Cerebral small vessel disease (CSVD) is a common disease among elderly individuals and recognized as a major cause of vascular cognitive impairment. Recent studies demonstrated that CSVD is a disconnection syndrome. However, due to the covert neurological symptoms and subtle changes in clinical performance, the connection alterations during the stage of preclinical cognitive impairment (PCI) and mild cognitive impairment (MCI) are usually neglected and still largely unknown. Using diffusion tensor imaging (DTI), we investigated the early structural network changes in PCI and MCI patients. The PCI group demonstrated well preserved rich-club organization, less nodal strength loss, and disruption of connections centered in the feeder and local connections. Nevertheless, the MCI group manifested a disruption in the rich-club organization, a worse nodal strength loss especially in hub nodes, and an overall disturbance in rich-club, feeder and local connections. Moreover, in all CSVD patients, the strength of the rich-club, feeder and local connections was significantly correlated with multiple cognitive scores, especially in attention, executive, and memory domains; while in MCI patients, only the strength of the rich-club connections was significantly correlated with cognition. Furthermore, based on the network-based statistic analysis, we also identified distinct network component disruption pattern between the PCI group and the MCI group, validating the results described above. These results suggest a disruption pattern from peripheral to central connections with the change of cognitive status, shedding light on the early identification and the underlying disruption of CSVD.

脑小血管疾病（CSVD）是老年人中的常见疾病，被认为是血管性认知障碍的主要原因。最近的研究表明，CSVD是一种断开连接综合征。但是，由于隐秘的神经系统症状和临床表现的细微变化，临床前认知障碍（PCI）和轻度认知障碍（MCI）阶段的连接改变通常被忽略，并且在很大程度上仍然未知。使用扩散张量成像（DTI），我们调查了PCI和MCI患者的早期结构网络变化。PCI小组展示了保存良好的富人俱乐部组织，节点强度损失少，并且以馈线和本地连接为中心的连接中断。不过，MCI小组在富人俱乐部组织中表现出了瓦解，特别是在集线器节点中，节点强度损失更严重，并且富杆，馈线和本地连接整体受到干扰。此外，在所有CSVD患者中，富人俱乐部，支线和本地联系的强度与多个认知得分显着相关，尤其是在注意力，执行力和记忆力方面。而在MCI患者中，只有丰富俱乐部联系的强度与认知显着相关。此外，基于基于网络的统计分析，我们还确定了PCI组和MCI组之间不同的网络组件破坏模式，从而验证了上述结果。这些结果表明，随着认知状态的改变，从外围连接到中心连接的中断模式，为早期识别和CSVD的潜在中断提供了亮点。