The cumulative effect of small vessel disease lesions is reflected in structural brain networks of memory clinic patients

ObjectiveTo evaluate the association between brain amyloid β (Aβ) and cerebral small vessel disease (CSVD) markers, as well as their joint effect on cognition, in a memory clinic study.MethodsA total of 186 individuals visiting a memory clinic, diagnosed with no cognitive impairment, cognitive impairment no dementia (CIND), Alzheimer dementia (AD), or vascular dementia were included. Brain Aβ was measured by [11C] Pittsburgh compound B–PET global standardized uptake value ratio (SUVR). CSVD markers including white matter hyperintensities (WMH), lacunes, and cerebral microbleeds (CMBs) were graded on MRI. Cognition was assessed by neuropsychological testing.ResultsAn increase in global SUVR is associated with a decrease in Mini-Mental State Examination (MMSE) in CIND and AD, as well as a decrease in global cognition Z score in AD, independent of age, education, hippocampal volume, and markers of CSVD. A significant interaction between global SUVR and WMH was found in relation to MMSE in CIND (P for interaction: 0.009), with an increase of the effect size of Aβ (β = −6.57 [−9.62 to −3.54], p < 0.001) compared to the model without the interaction term (β = −2.91 [−4.54 to −1.29], p = 0.001).ConclusionHigher global SUVR was associated with worse cognition in CIND and AD, but was augmented by an interaction between global SUVR and WMH only in CIND. This suggests that Aβ and CSVD are independent processes with a possible synergistic effect between Aβ and WMH in individuals with CIND. There was no interaction effect between Aβ and lacunes or CMBs. Therefore, in preclinical phases of AD, WMH should be targeted as a potentially modifiable factor to prevent worsening of cognitive dysfunction.

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Risk Factors for and Clinical Relevance of Incident and Progression of Cerebral Small Vessel Disease Markers in an Asian Memory Clinic Population

Journal of Alzheimer s Disease ◽

10.3233/jad-180911 ◽

2019 ◽

Vol 67 (4) ◽

pp. 1209-1219 ◽

Cited By ~ 7

Author(s):

Bibek Gyanwali ◽

Muhammad Amin Shaik ◽

Boon Yeow Tan ◽

Narayanaswamy Venketasubramanian ◽

Christopher Chen ◽

...

Keyword(s):

Risk Factors ◽

Clinical Relevance ◽

Small Vessel Disease ◽

Cerebral Small Vessel Disease ◽

Small Vessel ◽

Memory Clinic ◽

Vessel Disease ◽

Disease Markers ◽

Clinic Population

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Day-to-Day Home Blood Pressure Variability is Associated with Cerebral Small Vessel Disease Burden in a Memory Clinic Population

Journal of Alzheimer s Disease ◽

10.3233/jad-191134 ◽

2020 ◽

Vol 74 (2) ◽

pp. 463-472 ◽

Cited By ~ 1

Author(s):

Rianne A.A. de Heus ◽

Stacha F.I. Reumers ◽

Alba van der Have ◽

Maxime Tumelaire ◽

Phillip J. Tully ◽

...

Keyword(s):

Blood Pressure ◽

Blood Pressure Variability ◽

Disease Burden ◽

Small Vessel Disease ◽

Home Blood Pressure ◽

Cerebral Small Vessel Disease ◽

Small Vessel ◽

Memory Clinic ◽

Vessel Disease ◽

Clinic Population

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P1-420: ASSOCIATION BETWEEN NEUROPSYCHIATRIC DISORDERS AND CEREBRAL SMALL VESSEL DISEASE IN AN ASIAN NON-DEMENTED MEMORY CLINIC PATIENT COHORT

Alzheimer s & Dementia ◽

10.1016/j.jalz.2019.06.1025 ◽

2019 ◽

Vol 15 ◽

pp. P424-P425

Author(s):

Cheuk Ni Kan ◽

Bibek Gyanwali ◽

Eddie Chong ◽

Saima Hilal ◽

Narayanaswamy Venketasubramanian ◽

...

Keyword(s):

Small Vessel Disease ◽

Neuropsychiatric Disorders ◽

Cerebral Small Vessel Disease ◽

Small Vessel ◽

Memory Clinic ◽

Clinic Patient ◽

Patient Cohort ◽

Vessel Disease

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P4-286: CEREBRAL SMALL VESSEL DISEASE AND COGNITIVE DECLINE IN AN ASIAN MEMORY CLINIC POPULATION

Alzheimer s & Dementia ◽

10.1016/j.jalz.2019.06.3955 ◽

2019 ◽

Vol 15 ◽

pp. P1395-P1396

Author(s):

Bibek Gyanwali ◽

Eddie Chong ◽

Xin Xu ◽

Narayanaswamy Venketasubramanian ◽

Christopher Chen ◽

...

Keyword(s):

Cognitive Decline ◽

Small Vessel Disease ◽

Cerebral Small Vessel Disease ◽

Small Vessel ◽

Memory Clinic ◽

Vessel Disease ◽

Clinic Population

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Occurrence of Impaired Physical Performance in Memory Clinic Patients With Cerebral Small Vessel Disease

Alzheimer Disease & Associated Disorders ◽

10.1097/wad.0000000000000233 ◽

2018 ◽

Vol 32 (3) ◽

pp. 214-219 ◽

Cited By ~ 2

Author(s):

Jurre H. Verwer ◽

Geert-Jan Biessels ◽

Rutger Heinen ◽

Lieza G. Exalto ◽

Marielle H. Emmelot-Vonk ◽

...

Keyword(s):

Physical Performance ◽

Small Vessel Disease ◽

Cerebral Small Vessel Disease ◽

Small Vessel ◽

Memory Clinic ◽

Vessel Disease

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Total Cerebral Small Vessel Disease Burden on MRI Correlates With Medial Temporal Lobe Atrophy and Cognitive Performance in Patients of a Memory Clinic

Frontiers in Aging Neuroscience ◽

10.3389/fnagi.2021.698035 ◽

2021 ◽

Vol 13 ◽

Author(s):

Yangyi Fan ◽

Ming Shen ◽

Yang Huo ◽

Xuguang Gao ◽

Chun Li ◽

...

Keyword(s):

Risk Factors ◽

Small Vessel Disease ◽

Brain Mri ◽

Cognitive Status ◽

Cerebral Small Vessel Disease ◽

Small Vessel ◽

Memory Clinic ◽

Vessel Disease ◽

Mri Features ◽

The Impact

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.

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