Small vessel disease progression ups dementia risk

A study with 14-year follow-up has pointed to baseline small vessel disease (SVD) severity and SVD progression as independent predictors of dementia.

Dementia was assessed in 498 (99.0 percent) of 503 participants with sporadic SVD and was diagnosed in 108 (21.5 percent) individuals (38 with Alzheimer’s dementia, 34 with vascular dementia, and 26 with mixed-aetiology Alzheimer’s/vascular dementia) over a median follow-up of 13.2 years.

All-cause and vascular dementia both correlated with each of the following: higher baseline white matter hyperintensity (WMH) volume (hazard ratio [HR], 1.31, 95 percent confidence interval [CI], 1.02‒1.67), presence of diffusion-weighted-imaging-positive lesions (HR, 2.03, 95 percent CI, 1.01‒4.04), and higher peak width of skeletonized mean diffusivity (HR, 1.24, 95 percent CI, 1.02‒1.51).

Additionally, WMH progression appeared to contribute to the development of incident all-cause dementia (HR, 1.76, 95 percent CI, 1.18‒2.63).

“The results suggest that SVD progression precedes dementia and may causally contribute to its development,” the investigators said. “Slowing SVD progression may delay dementia onset.”

This study analysed participants from the prospective Radboud University Nijmegen Diffusion Tensor and Magnetic Resonance Cohort study, with screening for baseline inclusion done in 2006.

The investigators carried out cognitive assessments and magnetic resonance imaging scans during their follow-up in 2011, 2015, and 2020. They diagnosed dementia using the DSM-5 criteria and classified it into either Alzheimer’s or vascular.

“Cerebral SVD is considered the most important vascular contributor to cognitive decline and dementia,” the investigators said.