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Updated: Aug 7, 2025
Evaluation of the Cognitive Performance of Hypertensive Patients with Silent Cerebrovascular Lesions
Published on: April 23, 2021
Association between total cerebral small vessel disease score and cognitive function in patients with vascular risk
Megumi Hosoya1, Sono Toi1, Misa Seki1
1Department of Neurology, Tokyo Women's Medical University Hospital, Tokyo, Japan.
Insights
Hypertension is a key risk factor for cerebral small vessel disease (SVD). Higher SVD burden is independently linked to poorer global cognitive function and attention, suggesting SVD reduction may prevent cognitive decline.
Area of Science:
- Neurology
- Neuroimaging
- Cognitive Science
Background:
- Hypertension is the primary risk factor for cerebral small vessel disease (SVD).
- Cerebral SVD is associated with cognitive impairment, but its independent impact on specific cognitive domains requires further investigation.
- Understanding the relationship between SVD burden and cognitive function is crucial for developing preventative strategies.
Purpose of the Study:
- To investigate the independent association between the burden of cerebral SVD and global cognitive function.
- To examine the relationship between SVD burden and individual cognitive domains in patients with vascular risk factors.
- To determine if SVD burden predicts cognitive decline independent of other factors.
Main Methods:
- A cross-sectional study analyzing data from the Tokyo Women's Medical University Cerebral Vessel Disease (TWMU CVD) registry.
- Inclusion criteria: evidence of cerebral SVD on MRI and at least one vascular risk factor.
- Assessment of SVD burden using a total SVD score (0-4) based on white matter hyperintensity, lacunar infarction, cerebral microbleeds, and enlarged perivascular space.
- Cognitive function evaluated using the Mini-mental State Examination (MMSE) and the Japanese version of the Montreal Cognitive Assessment (MoCA-J).
Main Results:
- A total of 648 patients were analyzed after exclusions.
- The total SVD score was significantly associated with both MMSE and MoCA-J scores.
- After adjusting for age, sex, education, risk factors, and medial temporal atrophy, the association between total SVD score and MoCA-J remained significant.
- The total SVD score was independently associated with attention deficits.
Conclusions:
- The total SVD score, representing cerebral SVD burden, is independently associated with global cognitive function and attention.
- Reducing SVD burden may be a potential strategy to prevent cognitive decline.
- These findings highlight the importance of managing SVD in patients with vascular risk factors to preserve cognitive health.
Abstract:
Hypertension is the most important risk factor for cerebral small vessel disease (SVD). In this cross-sectional study, we tested the independent association of cerebral SVD burden with global cognitive function and each cognitive domain in patients with vascular risk factors. The Tokyo Women's Medical University Cerebral Vessel Disease (TWMU CVD) registry is an ongoing prospective, observational registry in which patients with any evidence of CVD in magnetic resonance imaging (MRI) and at least one vascular risk factor were consecutively enrolled. For SVD-related findings, we evaluated white matter hyperintensity, lacunar infarction, cerebral microbleeds, enlarged perivascular space, and medial temporal atrophy. We used the total SVD score as the SVD burden. They underwent the Mini-mental State Examination (MMSE) and Japanese version of the Montreal Cognitive Assessment (MoCA-J) global cognitive tests, and each cognitive domain was evaluated. After excluding patients without MRI T2* images and those with MMSE score <24, we analyzed 648 patients. The total SVD score was significantly associated with MMSE and MoCA-J scores. After adjustment for age, sex, education, risk factors, and medial temporal atrophy, the association between the total SVD score and MoCA-J score remained significant. The total SVD score was independently associated with attention. In conclusion, the total SVD score, cerebral SVD burden, was independently association with global cognitive function and attention. A strategy to reduce SVD burden will have the potential to prevent cognitive decline. A total of 648 patients with any evidence of cerebral small vessel disease (SVD) in MRI and at least one vascular risk factor underwent Mini-mental State Examination (MMSE) and Japanese version of the Montreal Cognitive Assessment (MoCA-J) global cognitive tests. The total SVD scores count the presence of each SVD-related findings (white matter hyperintensity, Lacunar infarction, cerebral microbleeds and enlarged perivascular space), ranging from 0 to 4, as the SVD burden. Total SVD scores were significantly associated with MoCA-J scores (r = -0.203, P < 0.001). After adjustment for age, sex, education, risk factors, and medial temporal atrophy, the association between the total SVD score and global cognitive scores remained significant.
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