Abstract
Introduction: Cerebral small vessel disease (CSVD) is the leading cause of vascular and mixed degenerative cognitive impairment (CI). The variability in the rate of progression of CSVD justifies the search for sensitive predictors of CI. Materials: A total of 74 patients (48 women, average age 60.6 ± 6.9 years) with CSVD and CI of varying severity were examined using 3T MRI. The results of diffusion tensor imaging with a region of interest (ROI) analysis were used to construct a predictive model of CI using binary logistic regression, while phase-contrast magnetic resonance imaging and voxel-based morphometry were used to clarify the conditions for the formation of CI predictors. Results: According to the constructed model, the predictors of CI are axial diffusivity (AD) of the posterior frontal periventricular normal-appearing white matter (pvNAWM), right middle cingulum bundle (CB), and mid-posterior corpus callosum (CC). These predictors showed a significant correlation with the volume of white matter hyperintensity; arterial and venous blood flow, pulsatility index, and aqueduct cerebrospinal fluid (CSF) flow; and surface area of the aqueduct, volume of the lateral ventricles and CSF, and gray matter volume. Conclusion: Disturbances in the AD of pvNAWM, CB, and CC, associated with axonal damage, are a predominant factor in the development of CI in CSVD. The relationship between AD predictors and both blood flow and CSF flow indicates a disturbance in their relationship, while their location near the floor of the lateral ventricle and their link with indicators of internal atrophy, CSF volume, and aqueduct CSF flow suggest the importance of transependymal CSF transudation when these regions are damaged.
Highlights
Cerebral small vessel disease (CSVD) is the leading cause of vascular and mixed degenerative cognitive impairment (CI)
Different regions of WMH in the hemispheres, corpus callosum, cingulate gyri, and hippocampi were selected as the region of interest (ROI), which were evaluated using fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD) metrics in patients with CSVD and CI of varying severity
The efficacy of the chosen logistical model was further evaluated by a receiver operating characteristic (ROC) analysis according to the probabilities predicted by the model, including calculation of the area under the curve, the ideal cut-off points, and their sensitivity and specificity
Summary
Cerebral small vessel disease (CSVD)/cerebral microangiopathy, associated with age and vascular risk factors, is the main cause of vascular and mixed degenerative cognitive impairment (CI) [1,2,3,4,5,6]. Different regions of WMH in the hemispheres, corpus callosum, cingulate gyri, and hippocampi were selected as the ROIs, which were evaluated using FA, MD, AD, and RD metrics in patients with CSVD and CI of varying severity. These data were used to construct a predictive model of CI that can reflect the leading conditions for its development in patients with. The association between DTI predictors and blood flow, cerebrospinal fluid flow, WMH, and atrophy was clarified
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