Abstract
Background: Cerebral small vessel disease (cSVD) and neurodegeneration are the two main causes of dementia and are considered distinct pathological processes, while studies have shown overlaps and interactions between the two pathological pathways. Medial temporal atrophy (MTA) is considered a classic marker of neurodegeneration. We aimed to investigate the relationship of total cSVD burden and MTA on MRI using a total cSVD score and to explore the impact of the two MRI features on cognition.Methods: Patients in a memory clinic were enrolled, who underwent brain MRI scan and cognitive evaluation within 7 days after the first visit. MTA and total cSVD score were rated using validated visual scales. Cognitive function was assessed by using Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) scales. Spearman's correlation and regression models were used to test (i) the association between MTA and total cSVD score as well as each cSVD marker and (ii) the correlation of the MRI features and cognitive status.Results: A total of 312 patients were finally enrolled, with a median age of 75.0 (66.0–80.0) years and 40.7% (127/312) males. All of them finished MRI and MMSE, and 293 subjects finished MoCA. Of note, 71.8% (224/312) of the patients had at least one of the cSVD markers, and 48.7% (152/312) of them had moderate–severe MTA. The total cSVD score was independently associated with MTA levels, after adjusting for age, gender, years of education, and other vascular risk factors (OR 1.191, 95% CI 1.071–1.324, P = 0.001). In regard to individual markers, a significant association existed only between white matter hyperintensities and MTA after adjusting for the factors mentioned above (OR 1.338, 95% CI 1.050–1.704, P = 0.018). Both MTA and total cSVD score were independent risk factors for MMSE ≤ 26 (MTA: OR 1.877, 95% CI 1.407–2.503, P < 0.001; total cSVD score: OR 1.474, 95% CI 1.132–1.921, P = 0.004), and MoCA < 26 (MTA: OR 1.629, 95% CI 1.112–2.388, P = 0.012; total cSVD score: OR 1.520, 95% CI 1.068–2.162, P = 0.020). Among all the cSVD markers, microbleed was found significantly associated with MMSE ≤ 26, while no marker was demonstrated a relationship with MoCA < 26.Conclusion: Cerebral small vessel disease was related to MTA in patients of a memory clinic, and both the MRI features had a significant association with cognitive impairment.
Highlights
Alzheimer’s disease (AD) and vascular dementia (VaD) are the most common types of dementia (Plassman et al, 2007)
The following patients were excluded: (1) patients with cognitive dysfunction secondary to central nervous infection, brain trauma, brain tumor, and brain injury caused by radiotherapy or chemotherapy; (2) patients with cognitive impairment caused by metabolic, nutritional, and infectious factors, such as thyroid dysfunction, vitamin B deficiency, alcoholic brain damage, and syphilis; (3) patients with severe psychiatric disease or severe psychiatric symptoms which disturbed the cognitive assessment; (4) patients with large vessel infarctions or severe hemorrhagic stroke or patients with white matter hyperintensities (WMH) on magnetic resonance imaging (MRI) due to leukodystrophy, demyelinating disease of central nervous disease, and vasculitis
38.5% (120/312) of the subjects were diagnosed with dementia clinically. 50.8% (61/120) of the patients with dementia were diagnosed with probable AD, 9.2% (11/120) were diagnosed with probable VaD, and 40.0% (48/120) were diagnosed with other types or untyped dementia
Summary
Alzheimer’s disease (AD) and vascular dementia (VaD) are the most common types of dementia (Plassman et al, 2007) They are considered to have distinct pathological and radiological features. Growing studies have revealed that there are some overlaps and interactions between the two main pathology pathways Similar risk factors, such as hypertension, diabetes, hyperlipidemia (Kivipelto et al, 2001; Casserly and Topol, 2004; Vuorinen et al, 2015), and APOEε4 allele gene (Schuur et al, 2011; Sudre et al, 2017; Rojas et al, 2018), have been found in both AD and VaD, which shared common pathophysiological mechanisms including oxidative stress, mitochondrial disruption, and inflammation (Liu et al, 2018). Cerebral small vessel disease (cSVD) and neurodegeneration are the two main causes of dementia and are considered distinct pathological processes, while studies have shown overlaps and interactions between the two pathological pathways. We aimed to investigate the relationship of total cSVD burden and MTA on MRI using a total cSVD score and to explore the impact of the two MRI features on cognition
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