Vasoreactivity in CADASIL: Comparison to structural MRI and neuropsychology

Area of Science:

• Neurology
• Vascular Biology
• Medical Imaging

Background:

• Cerebrovascular reactivity impairment precedes clinical signs of Cerebral Autosomal-Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL) in animal models.
• Peripheral and cerebral vascular function require further characterization in adult CADASIL patients.

Purpose of the Study:

• To characterize peripheral and cerebral vascular function and reactivity in adult CADASIL patients.
• To explore associations between vascular function, clinical status, imaging, and neuropsychological measures in CADASIL.

Main Methods:

• Exploratory study involving 22 adult CADASIL patients.
• Cerebral vasoreactivity assessed via transcranial Doppler and arterial spin labelling MRI with hypercapnia challenge.
• Peripheral vasoreactivity measured by flow-mediated dilation; MRI assessed lacunes, white matter hyperintensities, microbleeds, and brain volume.

Main Results:

• Cerebrovascular reactivity (ASL) correlated with peripheral vasoreactivity (flow-mediated dilation).
• Patients with ≥5 lacunes exhibited impaired cerebral and peripheral vasoreactivity, older age, and higher carotid intima-media thickness.
• Impaired vasoreactivity showed trends associated with depressive symptoms, disability, and delayed processing speed.

Conclusions:

• Impaired vasoreactivity and vascular dysfunction are significant in CADASIL pathophysiology.
• Vascular assessments may serve as valuable biomarkers for CADASIL severity in clinical trials and longitudinal studies.