![]() It is also important to realize that only a small proportion of the white matter (usually less than a few percent) is affected by SVD, even among individuals with severe SVD. Īs identical appearing WML on conventional MRI are actually histopathologically heterogeneous, it could be that only the WML with a high loss of microstructural integrity are related to cognitive and motor impairment. One of the other factors could be the presence the coexisting manifestations of cerebral SVD on conventional MRI such as lacunar infarcts and cerebral microbleeds which might influence the cognitive and motor performance. Apparently there are other factors that determine whether identical appearing WML on FLAIR lead to for example cognitive or motor decline in one person, while leaving others unaffected. However, individuals with a virtually identical WML burden on conventional FLuid Attenuated Inversion Recovery (FLAIR) imaging present with a wide variance in cognitive and motor performance ranging from no complaints at all to subjective cognitive complaints and mild parkinsonian signs to dementia and parkinsonism. There is evidence of an increased risk of cognitive decline, dementia, gait and balance disturbances and parkinsonism among individuals with SVD, although prospective studies are scarce. The prevalence of WML and lacunar infarcts varies considerably across studies from 5-95% and 8-28% respectively, depending on the population studied and the imaging technique used. In cerebral SVD symptoms are due to either complete (lacunar syndromes) or incomplete infarction (WML) of subcortical structures leading to accompanying complaints including the lacunar syndromes, cognitive, motor (gait) and/or mood disturbances. It is associated with vascular risk factors, such as hypertension, atherosclerosis, diabetes mellitus and atrial fibrillation. The execution and completion of the follow up of our study might ultimately unravel the role of SVD on the microstructural integrity of the white matter in the transition from "normal" aging to cognitive and motor decline and impairment and eventually to incident dementia and parkinsonism.Ĭerebral small vessel disease (SVD) includes white matter lesions (WML) and lacunar infarcts and is a frequent finding on computer tomography (CT) and magnetic resonance imaging (MRI) scans of elderly people. Our data could furthermore provide a better understanding of the pathophysiology of cognitive and motor disturbances in elderly with SVD. When proven, these changes might function as a surrogate endpoint for cognitive and motor function in future therapeutic trials. ![]() The follow up of the RUN DMC study has the potential to further unravel the causes and possibly better predict the consequences of changes in white matter integrity in elderly with SVD by using relatively new imaging techniques. ![]() ![]() Participants alive will be included and invited to the research centre to undergo a structured questionnaire on demographics and vascular risk factors, and a cognitive, and motor, assessment, followed by a MRI protocol including conventional MRI, DTI and resting state fMRI. First follow up is being prepared for July 2011. The RUN DMC study is a prospective cohort study on the risk factors and cognitive and motor consequences of brain changes among 503 non-demented elderly, aged between 50-85 years, with cerebral SVD. The association between SVD, its microstructural integrity, and incident dementia and parkinsonism has never been investigated. Diffusion tensor imaging (DTI) provides alternative information on microstructural white matter integrity. Both cannot be properly appreciated with conventional MRI. This might be explained by the diversity of underlying pathology of both white matter lesions (WML) and the normal appearing white matter (NAWM). In general, the relations are weak, and not all subjects with SVD become demented or get parkinsonism. Cerebral small vessel disease (SVD) is a frequent finding on CT and MRI scans of elderly people and is related to vascular risk factors and cognitive and motor impairment, ultimately leading to dementia or parkinsonism in some.
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