title: Enlarged perivascular spaces and cognitive impairment after stroke and transient ischemic attack.
abstract: Background Previous studies suggested that enlarged perivascular spaces are neuroimaging markers of cerebral small vessel disease. However, it is not clear whether enlarged perivascular spaces are associated with cognitive impairment. We aimed to determine the cross-sectional relationship between enlarged perivascular spaces and small vessel disease, and to investigate the relationship between enlarged perivascular spaces and subsequent cognitive impairment in patients with recent cerebral ischemic event. Methods Anonymized data were accessed from the virtual international stroke trial archive. We rated number of lacunes, white matter hyperintensities, brain atrophy, and enlarged perivascular spaces with validated scales on magnetic resonance brain images after the index stroke. We defined cognitive impairment as a mini mental state examination score of ≤26, recorded at one year post stroke. We examined the associations between enlarged perivascular spaces and clinical and imaging markers of small vessel disease at presentation and clinical evidence of cognitive impairment at one year using linear and logistic regression models. Results We analyzed data on 430 patients with mean (±SD) age 64.7 (±12.7) years, 276 (64%) males. In linear regression analysis, age (β = 0.24; p < 0.001), hypertension (β = 0.09; p = 0.025), and deep white matter hyperintensities (β = 0.31; p < 0.001) were associated with enlarged perivascular spaces. In logistic regression analysis, basal ganglia enlarged perivascular spaces were independently associated with cognitive impairment at one year after adjusting for clinical confounders (OR = 1.72, 95% CI = 1.22-2.42) and for clinical and imaging confounders (OR = 1.54; 95% CI = 1.03-2.31). Conclusions Our data show that in patients with ischemic cerebral events, enlarged perivascular spaces are cross-sectionally associated with age, hypertension, and white matter hyperintensities and suggest that enlarged perivascular spaces in the basal ganglia are associated with cognitive impairment after one year.
authors.affiliation: 1 Neurofarba Department, University of Florence, Florence, Italy.|2 Institute of Cardiovascular and Medical Sciences, Queen Elizabeth University Hospital Glasgow, Glasgow, UK.
authors.forename: Francesco
authors.initials: F
authors.lastname: Arba
authors.affiliation: 3 Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.
authors.forename: Terence J
authors.initials: TJ
authors.lastname: Quinn
authors.affiliation: 4 School of Medicine and Pharmacology, University of Western Australia, Harry Perkins Institute of Medical Research, QEII Medical Centre, Perth, Australia.
authors.forename: Graeme J
authors.initials: GJ
authors.lastname: Hankey
authors.affiliation: 5 Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, UK.
authors.forename: Kennedy R
authors.initials: KR
authors.lastname: Lees
authors.affiliation: 6 Division of Neuroimaging Sciences (J.M.W.), University of Edinburgh, Edinburgh, UK.
authors.forename: Joanna M
authors.initials: JM
authors.lastname: Wardlaw
authors.affiliation: 2 Institute of Cardiovascular and Medical Sciences, Queen Elizabeth University Hospital Glasgow, Glasgow, UK.
authors.forename: Myzoon
authors.initials: M
authors.lastname: Ali
authors.affiliation: 1 Neurofarba Department, University of Florence, Florence, Italy.
authors.forename: Domenico
authors.initials: D
authors.lastname: Inzitari
mesh_terms: D000368:Aged; D001479:Basal Ganglia / Q000000981:diagnostic imaging* / Q000473:pathology; D060825:Cognitive Dysfunction / Q000150:complications / Q000473:pathology*; D003430:Cross-Sectional Studies; D005110:Extracellular Space / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D002546:Ischemic Attack, Transient / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D059906:Neuroimaging; D020521:Stroke / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology*
keywords: Perivascular spaces; cognitive impairment; small vessel disease; stroke; transient ischemic attack