The following is a summary of “Cerebral Small Vessel Disease Progression and the Risk of Dementia: A 14-Year Follow-Up Study,” published in the July 2023 issue of Psychiatry by Jacob, et al.

For a study, researchers sought to investigate the relationship between baseline cerebral small vessel disease (SVD) severity and SVD progression on MRI markers with incident dementia, by subtype, in individuals with sporadic SVD over a 14-year follow-up period.

The study included 503 participants with sporadic SVD and without dementia from the Radboud University Nijmegen Diffusion Tensor and Magnetic Resonance Cohort (RUN DMC) study, with baseline inclusion conducted in 2006. Follow-ups in 2011, 2015, and 2020 included cognitive assessments and MRI scans. Dementia was diagnosed according to DSM-5 criteria and stratified into Alzheimer’s dementia and vascular dementia.

Dementia was observed as an endpoint in 498 participants (99.0%), with 108 participants (21.5%) developing dementia during the study period. Among those with dementia, 38 had Alzheimer’s dementia, 34 had vascular dementia, and 26 had mixed-etiology Alzheimer’s dementia/vascular dementia. The median follow-up time was 13.2 years (interquartile range, 8.8–13.8). Several factors were found to be independently associated with both all-cause dementia and vascular dementia. 

Higher baseline levels of white matter hyperintensity (WMH) (hazard ratio=1.31 per 1-SD increase, 95% CI=1.02-1.67), the presence of diffusion-weighted imaging (DWI) lesions (hazard ratio=2.03, 95% CI=1.01-4.04), and higher peak width of skeletonized mean diffusivity (hazard ratio=1.24 per 1-SD increase, 95% CI=1.02-1.51) were among these. Furthermore, WMH progression predicted incident all-cause dementia, with a hazard ratio of 1.76 per 1-SD increase (95% CI=1.18–2.63). The findings suggested that these MRI markers and their progression may play a significant role in the development of dementia, both all-cause and vascular types.

The study demonstrated that baseline SVD severity and SVD progression are independently associated with an increased risk of all-cause dementia over a 14-year follow-up. The results suggested that SVD progression may precede dementia and contribute causally to its development. The findings also implied that interventions aimed at slowing SVD progression might potentially delay the onset of dementia.

Source: ajp.psychiatryonline.org/doi/10.1176/appi.ajp.20220380