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Clinical Trial
. 2018 Mar;49(3):586-593.
doi: 10.1161/STROKEAHA.117.017526. Epub 2018 Feb 2.

Lacunar Infarcts, but Not Perivascular Spaces, Are Predictors of Cognitive Decline in Cerebral Small-Vessel Disease

Philip Benjamin  1 , Sarah Trippier  2 , Andrew J Lawrence  2 , Christian Lambert  2 , Eva Zeestraten  2 , Owen A Williams  2 , Bhavini Patel  2 , Robin G Morris  2 , Thomas R Barrick  2 , Andrew D MacKinnon  2 , Hugh S Markus  2
Affiliations
Clinical Trial

Lacunar Infarcts, but Not Perivascular Spaces, Are Predictors of Cognitive Decline in Cerebral Small-Vessel Disease

Philip Benjamin et al. Stroke. 2018 Mar.

Abstract

Background and purpose: Cerebral small-vessel disease is a major cause of cognitive impairment. Perivascular spaces (PvS) occur in small-vessel disease, but their relationship to cognitive impairment remains uncertain. One reason may be difficulty in distinguishing between lacunes and PvS. We determined the relationship between baseline PvS score and PvS volume with change in cognition over a 5-year follow-up. We compared this to the relationship between baseline lacune count and total lacune volume with cognition. In addition, we examined change in PvS volume over time.

Methods: Data from the prospective SCANS study (St Georges Cognition and Neuroimaging in Stroke) of patients with symptomatic lacunar stroke and confluent leukoaraiosis were used (n=121). Multimodal magnetic resonance imaging was performed annually for 3 years and neuropsychological testing annually for 5 years. Lacunes were manually identified and distinguished from PvS. PvS were rated using a validated visual rating scale, and PvS volumes calculated using T1-weighted images. Linear mixed-effect models were used to determine the impact of PvS and lacunes on cognition.

Results: Baseline PvS scores or volumes showed no association with cognitive indices. No change was detectable in PvS volumes over the 3 years. In contrast, baseline lacunes associated with all cognitive indices and predicted cognitive decline over the 5-year follow-up.

Conclusions: Although a feature of small-vessel disease, PvS are not a predictor of cognitive decline, in contrast to lacunes. This study highlights the importance of carefully differentiating between lacunes and PvS in studies investigating vascular cognitive impairment.

Keywords: cerebral small vessel diseases; cognition; leukoaraiosis; magnetic resonance imaging; neuroimaging.

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Figures

Figure 1.
Figure 1.
Summary of preprocessing pipeline. Please refer to Lambert et al for further details. FLAIR indicates fluid-attenuated inversion recovery; SPM, statistical parametric mapping; TPM, tissue probability map; and WMH, white matter hyperintensities.
Figure 2.
Figure 2.
The estimated marginal effect of baseline lacune number and perivascular spaces score (EPVS) on Executive and global function over a 5-year follow-up period. We chose the 10th, 50th, and 90th percentiles of baseline lacunes (0, 2, 10) and EPVS (3, 4, 6) to display effects. Values for all other covariates in the model were set to their sample average.
Figure 3.
Figure 3.
The estimated marginal effect of baseline lacune volume and perivascular spaces (PvS) volume on Executive and global function over a 5-year follow-up period. We chose the 10th, 50th, and 90th percentiles of baseline lacune volume (0, 0.47, 1.07) and PVS volume (20, 82, 406) to display effects. Values for all other covariates in the model were set to their sample average.
See this image and copyright information in PMC

Comment in

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