December 16, 2019, e-Pearl of the Week: Vascular cognitive impairment (VCI) due to CSVD

Vascular cognitive impairment due to cerebral small vessel disease

Vascular cognitive impairment (VCI) due to cerebral small vessel disease (SVD) results from microvascular insult to subcortical white matter involving disruption of blood-brain barrier from arteriolosclerosis and neuroinflammation.1-3 A major risk factor is hypertension.1,2 Clinical manifestations include impairment in executive function and gait ataxia.1,2 Brain MRI shows extensive periventricular/deep white matter hyperintensities with enlarged perivascular spaces.1-3 Cerebrospinal fluid biomarkers with neuropsychological testing and cerebral blood flow quantification helps differentiate VCI from Alzheimer’s disease and normal pressure hydrocephalus, respectively.1-3 Primary and secondary prevention include antihypertensives, statins, and life style modification although prognosis remains poor.1,4

References

  1. Huisa BN, Rosenberg GA. Binswanger's disease: toward a diagnosis agreement and therapeutic approach. Expert Rev Neurother 2014;14:1203–1213.
  2. Wallin A, Román GC, Esiri M, et al. Update on Vascular Cognitive Impairment Associated with Subcortical Small-Vessel Disease. J Alzheimers Dis 2018;62:1417–1441.
  3. Cuadrado-Godia E, Dwivedi P, Sharma S, et al. Cerebral Small Vessel Disease: A Review Focusing on Pathophysiology, Biomarkers, and Machine Learning Strategies. J Stroke 2018;20:302–320.
  4. Akiguchi I, Budka H, Shirakashi Y, et al. MRI features of Binswanger's disease predict prognosis and associated pathology. Ann Clin Transl Neurol 2014;1:813–21.

Jung-Hyun Lee—Medical Student, Wonkwang University School of Medicine—and Faisal Khan, MD, DABSM, DABPN, Consultant Neurologist, Sugar Land Neurology and Sleep, Texas

Jung-Hyun Lee and Faisal Khan report no disclosures.