Arteriolosclerosis CSVD: a common cause of dementia and stroke and its association with cognitive function and total MRI burden

Abstract

Objective: Arteriolosclerosis cerebral small vessel disease (CSVD) is a common type of CSVD. This study aimed to explore the factors associated with cognitive function and total MRI burden related to the disease.

Methods: The demographic characteristics, clinical manifestations, cognitive function score, Barthel Index (BI), blood test index, and follow-up results of arteriolosclerosis CSVD patients treated for the first time in our hospital from January 2014 to August 2022 were collected. White matter hyperintensity (WMH) Fazekas score, total MRI burden, and cerebral atrophy grade were evaluated according to brain MRI findings. Factors associated with CSVD cognitive function were analyzed by binary logistic regression. The correlative factors related to the total MRI burden of CSVD were analyzed by ordered multiple logistic regression.

Results: A total of 146 patients were included in this study, of which 132 cases (90.4%) had hypertension. There were 108 patients (74.0%) with cognitive dysfunction, 97 patients (66.4%) with balance and gait disorders, and 83 patients (56.8%) with moderate-to-severe dependence in daily life (BI ≤ 60 points). Of 146 patients, 79 (54.1%) completed clinical and imaging follow-ups for a median of 3 years. The number of patients with cognitive impairment and BI ≤ 60 points after follow-up significantly increased compared with the first admission (P < 0.001). There were also significant differences in total MRI burden (P = 0.001), WMH Fazekas score, and cerebral atrophy grade (P < 0.001). Mean age (P = 0.012), median deep WMH Fazekas score (P = 0.028), and median deep (P < 0.001) and superficial (P =0.002) cerebral atrophy grade of patients with cognitive impairment at first admission were all higher than those with non-cognitive impairment. Multivariate analysis showed that deep cerebral atrophy was independently and significantly associated with cognitive impairment of CSVD (P = 0.024), and hypertension was significantly and independently associated with total MRI burden (P = 0.001).

Conclusion: The disease course of arteriolosclerosis CSVD may be related to cognitive function and total MRI burden. Deep cerebral atrophy was an independent risk factor for cognitive dysfunction in arteriolosclerosis CSVD, and hypertension was an independent risk factor for total MRI burden.

Keywords: cerebral atrophy; cerebral microbleed; cerebral small vessel disease; cognitive impairment; lacunar infarcts; white matter hyperintensities.

Figure 1

Brain MRI changes in a patient with arteriolosclerosis CSVD. Male, 66 years old, was admitted to the hospital due to right limb weakness for 2 days in 2014. Brain MRI: (A) DWI showed a small flake of high signal in the left centrum semiovale. (B) T2WI showed irregular hyperintensity near the ventricle. (C, D) T1WI showed enlargement of the sulci and slight enlargement of the ventricles. In 2018, the patient was readmitted to the hospital due to dysarthria and left limb weakness for 1 day. Brain MRI: (E) DWI showed a small flake of high signal near the right lateral ventricle. (F) T2WI, the range of irregular hyperintensity near the ventricle was enlarged and extended to deep white matter with large area fusion. (G, H) T1WI showed enlargement of the sulci and enlargement of the ventricles, which made progress compared with 2014.