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Cerebral Small Vessel Disease Is Associated with Motor, Cognitive, and Emotional Dysfunction in Multiple System
Xiao-Li Yang1, Yu Guo2, Shu-Fen Chen2
1Department of Neurology, Shanghai Fifth People's Hospital, Fudan University, Shanghai, China.
Insights
Cerebral small vessel disease (CSVD) is more prevalent in multiple system atrophy (MSA) patients. This increased burden is linked to greater motor, cognitive, and emotional impairments in individuals with MSA.
Area of Science:
- Neurology
- Neuroimaging
- Neurodegenerative Diseases
Background:
- Cerebral small vessel disease (CSVD) has not been systematically studied in multiple system atrophy (MSA).
- Understanding the relationship between CSVD and MSA is crucial for patient management.
Purpose of the Study:
- To investigate the prevalence of CSVD in MSA patients compared to healthy controls.
- To explore the association between CSVD burden and motor, cognitive, and emotional dysfunction in MSA.
Main Methods:
- 190 MSA patients and 190 matched controls were recruited.
- CSVD markers (WMH, microbleeds, lacunes, EPVS) were assessed using neuroimaging.
- Motor, cognitive, and emotional outcomes were evaluated in 118 MSA patients.
Main Results:
- MSA patients exhibited a higher burden of overall CSVD, white matter hyperintensity (WMH), and enlarged perivascular spaces (EPVS) than controls.
- Severe CSVD correlated with worse motor and cognitive function.
- WMH was associated with motor, cognitive, and emotional deficits; EPVS showed region-specific correlations with motor, anxiety, and cognitive symptoms.
Conclusions:
- Concomitant CSVD is associated with increased multi-dimensional dysfunction in patients with MSA.
- CSVD imaging markers have distinct relationships with specific MSA symptoms.
Background:
Cerebral small vessel disease (CSVD) has not been systematically studied in patients with multiple system atrophy (MSA).
Objective:
We sought to explore whether MSA patients suffer from a heavier CSVD burden relative to healthy individuals and whether CSVD has a relationship with motor, cognitive, and emotional dysfunction in patients with MSA.
Methods:
This study consecutively recruited 190 MSA patients and 190 matched healthy controls whose overall CSVD burden and single CSVD imaging markers (including white matter hyperintensity (WMH), microbleeds, lacunes, and enlarged perivascular spaces (EPVS)) were measured. Of the MSA patients, 118 completed multi-dimensional outcome assessments. Spearman's correlations and multivariable linear regressions were performed.
Results:
We observed a greater burden of overall CSVD, WMH, and EPVS in MSA patients compared with controls, but not for microbleeds and lacunes. Motor dysfunction and cognitive impairment were significantly worse in subjects with severe CSVD than those with none-to-mild CSVD. In patients with MSA, the severity of CSVD burden was positively associated with motor impairments as measured by the Unified Multiple System Atrophy Rating Scale-II (β= 2.430, p = 0.039) and Scale for the Assessment and Rating of Ataxia (β= 1.882, p = 0.015). Of CSVD imaging markers, different associations with MSA outcomes were displayed. WMH was associated with motor, cognitive, and emotional deficits, while the EPVS in the centrum semiovale, basal ganglia, and hippocampus regions was correlated only with motor severity, anxiety, and cognition, respectively. Similar findings were noted in MSA-cerebellar and MSA-parkinsonian patients.
Conclusions:
Concomitant CSVD may be correlated with worse multi-dimensional dysfunction in patients with MSA.
