML and lacunar infarcts are significantly associated with accelerated brain atrophy.
- This relationship persists even after accounting for demographic factors and established vascular risk factors.
- Cerebrovascular changes like WML and lacunar infarcts play a critical role in the development of brain atrophy in patients with symptomatic atherosclerotic disease.
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