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Cerebral Microbleeds and White Matter Hyperintensities are Associated with Cognitive Decline in an Asian Memory
Bibek Gyanwali1, Benedict Lui1, Chuen S Tan2
1Memory Aging & Cognition Centre, National University Health System, 21 Lower Kent Ridge Rd, Singapore.
Background:
Cerebral Small Vessel Disease (SVD); lacunes, Cerebral Microbleeds (CMBs), and White Matter Hyperintensities (WMH) have a vital role in cognitive impairment and dementia. SVD in lobar location is related to cerebral amyloid angiopathy, whereas SVD in a deep location with hypertensive arteriopathy. It remains unclear how different locations of SVD affect long-term cognitive decline. The present study aimed to analyse the association between different locations and severity of SVD with global and domain-specific cognitive decline over the follow-up interval of 3 years.
Methods:
We studied 428 participants who had performed MRI scans at baseline and at least 3 neuropsychological assessments. Locations of lacunes and CMBs were categorized into strictly lobar, strictly deep and mixed-location, WMH volume into anterior and posterior. The National Institute of Neurological Disorders and Stroke-Canadian Stroke Network Harmonization Neuropsychological Battery was used to assess cognitive function. To analyse the association between baseline location and severity of SVD with cognitive decline, linear regression models with generalized estimated equations were constructed to calculate the mean difference, 95% confidence interval and two-way interaction factor between time and SVD.
Results:
Increased numbers of baseline CMBs were associated with a decline in global cognition as well as a decline in executive function and memory domains. Location-specific analysis showed similar results with strictly lobar CMBs. There was no association with strictly deep and mixed-location CMBs with cognitive decline. Baseline WMH volume was associated with a decline in global cognition, executive function and memory. Similar results were obtained with anterior and posterior WMH volumes. Lacunes and their locations were not associated with cognitive decline.
Conclusion:
Strictly lobar CMBs, as well as WMH volume in anterior and posterior regions, were associated with cognitive decline. Future research focuses are warranted to evaluate interventions that may prevent cognitive decline related to SVD.
Insights
Cerebral Small Vessel Disease (SVD) impacts cognition. Strictly lobar Cerebral Microbleeds (CMBs) and white matter hyperintensities (WMH) are linked to cognitive decline over three years.
Area of Science:
- Neurology
- Neuroimaging
- Cognitive Science
Background:
- Cerebral Small Vessel Disease (SVD), encompassing lacunes, Cerebral Microbleeds (CMBs), and White Matter Hyperintensities (WMH), significantly contributes to cognitive impairment and dementia.
- SVD in lobar regions is associated with cerebral amyloid angiopathy, while deep SVD is linked to hypertensive arteriopathy.
- The differential impact of SVD location on long-term cognitive decline remains incompletely understood.
Purpose of the Study:
- To investigate the association between the location and severity of SVD markers and global/domain-specific cognitive decline over a 3-year period.
- To differentiate the effects of lobar versus deep SVD on cognitive trajectories.
- To clarify the role of CMBs, WMH, and lacunes in progressive cognitive impairment.
Main Methods:
- A cohort of 428 participants with baseline MRI scans and at least three neuropsychological assessments was analyzed.
- Lacunes and CMB locations were classified as strictly lobar, strictly deep, or mixed. WMH volume was categorized as anterior or posterior.
- Linear regression models with generalized estimating equations were used to assess the relationship between baseline SVD characteristics and cognitive decline.
Main Results:
- Increased baseline Cerebral Microbleeds (CMBs) correlated with declines in global cognition, executive function, and memory.
- Strictly lobar CMBs, but not deep or mixed-location CMBs, were associated with cognitive decline.
- White Matter Hyperintensities (WMH) volume, both anterior and posterior, was linked to declines in global cognition, executive function, and memory. Lacunes showed no significant association with cognitive decline.
Conclusions:
- Strictly lobar CMBs and WMH volume in both anterior and posterior regions are significant predictors of cognitive decline.
- These findings highlight the importance of SVD location in understanding cognitive trajectories.
- Further research is needed to develop interventions targeting SVD to prevent cognitive decline.
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