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Cognitive evaluation in cerebral small vessel disease: towards an evidence-based identification of the reference standards. Part 1. A systematic review and qualitative data synthesis

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Abstract

Background

Cerebral small vessel disease (cSVD) is a leading cause of cognitive impairment in the elderly. Despite cSVD cognitive profile is thought to be mainly characterized by attention and executive functions deficits, there is no definite agreement on the standards for its evaluation. This systematic review aims at identifying cognitive domains and neuropsychological tools specifically chosen in the assessment of cognitive impairment related to cSVD, and the temporal and geographic trends in their utilization.

Methods

Following PRISMA guidelines, original articles focused on cSVD patient samples neuropsychologically evaluated were searched using PubMed, Scopus and PsycINFO databases without language or time restrictions (PROSPERO registration number CRD42018089882; date 27-02-2018).

Results

We screened 13,688 studies and included 298 in the qualitative data synthesis. Global cognitive functioning and attention/executive functions were the most evaluated domains (87% and 69%, respectively). Mini Mental State Examination was the most used screening tool (73%), followed by MoCA (14%) whose utilization rapidly increased over the last years. The most frequently used second level tests were phonemic and semantic fluencies (39% and 30%, respectively), Trail Making Test (TMT) part A and B (31% and 32%, respectively), Stroop (31.5%), and Boston naming (30%). All tests resulted stably utilized over time, except for semantic fluency and Stroop whose use increased. Phonemic fluency and Boston naming were the most used in North America (51% and 45%, respectively), TMT in Europe (43%), and Stroop and semantic fluency in Asia (43% and 40%, respectively).

Conclusions

This systematic review confirms that attention/executive functions domain is the most commonly evaluated in cSVD together with lexical retrieval abilities based on executive control processes. Temporal and geographic variability emerged in the choice of tests.

PROSPERO registration number

CRD42018089882 (27-02-2018).

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Availability of data and materials

The data that support the findings of this study are available on request from the corresponding author.

References

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. IRCCS Fondazione Don Carlo Gnocchi, Via di Scandicci, 269, 50143, Florence, Italy

    Emilia Salvadori

  2. Neurology Unit, Luigi Sacco University Hospital, Milan, Italy

    Michela Brambilla, Ilaria Cova & Simone Pomati

  3. Stroke and Dementia Lab, ‘Luigi Sacco’ Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy

    Leonardo Pantoni

Authors
  1. Emilia Salvadori
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  2. Michela Brambilla
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  3. Ilaria Cova
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  4. Simone Pomati
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  5. Leonardo Pantoni
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by ES, MB and IC. The first draft of the manuscript was written by ES, MB and LP and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Emilia Salvadori.

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The authors declare that they have no conflict of interest.

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Salvadori, E., Brambilla, M., Cova, I. et al. Cognitive evaluation in cerebral small vessel disease: towards an evidence-based identification of the reference standards. Part 1. A systematic review and qualitative data synthesis. J Neurol 268, 4563–4572 (2021). https://doi.org/10.1007/s00415-020-10262-2

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  • DOI: https://doi.org/10.1007/s00415-020-10262-2

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