Cerebral small vessel disease (SVD) is an important cause of cognitive impairment. Important MRI manifestations of SVD include white matter hyperintensities (WMH) and lacunes. This narrative review addresses the role of anatomical lesion location in the impact of SVD on cognition, integrating findings from early autopsy studies with emerging findings from recent studies with advanced image analysis techniques. Early autopsy and imaging studies of small case series indicate that single lacunar infarcts in, for example the thalamus, caudate nucleus or internal capsule can cause marked cognitive impairment. However, the findings of such case studies may not be generalizable. Emerging location-based image analysis approaches are now being applied to large cohorts. Recent studies show that WMH burden in strategic white matter tracts, such as the forceps minor or anterior thalamic radiation (ATR), is more relevant in explaining variance in cognitive functioning than global WMH volume. These findings suggest that the future diagnostic work-up of memory clinic patients could potentially be improved by shifting from a global assessment of WMH and lacune burden towards a quantitative assessment of lesion volumes within strategic brain regions. In this review, a summary of currently known strategic regions for SVD-related cognitive impairment is provided, highlighting recent technical developments in SVD research. The potential and challenges of location-based approaches for diagnostic purposes in clinical practice are discussed, along with their potential prognostic and therapeutic applications.
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April 2017
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An MRI angiogram of the brain vasculature (arteries). Articles in the area of small vessels, dementia and chronic diseases published in Clinical Science throughout 2017 are being gathered together as a collection that can be viewed at http://www.portlandpresspublishing.com/cc/small-vessels.
Review Article|
April 06 2017
Lesion location and cognitive impact of cerebral small vessel disease
J. Matthijs Biesbroek;
1Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, Netherlands
Correspondence: J.M. Biesbroek ([email protected] or [email protected])
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Nick A. Weaver;
Nick A. Weaver
1Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, Netherlands
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Geert Jan Biessels
Geert Jan Biessels
1Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, Netherlands
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Publisher: Portland Press Ltd
Received:
November 11 2016
Revision Received:
January 17 2017
Accepted:
January 20 2017
Online ISSN: 1470-8736
Print ISSN: 0143-5221
© 2017 The Author(s). published by Portland Press Limited on behalf of the Biochemical Society
2017
Clin Sci (Lond) (2017) 131 (8): 715–728.
Article history
Received:
November 11 2016
Revision Received:
January 17 2017
Accepted:
January 20 2017
Connected Content
This is a commentary on:
Diagnosis in vascular dementia, applying ‘Cochrane diagnosis rules’ to ‘dementia diagnostic tools’
Citation
J. Matthijs Biesbroek, Nick A. Weaver, Geert Jan Biessels; Lesion location and cognitive impact of cerebral small vessel disease. Clin Sci (Lond) 25 April 2017; 131 (8): 715–728. doi: https://doi.org/10.1042/CS20160452
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