2025
The cross-sectional associations between enlarged perivascular spaces and mild behavioral impairment in dementia-free older adults
Authors:
Mudalige, D., Guan, D. X., McLeod, G. A., Smith, E. E., Ganesh, A., & Ismail, Z.
Journal:
Journal of Alzheimer's Disease
Abstract
Background: Enlarged perivascular spaces (EPVS) and mild behavioral impairment (MBI) are associated with greater dementia risk.
Objective: We investigated cross-sectional associations between EPVS burden and MBI presence and symptom severity.
Methods: Participants were dementia-free older adults in the Comprehensive Assessment of Neurodegeneration and Dementia (COMPASS-ND) study. EPVS were assessed using a validated visual rating scale applied to T2-weighted magnetic resonance imaging. MBI was measured using the informant-reported MBI Checklist (MBI-C) with a cut-point of >5 for MBI presence. Multivariable logistic and zero-inflated negative binomial regressions modelled EPVS associations with MBI presence and symptom severity, respectively, adjusting for age, education, Montreal Cognitive Assessment score, and presence of hypertension with an EPVS*sex interaction term.
Results: Among 363 participants (52.9% female), every 1-point rise in total EPVS score was associated with 1.28-fold greater odds of having MBI (95%CI:1.06–1.53, p = 0.009). When examining regional EPVS burden, those with higher centrum semiovale scores had greater odds of MBI (aOR = 1.47, 95%CI:1.08–2.00, p = 0.01), but this association was not significant for the basal ganglia (aOR = 1.37, 95%CI:0.95–1.97, p = 0.09) or midbrain (aOR = 1.49, 95%CI:0.80–2.79, p = 0.21). Total and regional EPVS scores were not associated with MBI symptom severity. None of the associations were moderated by sex.
Conclusions: Older adults with greater global and centrum semiovale EPVS burden are more likely to have MBI. These findings suggest that early microvascular pathology may contribute to later-life emergent and persistent behavioral symptoms, although longitudinal data are required, along with other indicators of vascular pathology.
Plain Language Summary
There are fluid-filled spaces surrounding the blood vessels in the brain called perivascular spaces. These spaces can become larger due to diseases that affect the heart and vessels that provide blood to the brain, such as high blood pressure, and this has been linked to a higher risk of dementia. However, there may be warning signs that someone has enlarged perivascular spaces, even before dementia. We investigated whether older adults with enlarged perivascular spaces tended to show persistent changes in behaviour and/or personality, known as mild behavioral impairment, which could serve as early signs for enlarged perivascular spaces and future dementia.
To address this research question, we used data from the COMPASS-ND study, in which older adults from around the country underwent brain imaging and assessments of mild behavioral impairment. We found that older adults with a greater number of enlarged perivascular spaces were more likely to have mild behavioural impairment.
These findings mean that enlarged perivascular spaces might contribute to persistent behavioural and/or personality changes at older ages. Doctors and researchers may be able to look for these changes in behaviour as an indicator of vascular brain health and a higher risk of dementia.
Share
Receive the
latest news
Stay updated with the latest research developments from CCNA-CCNV. Our news section provides insights into cutting-edge studies, advancements in dementia care, and key findings in brain health research.
