Abstract
Objectives: We aim to investigate whether multi-dimensional diffusion tensor imaging (DTI) measures can sensitively identify different cognitive status of cerebral small vessel disease (CSVD) and to explore the underlying pattern of white matter disruption in CSVD.Methods: Two hundred and two participants were recruited, composed of 99 CSVD patients with mild cognitive impairment (VaMCI) and 60 with no cognitive impairment (NCI) and 43 healthy subjects as normal controls (NC). Full domain neuropsychological tests and diffusion-weighted imaging were performed on each subject. DTI metrics such as fractional anisotropy (FA), mean diffusivity (MD), the skeletonized mean diffusivity (PSMD), and structural brain network measures including network strength, global efficiency (EGlobal), and local efficiency (ELocal) were calculated. Region of interest (ROI) analysis of 42 white matter tracts was performed to examine the regional anatomical white matter disruption for each group.Results: Significant differences of multiple cognitive test scores across all cognitive domains especially processing and executive function existed among the three groups. DTI measures (FA, MD, and PSMD) showed significant group difference with the cognitive status changing. FA and EGlobal showed significant correlation with processing speed, executive function, and memory. ROI analysis found that white matter integrity impairment occurred from the preclinical stage of vascular cognitive impairment (VCI) due to CSVD. These lesions in the NCI group mainly involved some longitudinal fibers such as right superior longitudinal fasciculus (SLF-R), right superior fronto-occipital fasciculus (SFO-R), and right uncinate fasciculus (UNC-R), which might be more vulnerable to the cerebrovascular aging and disease process.Conclusions: DTI measures are sensitive neuroimaging markers in detecting the early cognitive impairment and able to differentiate the different cognitive status due to CSVD. Subtle changes of some vulnerable white matter tracts may be observed from the preclinical stage of VCI and have a local to general spreading pattern during the disease progression.
Highlights
Cerebral small vessel disease (CSVD) is a term referring to the pathological processes that affect small arteries, arterioles, capillaries, and small veins [1]
Post-hoc analysis revealed that education years of the VaMCI group was significantly lower than the normal controls (NC) and no cognitive impairment (NCI) group; no difference of prevalence of vascular risk factors (VRFs) was observed for NCI and VaMCI group
Significant difference existed between NC and MC, NCI, and VaMCI, while the difference between NC and NCI was only found for the digit symbol substitution test (DSS) and VFT
Summary
Cerebral small vessel disease (CSVD) is a term referring to the pathological processes that affect small arteries, arterioles, capillaries, and small veins [1]. Cerebral small vessels cannot be visualized in vivo currently [6]; a number of structural brain lesions detected by magnetic resonance imaging (MRI) are regarded as pathologic surrogate markers of cerebrovascular diseases [7]. White matter hyperintensity (WMH), lacunes, cerebral microbleeds, and enlarged perivascular spaces are well-established imaging markers according to the Standards for Reporting Vascular Changes on Neuroimaging (STRIVE) criteria [8]. CSVD is more regarded as a “whole brain disease” owing to the similar intrinsic microvascular pathologies of different structural lesions [2]. It comes to be of great significance to find a synthetic index that can reflect the composite effect of the disease
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