Neural network mechanisms of emotional dysregulation in cerebral small vessel disease

Cerebral small vessel disease (CSVD) is a prevalent age-related disorder that leads to progressive white matter damage, resulting in cognitive decline and depression. This study explored the neural network mechanisms of emotional dysregulation in CSVD, focusing on both depression and alexithymia and considering the broader context of studies on emotional cardiovascular risk factors. Study participants (n = 196, age 37-75) were assessed for CSVD, arterial hypertension, depressive symptoms, and alexithymia. Emotional dysregulation, defined by depression and alexithymia, was estimated using a structural equation model accounting for the potential of bidirectional links with CSVD. To investigate the connectivity of networks involved in emotional processing, 167 participants underwent resting-state functional MRI. The study showed that emotional dysregulation was associated with reduced functional connectivity between the salience and language networks and within the language network. Age was associated with reduced functional connectivity within the salience and language networks, suggesting a possibility of synergistic deleterious effects. The revealed alterations in brain connectivity might reflect the dysfunction of the system of allostasis, explaining the observed symptoms of depression and alexithymia, as well as the previous findings on emotional cardiovascular risk factors.