Abstract
ObjectiveTo evaluate the relationship between serum cortisol, cerebral small vessel disease (CSVD) neuroimaging markers, and cognitive performance.MethodsWe recruited patients over 50 years old who attended our hospital for physical examination between November 2020 and July 2021. All participants were subject to brain magnetic resonance imaging (MRI), serum cortisol examination, and the Montreal cognitive function assessment (MoCA). On brain MRI, we scored the presence of each marker of CSVD, including white matter hyperintensity (WMH), lacunes, cerebral microbleeds (CMBs), and enlarged perivascular spaces (EPVS). One point was awarded for the presence of each marker, producing a score between 0 and 4.ResultsIn total, 158 participants were included in this study with a mean age of 60.5 (56.0–66.3) years; 55.1% were male. In the multivariable analyses, serum cortisol level was an independent predictor of WMH severity, the presence of lacunes/CMBs, moderate-severe EPVS and total CSVD burden after adjusting for confounding factors. Serum cortisol level had positive associations with periventricular/deep Fazekas score, burdens of lacunes/CMBs, moderate-severe EPVS, and total CSVD burden in dose-dependent manner, and was an independent predictor of cognitive impairment. Furthermore, the results of the receiver operating characteristic (ROC) curve analysis revealed an area under curve (AUC) of 0.745 with 64.1% sensitivity and 82.5% specificity, and an AUC of 0.705 with 52.1% sensitivity and 85.5 specificity of cortisol in detecting patients with high CSVD burden and MCI, respectively.ConclusionsSerum cortisol level is independently associated with each CSVD MRI markers, total CSVD burden and cognitive impairment. These findings provide clues for pathological mechanisms and suggest serum cortisol as a promising biomarker associated with CSVD.
Highlights
Cerebral small vessel disease (CSVD) is a widespread cerebrovascular disease that shares common clinical manifestations, neuroimaging markers, and neuropathological findings thought to result from changes in the pial and parenchymal microcirculations (Pantoni, 2010)
Individuals in the higher serum cortisol group presented with higher frequencies of hypertension, moderate-severe white matter hyperintensity (WMH), lacunes, cerebral microbleeds (CMBs), moderate-severe enlarged perivascular spaces (EPVS) and lower Montreal Cognitive Assessment Test (MoCA) scores than the lower serum cortisol group; there was no statistically significant difference in other characteristics
In the model 1, serum cortisol was an independent predictor of WMH severity, lacunes, CMBs, moderate-severe EPVS and total CSVD burden after adjustment for confounding factors
Summary
Cerebral small vessel disease (CSVD) is a widespread cerebrovascular disease that shares common clinical manifestations, neuroimaging markers, and neuropathological findings thought to result from changes in the pial and parenchymal microcirculations (Pantoni, 2010). A recently published international consensus—STRIVE (STandards for ReportIng Vascular changes on nEuroimaging) — outlined the changes related to CSVD that may be reflected on an brain magnetic resonance imaging (MRI) scan: white matter hyperintensity (WMH), lacunes of presumed vascular origin, cerebral microbleeds (CMBs), and enlarged perivascular spaces (EPVS) (Wardlaw et al, 2013b). These neuroimaging surrogates are varied but frequently concurrent, suggesting a potential shared mechanism (Vilar-Bergua et al, 2016). High cortisol levels were reported to have neurotoxic effects on the hippocampus and be related to atrophy, eventually aggravating cognitive impairment and dementia development in the elderly (Byers and Yaffe, 2011; Geerlings et al, 2015; Echouffo-Tcheugui et al, 2018)
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