Background: Cerebral Small Vessel Disease (SVD); lacunes, Cerebral Microbleeds (CMBs), and White Matter Hyperintensities (WMH) have a vital role in cognitive impairment and dementia. SVD in lobar location is related to cerebral amyloid angiopathy, whereas SVD in a deep location with hypertensive arteriopathy. It remains unclear how different locations of SVD affect long-term cognitive decline. The present study aimed to analyse the association between different locations and severity of SVD with global and domain-specific cognitive decline over the follow-up interval of 3 years.

Methods: We studied 428 participants who had performed MRI scans at baseline and at least 3 neuropsychological assessments. Locations of lacunes and CMBs were categorized into strictly lobar, strictly deep and mixed-location, WMH volume into anterior and posterior. The National Institute of Neurological Disorders and Stroke-Canadian Stroke Network Harmonization Neuropsychological Battery was used to assess cognitive function. To analyse the association between baseline location and severity of SVD with cognitive decline, linear regression models with generalized estimated equations were constructed to calculate the mean difference, 95% confidence interval and two-way interaction factor between time and SVD.

Results: Increased numbers of baseline CMBs were associated with a decline in global cognition as well as a decline in executive function and memory domains. Location-specific analysis showed similar results with strictly lobar CMBs. There was no association with strictly deep and mixed-location CMBs with cognitive decline. Baseline WMH volume was associated with a decline in global cognition, executive function and memory. Similar results were obtained with anterior and posterior WMH volumes. Lacunes and their locations were not associated with cognitive decline.

Conclusion: Strictly lobar CMBs, as well as WMH volume in anterior and posterior regions, were associated with cognitive decline. Future research focuses are warranted to evaluate interventions that may prevent cognitive decline related to SVD.

背景：脑小血管病（SVD）；腔隙、脑微出血 (CMB) 和白质高信号 (WMH) 在认知障碍和痴呆症中起着至关重要的作用。大叶部位的 SVD 与脑淀粉样血管病有关，而深部部位的 SVD 与高血压动脉病变有关。目前尚不清楚 SVD 的不同位置如何影响长期认知能力下降。本研究旨在分析 SVD 的不同位置和严重程度与 3 年随访间隔内整体和特定领域认知能力下降之间的关联。

方法：我们研究了 428 名在基线时进行了 MRI 扫描和至少 3 次神经心理学评估的参与者。腔隙和CMB的位置分为严格叶状、严格深部和混合位置，WMH体积分为前部和后部。国家神经疾病和中风研究所 - 加拿大中风网络协调神经心理学电池用于评估认知功能。为了分析基线位置和SVD严重程度与认知能力下降之间的关系，构建了具有广义估计方程的线性回归模型来计算时间与SVD之间的平均差、95%置信区间和双向交互因子。

结果：基线 CMB 数量的增加与全球认知能力的下降以及执行功能和记忆域的下降有关。特定位置的分析显示了与严格叶状 CMB 类似的结果。严格的深度和混合位置的 CMB 与认知能力下降没有关联。基线 WMH 量与全球认知、执行功能和记忆力下降有关。前部和后部 WMH 体积获得了类似的结果。腔隙及其位置与认知能力下降无关。

结论：严格的大叶 CMB 以及前部和后部区域的 WMH 体积与认知能力下降有关。未来的研究重点是评估可能预防与 SVD 相关的认知能力下降的干预措施。