Multimodal MRI markers of white matter hyperintensities and their impact on cognition in cerebral small vessel disease: a systematic review.
Babina Aryal, Saikiran Pendem, Priya P S et al.
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In 30 seconds
This systematic review examined associations between multimodal MRI markers of white matter hyperintensities (WMH) and cognition in adults with cerebral small vessel disease. It included 15 studies with 5752 participants, synthesizing findings narratively across conventional and advanced MRI techniques. Greater WMH burden and disease severity were associated with poorer cognition, especially processing speed and global cognition; one conventional MRI study reported β = -0.371 (p < 0.001). Advanced imaging markers of white matter microstructural and microvascular damage and reduced blood flow were also associated with poorer cognitive performance. The authors call for larger, standardized studies to establish clinical value.
Key findings
- Greater WMH burden and CSVD severity were associated with poorer processing speed and global cognition; one study reported β = -0.371 (p < 0.001).
- Advanced MRI markers of white matter microstructural and microvascular damage and reduced blood flow were associated with poorer cognitive performance.
- One study reported predictive accuracy of AUC = 0.800, 95% CI: 0.710-0.891; advanced MRI studies reported diagnostic accuracy of AUC = 0.86-0.89.
Why it matters
The review links conventional WMH burden and advanced measures of white matter integrity and perfusion with cognitive performance in CSVD. These imaging features may help characterize the relationship between vascular brain injury and cognitive impairment, but the evidence does not yet establish them as reliable tools for early detection or monitoring.
What to keep in mind
The review synthesized findings narratively across 15 studies using varied MRI techniques and cognitive assessments; the authors state that larger, standardized studies are needed to determine clinical value.