Perivascular spaces mediate a relationship between diabetes and other cerebral small vessel disease markers in cerebrovascular and neurodegenerative diseases

• Published in: Journal of stroke and cerebrovascular diseases 2023-09, Vol.32 (9), p.107273-107273, Article 107273
• Main Authors: Zebarth, Julia, Kamal, Radia, Perlman, George, Ouk, Michael, Xiong, Lisa Y., Yu, Di, Lin, William Z., Ramirez, Joel, Masellis, Mario, Goubran, Maged, MacIntosh, Bradley J., Black, Sandra E., Cogo-Moreira, Hugo, Scott, Christopher J.M., Bartha, Robert, Symons, Sean, Haddad, Seyyed M.H., Ozzoude, Miracle, Nanayakkara, Nuwan, Beaton, Derek, Arnott, Stephen, Dowlatshahi, Dariush, Saposnik, Gustavo, Grimes, David, Lang, Anthony, Fischer, Corinne E., Frank, Andrew, Kumar, Sanjeev, Pollock, Bruce G., Tang-Wai, David, Finger, Elizabeth, Rabin, Jennifer S., Swardfager, Walter
• Format: Article
• Language: English
• Subjects: Cerebrovascular disease; Diabetes mellitus; Hypertension; Neurodegeneration; Perivascular spaces; Small vessel disease
• ISSN: 1052-3057; 1532-8511
• DOI: 10.1016/j.jstrokecerebrovasdis.2023.107273

•People who had both type 2 diabetes and hypertension had larger volumes of perivascular spaces (PVS) in their white matter visible on MRI•In people with hypertension, PVS) mediated associations between type 2 diabetes and small vessel disease (SVD) markers, and SVD progression over 1 year•PVS may be a target to mitigate the impact of T2DM and hypertension on the small cerebral vessels Type 2 diabetes mellitus (T2DM) and hypertension are established risk factors for cerebral small vessel disease (SVD); however, few studies have characterised their relationships with MRI-visible perivascular spaces (PVS). Patients with neurodegenerative diseases were stratified by presence or absence of T2DM. MRI was used to quantify deep (d) and periventricular (p) white matter hyperintensities (WMH), lacunes, and PVS in the white matter (wmPVS) or basal ganglia (bgPVS). Patients with T2DM had greater wmPVS volume, but not other SVD volumes, and there were greater wmPVS volumes in patients with T2DM and hypertension together. Counterfactual moderated mediation models found indirect effects of T2DM on volumes of other SVD markers that were mediated by wmPVS: pWMH, dWMH, periventricular lacunes, and deep lacunes, in patients with hypertension, but not in patients without hypertension. Studying the regulation of cortical perivascular fluid dynamics may reveal mechanisms that mediate the impact of T2DM on cerebral small vessels.