Global Burden of Small Vessel Disease-Related Brain Changes on MRI Predicts Cognitive and Functional Decline.
Laakso, Hanna M
Wolters Kluwer Health
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Jokinen, H., Koikkalainen, J., Laakso, H. M., Melkas, S., Nieminen, T., Brander, A., Korvenoja, A., et al. (2020). Global Burden of Small Vessel Disease-Related Brain Changes on MRI Predicts Cognitive and Functional Decline.. Stroke, 51 (1), 170-178. https://doi.org/10.1161/strokeaha.119.026170
Background and purpose: Cerebral small vessel disease (SVD) is characterized by a wide range of focal and global brain changes. We used an MRI segmentation tool to quantify multiple types of SVD-related brain changes and examined their individual and combined predictive value on cognitive and functional abilities. Methods: MRI scans of 560 older individuals from the Leukoaraiosis and Disability Study (LADIS) were analyzed using automated atlas- and convolutional neural network-based segmentation methods yielding volumetric measures of white matter hyperintensities (WMH), lacunes, enlarged perivascular spaces (EPVS), chronic cortical infarcts, and global and regional brain atrophy. The subjects were followed up with annual neuropsychological examinations for 3 years and evaluation of instrumental activities of daily living for 7 years. Results: The strongest predictors of cognitive performance and functional outcome over time were the total volumes of WMH, grey matter (GM) and hippocampi (p<0.001 for global cognitive function, processing speed, executive functions and memory; and p<0.001 for poor functional outcome). Volumes of lacunes, EVPS and cortical infarcts were significantly associated with part of the outcome measures, but their contribution was weaker. In a multivariable linear mixed model, volumes of WMH, lacunes, GM and hippocampi remained as independent predictors of cognitive impairment. A combined measure of these markers based on z-scores strongly predicted cognitive and functional outcomes (p<0.001) even above the contribution of the individual brain changes. Conclusions: Global burden of SVD-related brain changes as quantified by an image segmentation tool is a powerful predictor of long-term cognitive decline and functional disability. A combined measure of WMH, lacunar, GM and hippocampal volumes could be used as an imaging marker associated with vascular cognitive impairment.
Brain, Humans, Magnetic Resonance Imaging, Predictive Value of Tests, Cognition, Cost of Illness, Aged, Aged, 80 and over, Female, Male, Cerebral Small Vessel Diseases, Cognitive Dysfunction
The Leukoaraiosis and Disability study was supported by the European Union (grant QLRT-2000-00446). This work has received funding from the European Union’s Seventh Framework Programme for research, technological development and demonstration under grant agreements no. 611005 (PredictND) and no. 601055 (VPH-DARE@IT), Tekes – the Finnish Funding Agency for Technology and Innovation (4171/31/2017 DeepBrain-project).
External DOI: https://doi.org/10.1161/strokeaha.119.026170
This record's URL: https://www.repository.cam.ac.uk/handle/1810/297719
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