Abstract
Whether cerebral microbleeds cause cognitive impairment remains uncertain. We analyzed whether cerebral microbleeds are associated with cognitive dysfunction in patients with symptomatic cerebral small vessel disease, and whether this association is independent of other neuroimaging markers of cerebral small vessel disease. We analyzed consecutive patients with MRI-confirmed lacunar stroke included in DNA-Lacunar-2 multicenter study. Cerebral microbleeds were graded using the Brain Observer Microbleed Rating Scale (BOMBS). Neuropsychological assessment was performed using the Brief Memory and Executive Test (BMET). We analyzed the association between cerebral microbleeds, BMET, and the following subdomains: executive function/processing speed and orientation/memory. We also searched for an independent association between cerebral microbleeds and vascular cognitive impairment, defined as BMET ≤ 13. Out of 688 included patients, cerebral microbleeds were detected in 192 (27.9%). After adjusting for white matter hyperintensities severity, lacune count, and other confounders, both the presence and the number of cerebral microbleeds were significantly associated with impaired cognitive performance [β = -13.0; 95% CI = (-25.3, -0.6) and β = -13.1; 95% CI = (-19.8, -6.4), respectively]. On analysis of specific cognitive domains, associations were present for executive function/processing speed [β = -5.8; 95% CI = (-9.3, -2.2) and β = -4.3; 95% CI = (-6.2, -2.4), respectively] but not for orientation/memory [β = -0.4; 95% CI = (-4.0, 3.2) and β = -2.1; 95% CI = (-4.0, 0.1), respectively]. We also found an independent association between the presence and the number of cerebral microbleeds and vascular cognitive impairment [adjusted OR = 1.48; 95% CI = (1.01, 2.18) and OR = 1.43; 95% CI = (1.15, 1.79), respectively]. In a large cohort of symptomatic cerebral small vessel disease patients, after controlling for other neuroimaging markers of cerebral small vessel disease severity, cerebral microbleeds were associated with cognitive dysfunction. Executive function and processing speed were predominantly impaired. This might suggest a causal role of cerebral microbleeds in determining vascular cognitive impairment.
Highlights
Cerebral microbleeds (CMBs) are perivascular focal deposits of haemosiderin-laden macrophages, ranging in diameter between 0.80 and 1.5 mm, visible as signal voids on T2*-weighted gradient echo (GE) and susceptibility weighted imaging (SWI) magnetic resonance imaging (MRI).[1,2] Together with lacunar infarcts, white matter hyperintensities (WMH) and enlarged perivascular spaces, CMBs are a recognizedInternational Journal of Stroke, 0(0)International Journal of Stroke 0(0)neuroimaging marker of cerebral small vessel disease.[3]
CMB frequency increases with age;[4] they are common in patients with stroke, cognitive impairment, and dementia.[5,6]
This association persisted after controlling for other MRI markers of cerebral small vessel disease (cSVD), suggesting that CMB are independently related to cognitive impairment and may play a causal role
Summary
Neuroimaging marker of cerebral small vessel disease (cSVD).[3] CMB frequency increases with age;[4] they are common in patients with stroke, cognitive impairment, and dementia.[5,6]. Whether CMBs are independently associated with cognitive impairment in patients with stroke and cSVD is uncertain, with studies to date giving inconsistent results. In patients with previous stroke or TIA, those with CMBs showed impaired executive function and this was associated with CMBs in the frontal region and basal ganglia.[7] in another study of stroke patients, CMBs were not associated with cognitive performance during a four-year follow up.[8] In patients with cSVD and radiological lacunar stroke and confluent white matter hyperintensities, CMBs were only associated with cognition when very frequent.[9] the relationship was weakened after controlling for other markers of cSVD. We analyzed whether cerebral microbleeds are associated with cognitive dysfunction in patients with symptomatic cerebral small vessel disease, and whether this association is independent of other neuroimaging markers of cerebral small vessel disease
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