Total Cerebral Small Vessel Disease MRI Score Is Associated with Cognitive Decline in Executive Function in Patients with Hypertension

Renske Uiterwijk,Peter W De Leeuw,Robert J Van Oostenbrugge,Abraham A Kroon,Marjolein Huijts,Julie Staals

doi:10.3389/fnagi.2016.00301

Abstract

Objectives: Hypertension is a major risk factor for white matter hyperintensities (WMH), lacunes, cerebral microbleeds, and perivascular spaces, which are MRI markers of cerebral small vessel disease (SVD). Studies have shown associations between these individual MRI markers and cognitive functioning and decline. Recently, a “total SVD score” was proposed in which the different MRI markers were combined into one measure of SVD, to capture total SVD-related brain damage. We investigated if this SVD score was associated with cognitive decline over 4 years in patients with hypertension.Methods: In this longitudinal cohort study, 130 hypertensive patients (91 patients with uncomplicated hypertension and 39 hypertensive patients with a lacunar stroke) were included. They underwent a neuropsychological assessment at baseline and after 4 years. The presence of WMH, lacunes, cerebral microbleeds, and perivascular spaces were rated on baseline MRI. Presence of each individual marker was added to calculate the total SVD score (range 0–4) in each patient.Results: Uncorrected linear regression analyses showed associations between SVD score and decline in overall cognition (p = 0.017), executive functioning (p < 0.001) and information processing speed (p = 0.037), but not with memory (p = 0.911). The association between SVD score and decline in overall cognition and executive function remained significant after adjustment for age, sex, education, anxiety and depression score, potential vascular risk factors, patient group, and baseline cognitive performance.Conclusion: Our study shows that a total SVD score can predict cognitive decline, specifically in executive function, over 4 years in hypertensive patients. This emphasizes the importance of considering total brain damage due to SVD.

Highlights

Hypertension is a major risk factor for brain damage such as white matter hyperintensities (WMH), lacunes, cerebral microbleeds, and perivascular spaces (Veglio et al, 2009)
We showed that a total small vessel disease (SVD) score, that captures total SVDrelated brain damage on MRI imaging, was associated with cognitive decline in executive function over 4 years in patients with hypertension
By capturing all different MRI markers of cerebral SVD in one measure, we think that the SVD score better represents the underlying severity of the disease than just one MRI marker

Summary

Introduction

Hypertension is a major risk factor for brain damage such as white matter hyperintensities (WMH), lacunes, cerebral microbleeds, and perivascular spaces (Veglio et al, 2009). Studies in cerebral microbleeds and perivascular spaces are more sparse, but a few studies have reported that these might be related to cognitive decline or a higher risk of incident dementia (Zhu et al, 2010; Gregoire et al, 2012) These previous studies mostly focused on the different MRI markers of SVD separately. A “total SVD score” was proposed to combine all individual MRI markers into one measure of SVD, which aims to capture total brain damage from SVD (Staals et al, 2014) This total SVD score was found to be associated with higher blood pressure levels (Klarenbeek et al, 2013b), hypertension, age, and other risk factors for SVD (Staals et al, 2014). The SVD score, combining all four markers, has never been applied in longitudinal research, studying cognitive decline

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