Cerebral small vessel disease and cognition in older adults across the neurodegenerative spectrum: insights from the COMPASS-ND study

Abstract

Introduction: Imaging-based cerebral small vessel disease (CSVD) summary scores quantify CSVD burden. This study characterized CSVD scores and assessed their cognitive associations in older adults with various neurodegenerative diseases and cognitive profiles.

Methods: Baseline data from 958 Comprehensive Assessment of Neurodegeneration and Dementia (COMPASS-ND) study participants were analyzed (19.4% cognitively normal, 14.9% subjective cognitive decline, 40.3% mild cognitive impairment, 25.4% dementia). MRI markers of cerebral vascular injury (lacunes, microbleeds, white matter hyperintensities [WMHs], and enlarged perivascular spaces) were visually rated, and a cumulative CSVD score was generated. Cognition was measured using the Montreal Cognitive Assessment (MoCA), Clinical Dementia Rating-Sum of Boxes (CDR-SB), and a composite neuropsychological battery test z-score.

Results: Higher CSVD scores were associated with greater Hachinski ischemic scores, poorer MoCA performance, worse CDR-SB, and lower composite z-scores. Associations were strongest for cognitive domains of executive function, attention, and learning.

Discussion: CSVD burden may further contribute to poorer cognition across neurodegenerative conditions and cognitive profiles.

Plain Language Summary

The question we studied: We wanted to understand how damage to the brain’s small blood vessels affects thinking and
memory in older adults.

How we studied it: We investigated brain imaging and cognitive test results from 958 older adults enrolled in COMPASS-ND.

What we found: Our findings showed that people with more damage to the small blood vessels in their brain performed worse on the cognitive tests. People with more small vessel damage specifically had poorer attention, processing speed, and learning. The type of damage that seemed to affect cognition the most were those that affected the connections brain cells use to communicate with each other.

Why it matters: These results matter because damage to small blood vessels in the brain is common, and potentially preventable through healthy lifestyles. With this knowledge clinicians can better identify at-risk individuals. It may also guide future research aimed at slowing cognitive decline through improved vascular health.