The relationship between enlarged perivascular spaces and clinical outcomes in patients with vascular cognitive impairment

• Published in: Cerebral circulation - cognition and behavior 2024, Vol.6, p.100277, Article 100277
• Main Authors: Kilinc, Duygu, da Costa, Ana Sofia Ferreira Braga, Barkhof, Frederik, Boomsma, Jooske, van Harten, Argone, Exalto, Lieza, Moonen, Justine, Wardlaw, Joanna, van der Flier, Wiesje, Biessels, Geert Jan
• Format: Article
• Language: English
• ISSN: 2666-2450; 2666-2450
• DOI: 10.1016/j.cccb.2024.100277

Enlarged perivascular spaces (ePVS) on brain MRI are common in people with impaired cognition and have been linked to both small vessel disease (SVD) and Alzheimer's disease (AD). However, the predictive value of ePVS for clinical outcomes, in particular cognitive functioning and vascular events, as well as their interdependence with other markers of SVD and AD, remain unclear and was evaluated in the current study. 830 memory clinic patients from the TRACE-VCI cohort with possible vascular cognitive impairment were included, all with vascular injury on MRI. All had cognitive assessment and visual ePVS-ratings in the basal ganglia (BG) and centrum semiovale (CSO). CSF AD-biomarkers were available in 541 participants. Follow-up was obtained after 2.1±0.5 years from 97% of those eligible, 688 with ePVS-ratings. The relationship between ePVS and baseline neuropsychological assessment-derived domain z-scores, clinical dementia rating (CDR) at baseline and follow-up, and occurrence of major vascular events at follow-up were assessed with regression analyses adjusted for age, sex, and additionally for MRI markers of SVD and AD-biomarkers. Mean baseline age was 67.7 years and 54% were men. Increased CSO and BG ePVS were associated with worse attention and executive functioning (CSO β=-0.11, 95%CI=-0.21–-0.02, p=0.02; BG β=-0.10, 95%CI=-0.17–-0.02, p