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Updated: Nov 8, 2025
Evaluation of the Cognitive Performance of Hypertensive Patients with Silent Cerebrovascular Lesions
Published on: April 23, 2021
Cognitive impact of cerebral microbleeds in patients with symptomatic small vessel disease
Stefania Nannoni1, Laura Ohlmeier1, Robin B Brown1
1Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.
Background And Aim:
Whether cerebral microbleeds cause cognitive impairment remains uncertain. We analyzed whether cerebral microbleeds are associated with cognitive dysfunction in patients with symptomatic cerebral small vessel disease, and whether this association is independent of other neuroimaging markers of cerebral small vessel disease.
Methods:
We analyzed consecutive patients with MRI-confirmed lacunar stroke included in DNA-Lacunar-2 multicenter study. Cerebral microbleeds were graded using the Brain Observer Microbleed Rating Scale (BOMBS). Neuropsychological assessment was performed using the Brief Memory and Executive Test (BMET). We analyzed the association between cerebral microbleeds, BMET, and the following subdomains: executive function/processing speed and orientation/memory. We also searched for an independent association between cerebral microbleeds and vascular cognitive impairment, defined as BMET ≤ 13.
Results:
Out of 688 included patients, cerebral microbleeds were detected in 192 (27.9%). After adjusting for white matter hyperintensities severity, lacune count, and other confounders, both the presence and the number of cerebral microbleeds were significantly associated with impaired cognitive performance [β = -13.0; 95% CI = (-25.3, -0.6) and β = -13.1; 95% CI = (-19.8, -6.4), respectively]. On analysis of specific cognitive domains, associations were present for executive function/processing speed [β = -5.8; 95% CI = (-9.3, -2.2) and β = -4.3; 95% CI = (-6.2, -2.4), respectively] but not for orientation/memory [β = -0.4; 95% CI = (-4.0, 3.2) and β = -2.1; 95% CI = (-4.0, 0.1), respectively]. We also found an independent association between the presence and the number of cerebral microbleeds and vascular cognitive impairment [adjusted OR = 1.48; 95% CI = (1.01, 2.18) and OR = 1.43; 95% CI = (1.15, 1.79), respectively].
Conclusion:
In a large cohort of symptomatic cerebral small vessel disease patients, after controlling for other neuroimaging markers of cerebral small vessel disease severity, cerebral microbleeds were associated with cognitive dysfunction. Executive function and processing speed were predominantly impaired. This might suggest a causal role of cerebral microbleeds in determining vascular cognitive impairment.
Insights
Cerebral microbleeds are linked to cognitive decline in patients with symptomatic cerebral small vessel disease. This association, particularly affecting executive function and processing speed, suggests a potential causal role in vascular cognitive impairment.
Area of Science:
- Neurology
- Neuroimaging
- Cognitive Science
Background:
- Cerebral microbleeds are a marker of cerebral small vessel disease (CSVD).
- The causal relationship between cerebral microbleeds and cognitive impairment in symptomatic CSVD patients is not fully understood.
- Existing research needs to clarify if this association is independent of other CSVD neuroimaging markers.
Purpose of the Study:
- To investigate the association between cerebral microbleeds and cognitive dysfunction in patients with symptomatic CSVD.
- To determine if this association is independent of other neuroimaging markers of CSVD.
- To analyze the impact of cerebral microbleeds on specific cognitive domains, including executive function, processing speed, orientation, and memory.
Main Methods:
- Analysis of consecutive patients with MRI-confirmed lacunar stroke from the DNA-Lacunar-2 multicenter study.
- Grading of cerebral microbleeds using the Brain Observer Microbleed Rating Scale (BOMBS).
- Neuropsychological assessment using the Brief Memory and Executive Test (BMET), evaluating executive function/processing speed and orientation/memory.
- Statistical analysis to determine the association between cerebral microbleeds and cognitive performance, adjusted for confounders and other CSVD markers.
Main Results:
- Cerebral microbleeds were detected in 27.9% of the 688 included patients.
- Both the presence and number of cerebral microbleeds were significantly associated with impaired cognitive performance, even after adjusting for white matter hyperintensities and lacune count.
- The association was significant for executive function/processing speed but not for orientation/memory.
- An independent association was found between cerebral microbleeds and vascular cognitive impairment (BMET ≤ 13).
Conclusions:
- Cerebral microbleeds are significantly associated with cognitive dysfunction in symptomatic CSVD patients, independent of other neuroimaging markers.
- Executive function and processing speed are the cognitive domains predominantly affected by cerebral microbleeds.
- These findings suggest a potential causal role of cerebral microbleeds in the development of vascular cognitive impairment.
