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Updated: May 9, 2026
Evaluation of the Cognitive Performance of Hypertensive Patients with Silent Cerebrovascular Lesions
Published on: April 23, 2021
Influence of vascular risk factors and neuropsychological profile on functional performances in CADASIL: results from
L Ciolli1, F Pescini, E Salvadori
1NEUROFARBA Department, Neuroscience section, University of Florence, Florence, Italy.
Insights
Hypertension contributes to functional decline in Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL). Memory impairment significantly impacts functional abilities in CADASIL patients, unlike in age-related leukoencephalopathy.
Area of Science:
- Neurology
- Genetics
- Vascular Biology
Background:
- Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL) is a genetic small vessel disease.
- The factors influencing CADASIL phenotype remain largely unknown.
Purpose of the Study:
- To investigate the impact of vascular risk factors on functional abilities in CADASIL.
- To compare cognitive domain performance and its effect on function between CADASIL and age-related leukoencephalopathy (ARL) patients.
Main Methods:
- The MIcrovascular LEukoencephalopathy Study (MILES) included 51 CADASIL and 68 ARL patients.
- Vascular risk factors, cognitive functions (memory, psychomotor speed, executive functions), and functional abilities (Instrumental Activities of Daily Living, Disability Assessment for Dementia) were assessed.
- Stepwise linear regression analyzed associations between cognitive indices and functional performance.
Main Results:
- CADASIL patients exhibited higher BMI and greater disability compared to ARL patients.
- Hypertension was linked to poorer functional outcomes (DAD score, disability) in CADASIL.
- While cognitive profiles were similar, memory index significantly predicted functional performance in CADASIL, whereas executive function index did in ARL.
Conclusions:
- Hypertension appears to be a significant contributor to functional impairment in CADASIL.
- Memory decline substantially influences functional decline in CADASIL, differing from ARL patients.
Background And Purpose:
Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is an inherited cerebral small vessel disease that may lead to disability and whose phenotype modulators are still unknown.
Methods:
In the MIcrovascular LEukoencephalopathy Study (MILES), we assessed the influence of vascular risk factors and the effect of different cognitive domains (memory, psychomotor speed and executive functions) performances on functional abilities in CADASIL in comparison with age-related leukoencephalopathy (ARL).
Results:
We evaluated 51 CADASIL patients (mean age 50.3 ± 13.8 years, 47.1% males) and 68 ARL patients (70.6 ± 7.4 years, 58.8% males). Considering vascular risk factors, after adjustment for age, CADASIL patients had higher mean BMI values than ARL patients. Stroke history frequency was similar in the two groups. After adjustment for age, more CADASIL patients were disabled (impaired on ≥ 2 items of the Instrumental Activities of Daily Living scale) in comparison with ARL patients, and CADASIL patients had worse functional performances evaluated with the Disability Assessment for Dementia (DAD) scale. In CADASIL patients, hypertension was related to both DAD score and disability. The cognitive profile of CADASIL and ARL patients was similar, but on a stepwise linear regression analysis functional performances were mainly associated with the memory index (β = -0.418, P < 0.003) in CADASIL patients and the executive function index (β = -0.321, P = 0.028) in ARL.
Conclusions:
This study suggests that hypertension may contribute to functional impairment in CADASIL and that memory impairment has a large influence on functional decline in contrast with that observed in a sample of subjects with ARL.
