Modified cerebral small vessel disease score is associated with vascular cognitive impairment after lacunar stroke

Abstract

We conducted a cross-sectional study to characterize the relationship between total and modified small vessel disease (SVD) score with vascular cognitive impairment (VCI). Patients (n = 157) between the ages of 50 and 85 years old who had suffered their first lacunar infarction were analyzed prospectively. Brain magnetic resonance imaging was performed to identify SVD manifestations, which were used to calculate total or modified SVD scores. Neuropsychological assessments measured cognitive function. Spearman correlation analysis demonstrated that the total and modified SVD scores were associated with overall cognition as well as with function in the executive and visuospatial domains. The associations remained significant in linear regression after adjusting for age, sex, education and vascular risk factors. Binary logistic regression and chi-squared trend tests revealed that VCI risk increased significantly with SVD burden based on the modified SVD score. Subsequent chi-squared testing demonstrated that the VCI rate was significantly higher in patients with a modified SVD score of 5-6 than in patients without any SVD burden. Our results suggest that both the total and modified SVD scores show a negative association with cognitive function, but the modified SVD score may be better at identifying patients at high VCI risk.

Keywords: cognitive impairment; executive function; lacunar stroke; small vessel disease score; visuospatial function.

Figure 1

Schematic representation of patient enrollment. A total of 157 of 189 patients completed comprehensive evaluations, including neuroimaging and neuropsychological assessments, and were recruited into the study. Based on their performance on neuropsychological tests, patents were divided into those with vascular cognitive impairment (VCI) or those with no cognitive impairment (NCI).

Figure 2

Proportions of patients with vascular cognitive impairment (VCI) based on modified SVD score. When patients were stratified based on the modified SVD score, the proportion of patients with VCI was significantly higher among those with high SVD burden (P = 0.009). This suggests that the modified SVD score is better at identifying patients at high risk of SVD.