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Lesion location and cognitive impact of cerebral small vessel disease
J Matthijs Biesbroek1, Nick A Weaver2, Geert Jan Biessels2
1Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, Netherlands j.m.biesbroek@umcutrecht.nl matthijs.biesbroek@gmail.com.
Abstract:
Cerebral small vessel disease (SVD) is an important cause of cognitive impairment. Important MRI manifestations of SVD include white matter hyperintensities (WMH) and lacunes. This narrative review addresses the role of anatomical lesion location in the impact of SVD on cognition, integrating findings from early autopsy studies with emerging findings from recent studies with advanced image analysis techniques. Early autopsy and imaging studies of small case series indicate that single lacunar infarcts in, for example the thalamus, caudate nucleus or internal capsule can cause marked cognitive impairment. However, the findings of such case studies may not be generalizable. Emerging location-based image analysis approaches are now being applied to large cohorts. Recent studies show that WMH burden in strategic white matter tracts, such as the forceps minor or anterior thalamic radiation (ATR), is more relevant in explaining variance in cognitive functioning than global WMH volume. These findings suggest that the future diagnostic work-up of memory clinic patients could potentially be improved by shifting from a global assessment of WMH and lacune burden towards a quantitative assessment of lesion volumes within strategic brain regions. In this review, a summary of currently known strategic regions for SVD-related cognitive impairment is provided, highlighting recent technical developments in SVD research. The potential and challenges of location-based approaches for diagnostic purposes in clinical practice are discussed, along with their potential prognostic and therapeutic applications.
Insights
Small vessel disease (SVD) significantly impacts cognition. Focusing on lesion location in strategic brain areas, rather than overall burden, offers a more precise understanding of SVD
Area of Science:
- Neurology
- Neuroimaging
- Cognitive Science
Background:
- Cerebral small vessel disease (SVD) is a primary contributor to cognitive impairment.
- Key MRI markers of SVD include white matter hyperintensities (WMH) and lacunes.
- The impact of SVD on cognition is influenced by the anatomical location of these lesions.
Purpose of the Study:
- To review the role of lesion location in SVD-related cognitive impairment.
- To integrate findings from autopsy studies with advanced neuroimaging techniques.
- To discuss the potential of location-based assessments for diagnosis, prognosis, and therapy.
Main Methods:
- Review of early autopsy and imaging studies.
- Analysis of recent large-cohort studies using advanced image analysis.
- Integration of findings on lesion location and cognitive function.
Main Results:
- Early studies suggested specific lacunar infarct locations (e.g., thalamus) cause significant cognitive deficits.
- Recent research indicates WMH burden in strategic tracts (e.g., forceps minor, ATR) is more predictive of cognitive variance than global WMH volume.
- Location-based assessment of SVD lesions shows promise over global burden assessment.
Conclusions:
- The anatomical location of SVD lesions is critical for cognitive impact.
- Future diagnostic approaches may benefit from quantitative assessment of lesions in strategic brain regions.
- Location-based SVD analysis holds potential for improved clinical diagnosis, prognosis, and therapeutic strategies.