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MRI technique predicts 5-year dementia risk in cerebral small vessel disease
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Using diffusion tensor imaging segmentation, an advanced MRI brain scan analysis, researchers were able to assess microstructural brain damage to predict dementia in patients with cerebral small vessel disease and lacunar strokes.
According to the study published in Stroke, the diffusion tensor imaging segmentation (DSEG) technique, acting as a marker of cerebral small vessel disease (SVD) severity, is sensitive enough to distinguish from a single imaging modality whether an individual will develop dementia within a 5-year period, according to the study.
“Following a group of patients with SVD over 5 years, we predicted who would develop difficulties with executive functions (planning, organizing information and flexible thinking) or go on to develop vascular dementia,” Rebecca A. Charlton, PhD, of the department of psychology at Goldsmiths, University of London, told Healio. “We know that vascular disease can impact the brain, and through accumulated damage affect cognitive function. This research shows that existing damage in the brain and additional damage over time lead to specific problems in executive functions; memory abilities were spared.”
The researchers found that dementia risk increased according to baseline DSEG- (HR = 3.331; 95% CI, 2.076-5.343) and change in DSEG- (HR = 3.905; P < .001).
Furthermore, DSEG in patients with SVD and lacunar strokes was significantly related to cognitive decline (P < .001), with a balanced classification rate of 75.95% (area under the curve, 0.839).
“A key concern for patients is the long-term trajectory of their illness. This is particularly true when cognitive abilities are at risk of decline,” Charlton said. “While this research is not yet ready for use in clinical practice, it shows promise that it may be possible to predict individual trajectories. Such individualized healthcare will allow for early, targeted treatment to slow disease progression.”
Researchers analyzed 99 patients with SVD (mean age, 68 years; 66% men) who underwent annual DSEG for 3 years and cognitive assessment for 5 years, using DSEG- as a measure of SVD severity. Additionally, a Cox regression identified which DSEG measures and vascular risk factors were associated with an increased risk for dementia, according to the study.
“Importantly, this new technique, DSEG, relies on just one readily available MRI scan. Previous research predicting cognitive decline and dementia generally use several scans and/or several different clinical tests. By using just one scan, the patient can spend less time in the MRI scanner, and the results are equally accurate.” – by Scott Buzby
Disclosures: Charlton reports no relevant financial disclosures.
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Williams OA, et al. Stroke. 2019;doi:10.1161/STROKEAHA.119.025843.
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