Quantitative cerebrovascular pathology in a community-based cohort of older adults

Cerebrovascular disease, especially small vessel pathology, is the leading comorbidity in degenerative disorders. We applied arterial spin labeling and cerebrovascular reserve (CVR) imaging to quantify small vessel disease and study its effect on cognitive symptoms in nondemented older adults from a community-based cohort. We evaluated baseline cerebral blood flow (CBF) using arterial spin labeling and percent signal change as a marker of CVR using blood-oxygen level-dependent imaging following a breath-hold stimulus. Measurements were performed in and near white matter hyperintensities, which are currently the standard to assess severity of vascular pathology. We show that similar to other studies (1) CBF and CVR are markedly reduced in the hyperintensities as well as in the tissue surrounding them, indicating susceptibility to infarction; (2) low CBF and CVR are significantly correlated with poor cognitive performance; and (3) in addition, compared to a 58.4% reduction in CBF, larger exhaustion (79.3%) of CVR was observed in the hyperintensities with a faster, nonlinear rate of decline. We conclude that CVR may be a more sensitive biomarker of small vessel disease than CBF.