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Meta-Analysis
. 2018 Jul:90:164-173.
doi: 10.1016/j.neubiorev.2018.04.003. Epub 2018 Apr 13.

Cerebral small vessel disease and risk of incident stroke, dementia and depression, and all-cause mortality: A systematic review and meta-analysis

Sytze P Rensma  1 , Thomas T van Sloten  2 , Lenore J Launer  3 , Coen D A Stehouwer  4
Affiliations
Meta-Analysis

Cerebral small vessel disease and risk of incident stroke, dementia and depression, and all-cause mortality: A systematic review and meta-analysis

Sytze P Rensma et al. Neurosci Biobehav Rev. 2018 Jul.

Abstract

MRI features of cerebral small vessel disease (CSVD), i.e. white matter hyperintensities, lacunes, microbleeds, perivascular spaces, and cerebral atrophy, may be associated with clinical events, but the strength of these associations remains unclear. We conducted a systematic review and meta-analysis on the association between these features and incident ischaemic and haemorrhagic stroke, all-cause dementia and depression, and all-cause mortality. For the association with stroke, 36 studies were identified (number of individuals/events [n] = 38,432/4,136), for dementia 28 (n = 16,458/1,709), for depression nine (n = 9,538/1,746), and for mortality 28 (n = 23,031/2,558). Only two studies evaluated perivascular spaces; these results were not pooled. Pooled analyses showed that all other features were associated with all outcomes (hazard ratios ranged 1.22-2.72). Combinations of two features were more strongly associated with stroke than any individual feature. Individual features and combinations of CSVD features are strongly associated with incident ischaemic and haemorrhagic stroke, all-cause dementia and depression, and all-cause mortality. If these associations are causal, the strength of these associations suggests that a substantial burden of disease is attributable to CSVD.

Keywords: Cerebral atrophy; Cerebral small vessel disease; Dementia; Depression; Lacunes; Meta-analysis; Microbleeds; Mortality; Perivascular spaces; Stroke; Systematic review; White matter hyperintensities.

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Conflict of interest statement

Conflicts of interest

None

Figures

Fig. 1
Fig. 1
Flow chart of selection procedures for ischaemic and haemorrhagic stroke (panel A), all-cause dementia (B), depression (C) and all-cause mortality (D). *Some studies evaluated multiple markers of cerebral small vessel disease.
Fig. 1
Fig. 1
Flow chart of selection procedures for ischaemic and haemorrhagic stroke (panel A), all-cause dementia (B), depression (C) and all-cause mortality (D). *Some studies evaluated multiple markers of cerebral small vessel disease.
Fig. 1
Fig. 1
Flow chart of selection procedures for ischaemic and haemorrhagic stroke (panel A), all-cause dementia (B), depression (C) and all-cause mortality (D). *Some studies evaluated multiple markers of cerebral small vessel disease.
Fig. 1
Fig. 1
Flow chart of selection procedures for ischaemic and haemorrhagic stroke (panel A), all-cause dementia (B), depression (C) and all-cause mortality (D). *Some studies evaluated multiple markers of cerebral small vessel disease.
Fig. 2
Fig. 2
Pooled hazard ratios (95% confidence intervals) for the association between MRI features of cerebral small vessel disease (CSVD) and incident ischaemic and haemorrhagic stroke, all-cause dementia and depression, and all-cause mortality. *Higher vs. lower as defined by the individual studies. †Heterogeneity, I2 < 30%, ‡I2 = 30–60%, #I2 > 60%. For the forest plots of each pooled analysis, see supplemental material, Figures S1.1-S1.4. Abbreviations: WMHs = white matter hyperintensities; SD = standard deviation
See this image and copyright information in PMC

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