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Lacunar Infarcts, but Not Perivascular Spaces, Are Predictors of Cognitive Decline in Cerebral Small-Vessel Disease.

Benjamin, P; Trippier, S; Lawrence, AJ; Lambert, C; Zeestraten, E; Williams, OA; Patel, B; Morris, RG; Barrick, TR; MacKinnon, AD; et al. Benjamin, P; Trippier, S; Lawrence, AJ; Lambert, C; Zeestraten, E; Williams, OA; Patel, B; Morris, RG; Barrick, TR; MacKinnon, AD; Markus, HS (2018) Lacunar Infarcts, but Not Perivascular Spaces, Are Predictors of Cognitive Decline in Cerebral Small-Vessel Disease. Stroke, 49 (3). pp. 586-593. ISSN 1524-4628 https://doi.org/10.1161/STROKEAHA.117.017526
SGUL Authors: Barrick, Thomas Richard

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Abstract

BACKGROUND AND PURPOSE: Cerebral small-vessel disease is a major cause of cognitive impairment. Perivascular spaces (PvS) occur in small-vessel disease, but their relationship to cognitive impairment remains uncertain. One reason may be difficulty in distinguishing between lacunes and PvS. We determined the relationship between baseline PvS score and PvS volume with change in cognition over a 5-year follow-up. We compared this to the relationship between baseline lacune count and total lacune volume with cognition. In addition, we examined change in PvS volume over time. METHODS: Data from the prospective SCANS study (St Georges Cognition and Neuroimaging in Stroke) of patients with symptomatic lacunar stroke and confluent leukoaraiosis were used (n=121). Multimodal magnetic resonance imaging was performed annually for 3 years and neuropsychological testing annually for 5 years. Lacunes were manually identified and distinguished from PvS. PvS were rated using a validated visual rating scale, and PvS volumes calculated using T1-weighted images. Linear mixed-effect models were used to determine the impact of PvS and lacunes on cognition. RESULTS: Baseline PvS scores or volumes showed no association with cognitive indices. No change was detectable in PvS volumes over the 3 years. In contrast, baseline lacunes associated with all cognitive indices and predicted cognitive decline over the 5-year follow-up. CONCLUSIONS: Although a feature of small-vessel disease, PvS are not a predictor of cognitive decline, in contrast to lacunes. This study highlights the importance of carefully differentiating between lacunes and PvS in studies investigating vascular cognitive impairment.

Item Type: Article
Additional Information: © 2018 The Authors. Stroke is published on behalf of the American Heart Association, Inc., by Wolters Kluwer Health, Inc. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution, and reproduction in any medium, provided that the original work is properly cited.
Keywords: cerebral small vessel diseases, cognition, leukoaraiosis, magnetic resonance imaging, neuroimaging, Aged, Aged, 80 and over, Cognitive Dysfunction, Female, Follow-Up Studies, Humans, Magnetic Resonance Imaging, Male, Middle Aged, Multimodal Imaging, Predictive Value of Tests, Stroke, Lacunar, cerebral small vessel diseases, cognition, leukoaraiosis, magnetic resonance imaging, neuroimaging, Neurology & Neurosurgery, 1103 Clinical Sciences, 1102 Cardiovascular Medicine And Haematology, 1109 Neurosciences
SGUL Research Institute / Research Centre: Academic Structure > Molecular and Clinical Sciences Research Institute (MCS)
Journal or Publication Title: Stroke
ISSN: 1524-4628
Language: eng
Dates:
DateEvent
March 2018Published
2 February 2018Published Online
21 December 2017Accepted
Publisher License: Creative Commons: Attribution 4.0
Projects:
Project IDFunderFunder ID
081589Wellcome Trusthttp://dx.doi.org/10.13039/100004440
PubMed ID: 29438074
Web of Science ID: WOS:000426560100037
Go to PubMed abstract
URI: https://openaccess.sgul.ac.uk/id/eprint/109708
Publisher's version: https://doi.org/10.1161/STROKEAHA.117.017526

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