Features of early diagnosis of cerebral small vessels disease in the elderly: сlinical neurovisualization correlations

Abstract

Early diagnosis of cerebral small vessels disease (CSVD) in the elderly in the elderly is a daunting task due to the similarity of its clinical and neuroimaging manifestations to age-related changes and high comorbidity with neurodegenerative diseases. The aim of the work is to determine the features of early neuropsychological and neuroimaging manifestations of CSVD, which was first diagnosed in old age. Material and methods. 37 elderly patients (EP: 60-75 years) with arterial hypertension (AH) st. 1-2, stage I-II and CSVD (women – 17 (45.9%), men – 220 (54.1%) were examined. Control groups: KGEP – 20 practically healthy elderly people and a group of middle-aged patients (ME – 44-59 years) with AH st. 1-2, stage I-II and CSVD are identical in age, gender and general duration of education. Total Cerebral volume blood flow (TcVBF) was determined using duplex ultrasound (USDS). MRI (3T) was performed in the following modes: T1-2WI, DWI, 3D Brain FLAIR SHC, 3D tra, VEN BOLD, DTI medium iso SENSE. Neuropsychological studies were performed using: MoCA questionnaire with evaluation of EIS, VIS, AIS, LIS, MIS, OIS domains; MMSE; SSR and PhSR (Semantic and Phonetic Speech Rate); FAB (Fontal Assessment Battery). Results and discussion. Using the modified scoring system for determining the severity of the burden of cerebral small vessels disease (BCSVDearly), it was found that the only difference between patients with clinical manifestations of the pathological process in middle and old age is the presence of lacunar infarctions in 16.2% of elderly patients. The relative changes in pre-visual markers of CSVD (DTI - MRI) in older patients were less pronounced than in middle-aged patients (FA: up to -24.1% in fibers and up to -18.6% in ROI; MD: up to +14, 9% in fibers and + 18.2% in ROI). There are also significant differences in the influence of diffusion disorders in the white matter (WM) of the brain on the cognitive status of patients with CSVD of middle-aged and elderly (emphasis on the number and rank of correlations). In the group of middle-aged patients, 270 out of 280 (96.4%) possible correlations were identified, including 22.1% (60) of those classified as noticeable (≥ + 0.5 / ≤ -0.5). In older subjects, the proportion of established moderate correlations reached only 21.4%, with a minimum negative rs = -0.45. Conclusion. The principal differences of the clinical and neuroimaging manifestation of CSVD in the elderly were determined: the relative decrease in the scores of cognitive functions to 73.0% (against 91.2% in the ME group); the presence of LI in the list of visual signs of CSVD; less pronounced, compared to ME, changes in pre-visual (diffusion) indicators of the state of deep WM; no correlations for MoCA, BCSVDearly, FA and MD domains.