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Focus on SVD markers needed to delay cognitive decline, cerebrovascular disease

02 Aug 2017

A high burden of small vessel disease (SVD) is common among elderly Asians, which makes them susceptible to cognitive dysfunction, according to a recent study.

Researchers conducted clinical, cognitive and 3-Tesla brain magnetic resonance imaging assessments among participants of three studies from Singapore, Hong Kong and Korea to determine the prevalence, risk factors and consequences of SVD. Markers of SVD include white matter hyperintensities (WMHs) using the modified Fazekas scale, lacunes and microbleeds.

The Mini Mental Status Examinations (MMSE) and Montreal Cognitive Assessment (MoCA) were used to assess cognition. Adjustments were made for age, sex and cardiovascular risk factors.

Overall, 1,797 participants (mean age 70.1 years; 57 percent women) were available for analysis. The prevalence of confluent WMH, lacunes and microbleeds were 36.6, 24.6 and 26.9 percent, respectively.

The presence of all three SVD markers demonstrated a steeper rise with increasing age rising from 1.9 percent in the lowest to 46.2 percent in the highest 5-year age strata. Hypertension and advancing age were the major risk factors for the increased severity of SVD markers.

In addition, there was an independent association between increasing severity of SVD markers and worse performance on MMSE and MoCA.

“This suggests that SVD markers should be a potential target for treatment in clinical trials so as to delay progression of cerebrovascular disease and potentially cognitive decline,” researchers said.

In another study, researchers found that the rise of ambulatory systolic blood pressure, pulse pressure and the decline of blood pressure may predict cognitive impairment in patients with cerebral SVD. Thus, improving blood pressure management may help lower the incidence of cognitive impairment caused by SVD. [Eur Rev Med Pharmacol Sci 2017 Jul;21(3 Suppl):52-56.]

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