Microbleeds in fronto-subcortical circuits are predictive of dementia conversion in patients with vascular cognitive impairment but no dementia

Yang-Kun Chen; Wei-Min Xiao; Wei Li; Zhuo-Xin Ni; Yong-Lin Liu; Li Xu; Jian-Feng Qu; Chee H Ng; Yu-Tao Xiang

doi:10.4103/1673-5374.239441

Microbleeds in fronto-subcortical circuits are predictive of dementia conversion in patients with vascular cognitive impairment but no dementia

Neural Regen Res. 2018 Nov;13(11):1913-1918. doi: 10.4103/1673-5374.239441.

Authors

Yang-Kun Chen¹, Wei-Min Xiao¹, Wei Li¹, Zhuo-Xin Ni², Yong-Lin Liu¹, Li Xu¹, Jian-Feng Qu¹, Chee H Ng³, Yu-Tao Xiang⁴

Affiliations

¹ Department of Neurology, Dongguan People's Hospital (Affiliated Dongguan Hospital, South Medical University), Dongguan, Guangdong Province, China.
² Department of Neurology, Dongguan People's Hospital (Affiliated Dongguan Hospital, South Medical University), Dongguan; Faculty of Neurology, Guangdong Medical University, Zhanjiang, Guangdong Province, China.
³ Department of Psychiatry, University of Melbourne, Melbourne, Victoria, Australia.
⁴ Faculty of Health Sciences, University of Macau, Macao SAR, China.

Abstract

Cerebral small vessel disease (CSVD) is a common etiology of vascular cognitive impairment with no dementia (V-CIND). Studies have revealed that cerebral microbleeds (CMBs), a feature of CSVD, contribute to cognitive impairment. However, the association between CMBs and dementia conversion in individuals with V-CIND is still unclear. Here, we analyzed the predictive role of CMBs in the conversion from V-CIND to dementia in CSVD patients. We recruited and prospectively assessed 85 patients with CSVD and V-CIND. V-CIND was evaluated using a series of comprehensive neuropsychological scales, including the Chinese version of the Montreal Cognitive Assessment and the Clinical Dementia Rating. MRI assessments were used to quantify lacunar infarcts, white matter hyperintensities, CMBs, and medial temporal lobe atrophy. Eighty-two of the 85 patients completed the assessment for dementia conversion at a 1-year follow-up assessment. Multivariate logistic regression analyses were conducted to examine independent clinical and MRI variables associated with dementia conversion. Twenty-four patients (29.3%) had converted to dementia at the 1-year follow-up, and these individuals had significantly more CMBs in the fronto-subcortical circuits. Multivariate logistic regression analyses revealed that the patients with CMBs in the fronto-subcortical circuits (odds ratio = 4.4; 95% confidence interval: 1.602-12.081, P = 0.004) and 5 or more CMBs overall (odds ratio = 17.6, 95% confidence interval: 3.23-95.84, P = 0.001) had a significantly increased risk of dementia at the 1-year follow-up. These findings indicate that CMBs in the fronto-subcortical circuits may be predictive of dementia conversion in CSVD patients with V-CIND, and thus extend the clinical significance of CMBs. This trial was registered with the Chinese Clinical Trial Registry (registration number: ChiCTR1800017077). Protocol version: 1.0.

Keywords: cerebral microbleeds; cerebrovascular disease; cognitive impairment; fronto-subcortical circuits; lacunar infarct; magnetic resonance imaging; small vessel disease; stroke; subcortical ischemic vascular disease; white matter hyperintensities.