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. 2021 Mar 16;96(11):e1501-e1511.
doi: 10.1212/WNL.0000000000011537. Epub 2021 Jan 27.

Association of Dilated Perivascular Spaces With Cognitive Decline and Incident Dementia

Matthew Paradise  1 , John D Crawford  2 , Ben C P Lam  2 , Wei Wen  2 , Nicole A Kochan  2 , Steve Makkar  2 , Laughlin Dawes  2 , Julian Trollor  2 , Brian Draper  2 , Henry Brodaty  2 , Perminder S Sachdev  2
Affiliations

Association of Dilated Perivascular Spaces With Cognitive Decline and Incident Dementia

Matthew Paradise et al. Neurology. .

Abstract

Objective: To determine whether severe perivascular space (PVS) dilation is associated with longitudinal cognitive decline and incident dementia over 4 and 8 years, respectively, we analyzed data from a prospective cohort study.

Methods: A total of 414 community-dwelling older adults aged 72-92 years were assessed at baseline and biennially for up to 8 years, with cognitive assessments, consensus dementia diagnoses, and 3T MRI. The numbers of PVS in 2 representative slices in the basal ganglia (BG) and centrum semiovale (CSO) were counted and severe PVS pathology defined as the top quartile. The effects of severe PVS pathology in either region or both regions and those with severe BG PVS and severe CSO PVS were examined. White matter hyperintensity volume, cerebral microbleed number, and lacune number were calculated.

Results: Participants with severe PVS pathology in both regions or in the CSO alone had greater decline in global cognition over 4 years, even after adjustment for the presence of other small vessel disease neuroimaging markers. The presence of severe PVS pathology in both regions was an independent predictor of dementia across 8 years (odds ratio 2.91, 95% confidence interval 1.43-5.95, p = 0.003). The presence of severe PVS pathology in all groups examined was associated with greater dementia risk at either year 4 or 6.

Conclusions: Severe PVS pathology is a marker for increased risk of cognitive decline and dementia, independent of other small vessel disease markers. The differential cognitive associations for BG and CSO PVS may represent differences in their underlying pathology.

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Figures

Figure 1
Figure 1. Participant Flow Chart
Figure 2
Figure 2. Severe Basal Ganglia and Severe Centrum Semiovale Perivascular Space (PVS) Pathology
(A) Severe basal ganglia and (B) severe centrum semiovale PVS pathology. Arrow points to an example of a PVS in each region.
Figure 3
Figure 3. Predicted Probability at Each Wave of Developing Dementia Since Baseline in Each Perivascular Space (PVS) Group, Based on Discrete-Time Survival Analysis
Predicted values adjusted for age, sex, education, APOE ε4 carrier status, body mass index, smoking status, hypertension, diabetes, white matter hyperintensity volume (log-transformed), presence of lacunes, and presence of multiple (≥1) microbleeds. BG = basal ganglia; CSO = centrum semiovale.
See this image and copyright information in PMC

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