Biomarkers

Area of Science:

• Neurology
• Radiology
• Neuroimaging

Background:

• Enlarged perivascular spaces (EPVS) are fluid-filled spaces around cerebral arteries, often seen in basal ganglia (BG-EPVS) and centrum semiovale (CSO-EPVS).
• Lacunar infarcts are small lesions associated with cognitive decline in vascular dementia (VaD) and Alzheimer's disease (AD), contributing to mixed dementia (MD).
• État criblé and état lacunaire describe specific MRI patterns of widened EPVS and lacunar infarcts, respectively, particularly in deep brain structures.

Purpose of the Study:

• To report a rare case of mixed dementia (MD) with a unique MRI pattern.
• To characterize the coexistence of état criblé and état lacunaire in a patient with cognitive impairment.

Main Methods:

• Clinical and imaging features of an 85-year-old woman with cognitive decline were analyzed.
• Brain MRI was performed to assess for enlarged perivascular spaces (EPVS) and lacunar infarcts.
• Neuropsychological evaluation was conducted to quantify cognitive deficits.

Main Results:

• The patient presented with progressive amnestic and dysexecutive cognitive impairment over six years.
• MRI revealed temporal mesial and hippocampal atrophy, chronic white matter changes, multiple basal ganglia-EPVS (BG-EPVS), and multifocal lacunar infarcts in the basal ganglia.
• Neuropsychological tests showed impaired memory and executive function.

Conclusions:

• Basal ganglia-EPVS, especially when associated with lacunar infarcts, are strongly linked to cognitive decline in mixed dementia.
• This case underscores the importance of recognizing the co-occurrence of état criblé and état lacunaire in patients with MD and other dementias.