Abstract
White matter hyperintensities (WMHs) of presumed vascular origin are one of the most important neuroimaging markers of cerebral small vessel disease (CSVD), which are closely associated with cognitive impairment. The aim of this study was to elucidate the pathogenesis of WMHs from the perspective of inflammation and hypoperfusion mechanisms. A total of 65 patients with WMHs and 65 healthy controls were enrolled in this study. Inflammatory markers measurements [hypersensitive C-reactive protein (hsCRP) and lipoprotein-associated phospholipase A2 (Lp-PLA2)], cognitive evaluation, and pseudocontinuous arterial spin labeling (PCASL) MRI scanning were performed in all the subjects. The multivariate logistic regression analysis showed that Lp-PLA2 was an independent risk factor for WMHs. Cerebral blood flow (CBF) in the whole brain, gray matter (GM), white matter (WM), left orbital medial frontal gyrus [MFG.L (orbital part)], left middle temporal gyrus (MTG.L), and right thalamus (Tha.R) in the patients was lower than those in the controls and CBF in the left triangular inferior frontal gyrus [IFG.L (triangular part)] was higher in the patients than in the controls. There was a significant correlation between Lp-PLA2 levels and CBF in the whole brain (R = −0.417, p < 0.001) and GM (R = −0.278, p = 0.025), but not in the WM in the patients. Moreover, CBF in the MFG.L (orbital part) and the Tha.R was, respectively, negatively associated with the trail making test (TMT) and the Stroop color word test (SCWT), suggesting the higher CBF, the better executive function. The CBF in the IFG.L (triangular part) was negatively correlated with attention scores in the Cambridge Cognitive Examination-Chinese Version (CAMCOG-C) subitems (R = −0.288, p = 0.020). Our results revealed the vascular inflammation roles in WMHs, which may through the regulation of CBF in the whole brain and GM. Additionally, CBF changes in different brain regions may imply a potential role in the modulation of cognitive function in different domains.
Highlights
Cerebral small vessel disease (CSVD) is a complex cerebrovascular syndrome that comprises diverse clinical, neuropathologic, and neuroimaging manifestations and is associated with cerebrovascular architecture dysfunction [1]
The Cerebral blood flow (CBF) values in the whole brain, gray matter (GM), and white matter (WM) were significantly lower in the White matter hyperintensities (WMHs) group than those of healthy controls (HCs)
We found that lipoprotein-associated phospholipase A2 (Lp-PLA2) could be seemed as an independent risk factor for WMHs
Summary
Cerebral small vessel disease (CSVD) is a complex cerebrovascular syndrome that comprises diverse clinical, neuropathologic, and neuroimaging manifestations and is associated with cerebrovascular architecture dysfunction [1]. The clinical presentations of CSVD are highly heterogeneous, ranging from asymptomatic to vascular cognitive impairment [2], stroke [3], neuropsychiatric symptoms [4], urinary symptoms [5], gait disturbance [6], and so on. Neuroimaging markers of CSVD include recent small subcortical infarcts, lacunes, white matter hyperintensities (WMHs) of presumed vascular origin, perivascular spaces, microbleeds, and brain atrophy [10]. WMHs are related to loss of structural integrity of WM and disruptions in focal to remote functional connectivity and brain networks, which impair the brain reserve and compensatory mechanisms and contribute to worsening clinical outcomes [18]. Previous investigations examining systemic and vascular inflammation markers—hypersensitive C-reactive protein (hsCRP) and lipoprotein-associated phospholipase A2 (Lp-PLA2), in the occurrence and development of WMHs, have demonstrated mixed results, with some reporting significant associations [19, 20], yet others finding no correlations [21]
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