Longitudinal brain volume changes are associated with cognitive decline in patients with cerebral small vessel disease A prospective cohort study: the RUN DMC study

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Background: Cerebral small vessel disease (SVD) is a leading cause of cognitive decline and the most common cause of vascular dementia in elderly. Recently, bra in atrophy has been suggested as a major predictor of cognitive decline. However, the interactions between SVD features and bra in atrophy and their influence on cognitive decline remain largely unexamined. In the present study we therefore investigated the relation between longitudinal brain changes and cognitive function in various domains in elderly with cerebral SVD. Methods: As part of the prospective RUN DMC study, 359 elderly (mean age 64.1 ± 8.4 years) with cerebral SVD underwent an extensive MRI protocol and extensive cognitive assessment, bath at baseline and follow up (mean follow up 5.4 ± 0.20 years). Longitudinal percentage bra in volume change (PBVC) was estimated with SIENA. The relation between brain volume changes and cognitive performance was assessed by means of linear regression analysis, with extensive adjustments. Results: The mean percentage brain volume change (PBVC) was -3.1% (SD 2.0), which corresponds to an annual PBVC of -0.59 ± 0.39%/year. The annual atrophy rate was positively related to a decline in fluency (􀀜=0.197, p=0.001), concept shifting (􀀜=0.147, p=0.019), attention (􀀜=0.173, p=0.005) and to a decline in executive function (􀀜=0.196, p=0.001). Voxel-based, ventricle enlargement was positively related to cognitive decline in fluency and executive function, even after extensive adjustments. Conclusion: Longitudinal brain volume changes are associated with cognitive decline, specifically in attention, fluency, concept-shifting and executive function, independently of SVD features. This implies an important role for brain atrophy in the cognitive decline in patients with SVD.
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