PROGRESSION OF CEREBRAL SMALL VESSEL DISEASE AND THE VERY LONG-TERM RISK OF DEMENTIA
- Mina A. Jacob (Netherlands)
Abstract
Background And Aims
The number of dementia cases is expected to triple the next decades. SVD is the most important vascular contributor to dementia and may constitute an early modifiable treatment target. We aimed to investigate the relation between SVD burden and progression, and incident dementia during a 14 years follow-up.
Methods
We included 503 participants with sporadic SVD from the prospective RUN DMC study. In 2006, 2011, 2015 and 2020 patients underwent a standardized MRI-protocol and cognitive assessments. Progression of SVD was analyzed between 2006 and 2011. Dementia adjudication (based on DSM IV criteria ) was done multidisciplinary until December 9, 2020. Cumulative dementia risk was estimated using Kaplan-Meier analysis. The relation between baseline and progression of SVD-burden and incident dementia was analyzed with cox regression models.
Results
Of 498 patients with available dementia endpoint, 108 patients (21.5%) developed dementia during median follow-up of 14.0 years. Impaired microstructural integrity (PSMD) and WMH volumes were associated with incident dementia (Figure 1). In the multivariable regression model, presence of DWI+ lesions (2.29 [1.11-4.75]; P = 0.03) was associated with all-cause dementia. PSMD was specifically associated with vascular dementia. After adjustment for demographic and vascular risk factors, WMH progression (1.23 per 1-SD increase [1.02-1.48]; P = 0.03) was significantly associated with incident dementia, however not after adjustment for hippocampus atrophy rate.
Conclusions
We reveal that SVD-markers on MRI are associated with very long-term dementia outcomes in SVD patients. They can be considered an early risk factor for late life dementia, with now potential treatments available.