Association between serum uric acid levels and cerebral white matter lesions in Chinese individuals

Purpose/aim of the study: We aimed to evaluate the association between serum uric acid (SUA) levels and cerebral white matter lesions (WMLs) in Chinese individuals. Material and methods: We prospectively identified patients aged 50 years and older in neurology department from July 2014 to March 2015. Both periventricular WMLs (P-WMLs) and deep WMLs (D-WMLs) were identified on magnetic resonance imanging (MRI) scans and the severity was graded using the Fazekas method. Multivariate logistic regression analyses were performed to examine the association between SUA and WMLs. Results: A total of 480 eligible participants were enrolled in this study. SUA level in severe group was much higher than that in mild group (for P-WMLs: 320.21 ± 79.97 vs. 286.29 ± 70.18, p = 0.000; for D-WMLs: 314.71 ± 74.74 vs. 290.07 ± 74.04, p = 0.031). Subgroup analyses showed that higher SUA level was associated with higher severity of P-WMLs in women, but not in male patients. Multivariate logistic regression analyses showed that SUA was still associated with increased risk of higher severity of P-WMLs (OR = 1.003, 95% = 1.000–1.006), but not D-WMLs. Conclusion: Elevated SUA level was independently associated with greater odds of higher severity of P-WMLs, particularly in women.     

Superficial white matter microstructure affects processing speed in cerebral small vessel disease

White matter hyperintensities (WMH) are a typical feature of cerebral small vessel disease (CSVD), which contributes to about 50% of dementias worldwide. Microstructural alterations in deep white matter (DWM) have been widely examined in CSVD. However, little is known about abnormalities in superficial white matter (SWM) and their relevance for processing speed, the main cognitive deficit in CSVD. In 141 CSVD patients, processing speed was assessed using Trail Making Test Part A. White matter abnormalities were assessed by WMH burden (volume on T2‐FLAIR) and diffusion MRI measures. SWM imaging measures had a large contribution to processing speed, despite a relatively low SWM WMH burden. Across all imaging measures, SWM free water (FW) had the strongest association with processing speed, followed by SWM mean diffusivity (MD). SWM FW was the only marker to significantly increase between two subgroups with the lowest WMH burdens. When comparing two subgroups with the highest WMH burdens, the involvement of WMH in the SWM was accompanied by significant differences in processing speed and white matter microstructure. Mediation analysis revealed that SWM FW fully mediated the association between WMH volume and processing speed, while no mediation effect of MD or DWM FW was observed. Overall, results suggest that the SWM has an important contribution to processing speed, while SWM FW is a sensitive imaging marker associated with cognition in CSVD. This study extends the current understanding of CSVD‐related dysfunction and suggests that the SWM, as an understudied region, can be a potential target for monitoring pathophysiological processes.     

T2 relaxation time of the normal-appearing white matter is related to the cognitive status in cerebral small vessel disease

Previous diffusion tensor imaging (DTI) studies indicate that impaired microstructural integrity of the normal-appearing white matter (NAWM) is related to cognitive impairment in cerebral small vessel disease (SVD). This study aimed to investigate whether quantitative T₂ relaxometry is a suitable imaging biomarker for the assessment of tissue changes related to cognitive abnormalities in patients with SVD. 39 patients and 18 age-matched healthy control subjects underwent 3 T magnetic resonance imaging (MRI) with T2-weighted multiple spin echo sequences for T₂ relaxometry and DTI sequences, as well as comprehensive cognitive assessment. Averaged quantitative T₂, fractional anisotropy (FA) and mean diffusivity (MD) were determined in the NAWM and related to cognitive parameters controlling for age, normalized brain volume, white matter hyperintensity volume and other conventional SVD markers. In SVD patients, quantitative T₂ values were significantly increased compared to controls (p = 0.002) and significantly negatively correlated with the global cognitive performance (r= –0.410, p = 0.014) and executive function (r= –0.399, p = 0.016). DTI parameters did not correlate with cognitive function. T₂ relaxometry of the NAWM seems to be sensitive to microstructural tissue damage associated with cognitive impairment in SVD and might be a promising imaging biomarker for evaluation of disease progression and possible effects of therapeutic interventions.     

Implication of heart rate variability on cerebral small vessel disease: A potential therapeutic target

Objective

This study aimed to investigate the relationships of heart rate variability (HRV) with the presence, severity, and individual neuroimaging markers of cerebral small vessel disease (CSVD).

Method

A total of 4676 participants from the Third China National Stroke Registry (CNSR-III) study were included in this cross-sectional analysis. CSVD and its markers, including white matter hyperintensity (WMH), lacunes, enlarged perivascular spaces (EPVS), cerebral microbleeds (CMBs), and brain atrophy (BA), were evaluated. Two common HRV parameters, including the square root of the mean of the sum of the squares of differences between adjacent N–N intervals (RMSSD) and the standard deviation of all N–N intervals (SDNN), were used to evaluate the function of the autonomic nervous system (ANS). Binary or ordinal logistic regression analyses were performed to investigate the association between HRV and CSVD. In addition, two-sample mendelian randomization (MR) analyses were performed to investigate the causality of HRV with CSVD.

Results

RMSSD was significantly associated with total burden of CSVD (Wardlaw's scale, common odds ratio [cOR] 0.80, 95% confidence interval [CI] 0.67–0.96, p = 0.02; Rothwell's scale, cOR 0.75, 95% CI 0.60–0.93, p = 0.008) and the presence of CSVD (Rothwell, OR 0.75, 95% CI 0.60–0.93, p = 0.008). However, no significant associations between SDNN and the presence or total burden of CSVD were observed. Moreover, RMSSD was related to WMH burden (OR 0.80, 95% CI 0.66–0.96, p = 0.02), modified WMH burden (cOR 0.82, 95% CI 0.69–0.97, p = 0.02), and Deep-WMH (OR 0.75, 95% CI 0.62–0.91, p = 0.003), while SDNN was related to Deep-WMH (OR 0.80, 95% CI 0.66–0.96, p = 0.02) and BA (cOR 0.80, 95% CI 0.68–0.95, p = 0.009). Furthermore, adding HRV to the conventional model based on vascualr risk factors enhanced the predictive performance for CSVD, as validated by the integrated discrimination index (p < 0.05). In addition, no causality between HRV and CSVD was observed in two-sample MR analyses.

Conclusion

Decreased HRV may be a potential risk factor of CSVD, implying the possible role of the ANS in the pathogenesis of CSVD.     

半自动MRI定量方法测定脑白质高信号体积与病变定性评分的相关性

背景：在磁共振T2加权像和液体衰减反转恢复像中脑白质病变表现为白质高信号,目前对脑白质高信号体积、部位与认知功能损害的关系仍存在争议。 目的：以头颅磁共振对皮质下缺血性脑血管病患者白质高信号进行定量和定性测定,分析高信号体积和部位与认知损害的关系。 设计、时间及地点：于2007-12/2008-09在河北省人民医院神经内科完成。 对象：依据影像学诊断标准确定皮质下缺血性脑血管病53例,记录症状和体征,并进行神经心理学评估。 方法：采用美国GE公司生产的半自动1.5T MRI机对患者行头MRI扫描,定量测定脑白质高信号体积,并结合脑白质病变定性评分。 主要观察指标：分析皮质下缺血性脑血管病患者脑白质高信号体积与评分的相关性,以及白质病变与认知损害的关系。 结果：脑白质高信号体积和评分高度相关（rs=0.989, P < 0.001）,两者呈曲线关系。分层多元线性回归分析显示,白质高信号体积、白质高信号总评分的变化可以分别解释简明精神状态检查评分改变的10.5%和6.8%,前者较后者能更敏感地预测简明精神状态检查评分变化。不同区域脑白质病变中,仅基底核区白质高信号评分与简明精神状态检查评分有关（t=-2.126, P=0.039）,其他各区域白质高信号评分均非简明精神状态检查评分独立预测指标。 结论：脑白质高信号体积与评分均可应用于脑白质病变的测定,前者测定较脑白质高信号评分更敏感;皮质下缺血性脑血管病患者认知功能损害随着脑白质病变的增多,尤其是基底核区白质病变的增多而加重。     

Lesion probability maps of white matter hyperintensities in elderly individuals

Objective White matter hyperintensities (WMH) are common on brain MRI of the elderly. Their size ranges from punctate to early confluent to confluent lesions. While this increase in extension is frequently seen as evidence for a continuum of changes, histological data and clinical follow-up suggest differences in underlying pathology and their progression. Methods We tested this hypothesis by exploring the distributions of punctuate and confluent lesions using lesion probability maps (LPM) generated from MRI scans of 189 participants (mean age 60.8+/−6.2 years) in the Austrian Stroke Prevention Study. We dichotomised WMH according to the classification by Fazekas et al. [punctate (n=143) vs. early confluent and confluent (n=33)] to run voxel-based t-tests using permutation-based nonparametric inference. To test alternative hypotheses, we created similar LPM for age and arterial hypertension. Results We observed significant differences in the spatial distribution of lesions for the two WMH groups (p<0.01). Punctate lesions were more diffusely distributed throughout the cerebral white matter (peak probability ∼5%) relative to confluent lesions (peak probability 45%). Confluent lesions had greatest likelihood of being found in perfusion “watershed” regions. These differences in distribution could not be explained by differences in age or hypertension only, as both greater age and the diagnosis of hypertension were associated with WMH abutting the occipital horns. Conclusions Punctate and early confluent to confluent WMH show distinguishable differences in their spatial distribution within a normal elderly population. The pattern of punctate WMH is probably a consequence of mixed etiologies. Preferential localization of the more confluent WMH with arterial watershed areas implies a stronger ischemic component in their development. Received in revised form: 31 October 2005     

Cerebral small vessel disease affects white matter microstructure in mild cognitive impairment

Microstructural white matter deterioration is a frequent finding in mild cognitive impairment (MCI), potentially underlying default mode network (DMN) dysfunctioning. Thus far, microstructural damage in MCI has been attributed to Alzheimer's disease pathophysiology. A cerebrovascular role, in particular the role of cerebral small vessel disease (CSVD), received less interest. Here, we used diffusion tensor imaging (DTI) to examine the role of CSVD in microstructural deterioration within the normal appearing white matter (NAWM) in MCI. MCI patients were subdivided into those with (n = 20) and without (n = 31) macrostructural CSVD evidence on MRI. Using TBSS we performed microstructural integrity comparisons within the whole brain NAWM. Secondly, we segmented white matter tracts interconnecting DMN brain regions by means of automated tractography segmentation. We used NAWM DTI measures from these tracts as dependent variables in a stepwise‐linear regression analysis, with structural and demographical predictors. Our results indicated microstructural deterioration within the anterior corpus callosum, internal and external capsule and periventricular white matter in MCI patients with CSVD, while in MCI patients without CSVD, deterioration was restricted to the right perforant path, a tract along the hippocampus. Within the full cohort of MCI patients, microstructure within the NAWM of the DMN fiber tracts was affected by the presence of CSVD. Within the cingulum along the hippocampal cortex we found a relationship between microstructural integrity and ipsilateral hippocampal volume and the extent of white matter hyperintensity. In conclusion, we found evidence of CSVD‐related microstructural damage in fiber tracts subserving the DMN in MCI. Hum Brain Mapp 35:2836–2851, 2014. © 2013 Wiley Periodicals, Inc .     

Memory decline in elderly with cerebral small vessel disease explained by temporal interactions between white matter hyperintensities and hippocampal atrophy

White matter hyperintensities (WMH) constitute the visible spectrum of cerebral small vessel disease (SVD) markers and are associated with cognitive decline, although they do not fully account for memory decline observed in individuals with SVD. We hypothesize that WMH might exert their effect on memory decline indirectly by affecting remote brain structures such as the hippocampus. We investigated the temporal interactions between WMH, hippocampal atrophy and memory decline in older adults with SVD. Five hundred and three participants of the RUNDMC study underwent neuroimaging and cognitive assessments up to 3 times over 8.7 years. We assessed WMH volumes semi‐automatically and calculated hippocampal volumes (HV) using FreeSurfer. We used linear mixed effects models and causal mediation analyses to assess both interaction and mediation effects of hippocampal atrophy in the associations between WMH and memory decline, separately for working memory (WM) and episodic memory (EM). Linear mixed effect models revealed that the interaction between WMH and hippocampal volumes explained memory decline (WM: β = .067; 95%CI[.024–0.111]; p < .01; EM: β = .061; 95%CI[.025–.098]; p < .01), with better model fit when the WMH*HV interaction term was added to the model, for both WM (likelihood ratio test, χ²[1] = 9.3, p < .01) and for EM (likelihood ratio test, χ²[1] = 10.7, p < .01). Mediation models showed that both baseline WMH volume (β = ?.170; p = .001) and hippocampal atrophy (β = 0.126; p = .009) were independently related to EM decline, but the effect of baseline WMH on EM decline was not mediated by hippocampal atrophy (p value indirect effect: 0.572). Memory decline in elderly with SVD was best explained by the interaction of WMH and hippocampal volumes. The relationship between WMH and memory was not causally mediated by hippocampal atrophy, suggesting that memory decline during aging is a heterogeneous condition in which different pathologies contribute to the memory decline observed in elderly with SVD.     

同型半胱氨酸与脑小血管病的相关性研究

目的探讨血浆同型半胱氨酸(Hcy)水平与脑小血管病(SVD)的相关性。方法回顾性分析218例脑SVD患者的临床资料,并根据诊断将其分为无症状脑梗死组(SBI,56例),脑白质疏松组(LA,143例),颅外段动脉硬化组(EC,28例),颅内段动脉硬化组(IC,31例)。测定所有患者的血浆Hcy水平,分析其对脑SVD发病的影响。结果脑SVD患者以老年女性居多,高血压、糖尿病比例高,且尿酸、Hcy、CRP水平也普遍升高。单因素logistic分析显示,血浆Hcy均是SBI、LA、EC、IC发生的危险因素,而多因素logistic回归分析显示,血浆Hcy是SBI(OR:3.47,95%CI:1.76⁴.65)、LA(OR:2.98,95%CI:1.484.65)、LA(OR:2.98,95%CI:1.48⁵.64)的独立危险因素(P<0.05),而血浆Hcy与EC、IC无明显相关性(P>0.05)。LA患者中随着Fazekas分级的增加,血浆Hcy水平依次升高(P<0.05)。结论血浆Hcy与脑SVD,尤其是SBI、LA具有相关性,是脑SVD发病的独立危险因素,但与脑大血管病变(EC、IC)之间的关系不明显。     

Intracranial vessel wall lesions on 7T MRI and MRI features of cerebral small vessel disease: The SMART-MR study

The etiology of cerebral small vessel disease (CSVD) is the subject of ongoing research. Although intracranial atherosclerosis (ICAS) has been proposed as a possible cause, studies on their relationship remain sparse. We used 7 T vessel wall magnetic resonance imaging (MRI) to study the association between intracranial vessel wall lesions—a neuroimaging marker of ICAS—and MRI features of CSVD. Within the SMART-MR study, cross-sectional analyses were performed in 130 patients (68 ± 9 years; 88% male). ICAS burden—defined as the number of vessel wall lesions—was determined on 7 T vessel wall MRI. CSVD features were determined on 1.5 T and 7 T MRI. Associations between ICAS burden and CSVD features were estimated with linear or modified Poisson regression, adjusted for age, sex, vascular risk factors, and medication use. In 125 patients, ≥1 vessel wall lesions were found (mean 8.5 ± 5.7 lesions). ICAS burden (per + 1 SD) was associated with presence of large subcortical and/or cortical infarcts (RR = 1.65; 95%CI: 1.12–2.43), lacunes (RR = 1.45; 95% CI: 1.14–1.86), cortical microinfarcts (RR = 1.48; 95%CI: 1.13–1.94), and total white matter hyperintensity volume (b = 0.24; 95%CI: 0.02–0.46). Concluding, patients with a higher ICAS burden had more CSVD features, although no evidence of co-location was observed. Further longitudinal studies are required to determine if ICAS precedes development of CSVD.     

Visual hallucinations, white matter lesions and disease severity in Parkinson's disease

OBJECTIVES: To determine if visual hallucinations in patients with Parkinson's disease are associated with an increased prevalence of white matter lesions. PATIENTS AND METHODS: Fifteen patients with (group 1) and 15 patients without (group 2) a history of visual hallucinations were studied. Both groups were matched for age. Magnetic resonance imaging was performed in all patients using standard T2 weighted Fast-Spin-Echo sequences. Assessment of cerebral white matter changes was performed using a modification of established criteria, with semiquantitative evaluation of periventricular and deep white matter changes. RESULTS: There was no significant group difference with regard to the total amount of white matter changes, nor was a group difference found between the amount or extent of periventricular hyperintensities or deep white matter lesions. Group 1 was significantly (P = 0.001) more disabled as evaluated by Hoehn/Yahr stage controlling for age and duration of disease. Mean increases in Hoehn/Yahr stage were not significantly greater in group 1 compared with group 2 at a 2-year follow-up examination (0.6 vs. 0.3, P = 0.166). CONCLUSION: Our data suggest that visual hallucinations are an indicator of a more aggressive course of the disease, but are not associated with a higher prevalence of global or occipital white matter lesions.     

25-Hydroxy vitamin D level is associated with total MRI burden of cerebral small vessel disease in ischemic stroke patients

Background: Decreased 25-hydroxyvitamin D [25(OH)D] has been reported to be related to increased risk of cerebrovascular disease. We aimed to investigate whether an association exists between 25(OH)D levels and cerebral small vessel disease (cSVD).

Method: Patients with first-ever minor ischemic stroke or transient ischemic attack were recruited prospectively during Jan 2017 to December 2017. Serum 25(OH)D levels were measured at admission in all patients. Magnetic resonance imaging (MRI) was performed to determine the presence of cSVD, including silent lacunar infarcts (SLIs), white matter lesions (WMLs), cerebral microbleeds (CMBs), and enlarged perivascular spaces (EPVs). The severity of cSVD was evaluated by total MRI cSVD burden, an ordinal score from 0 to 4. The association between the baseline 25(OH)D level and cSVD was analyzed by multiple logistic regression models.

Results: Of 234 patients included, the median 25(OH)D level was 39.2?nmol/L. The proportions of patients with 0 to 4 cSVD features were 8.5%, 29.1%, 42.3%, 16.2%, and 3.8%, respectively. After adjusting for potential confounders, multiple logistic regression analysis demonstrated that patients with 25(OH)D level in its first quartile, compared with those in its fourth quartile, were more likely to have severe WMLs [odds ratio (OR), 3.31; 95% confidence interval (CI) 1.74–9.67; p?=?.004], severe EPVs (OR, 2.35; 95% CI 1.11–6.02, p?=?.046] and increasing total MRI cSVD burden (OR, 3.00; 95% CI 1.36–6.53, p?=?.006).

Conclusions: Lower levels of 25(OH)D are associated with greater total MRI cSVD burden in ischemic stroke patients.     

Blood pressure and sodium: Association with MRI markers in cerebral small vessel disease

Dietary salt intake and hypertension are associated with increased risk of cardiovascular disease including stroke. We aimed to explore the influence of these factors, together with plasma sodium concentration, in cerebral small vessel disease (SVD). In all, 264 patients with nondisabling cortical or lacunar stroke were recruited. Patients were questioned about their salt intake and plasma sodium concentration was measured; brain tissue volume and white-matter hyperintensity (WMH) load were measured using structural magnetic resonance imaging (MRI) while diffusion tensor MRI and dynamic contrast-enhanced MRI were acquired to assess underlying tissue integrity. An index of added salt intake (P = 0.021), pulse pressure (P = 0.036), and diagnosis of hypertension (P = 0.0093) were positively associated with increased WMH, while plasma sodium concentration was associated with brain volume (P = 0.019) but not with WMH volume. These results are consistent with previous findings that raised blood pressure is associated with WMH burden and raise the possibility of an independent role for dietary salt in the development of cerebral SVD.     

Cerebral white matter hyperintensity in Parkinson's disease: A major risk factor for mild cognitive impairment

BackgroundMild cognitive impairment (MCI) and dementia contribute to a poor quality of life among patients with PD. The influence of cerebral ischemia as a risk factor for MCI in PD has not been adequately investigated. To address this issue, we examined the influence of the volume and distribution of white matter hyperintensity (WMH) as a risk factor for MCI in early PD.MethodsProspective study of patients with early idiopathic PD. All patients had baseline MRI-FLAIR, clinical assessment and detailed neuropsychological evaluation. Data on demographics, vascular risk factors, cognitive performance and WMH volumes were analyzed.Results91 patients; mean age 64.9 years, mean education of 10.5 years. 24 patients fulfilled the Movement Disorder Society criteria for MCI and were classified as PD-MCI while the rest were classified as PD with no cognitive impairment (PD-NCI). Patients with PD-MCI and PD-NCI did not differ in Hoehn & Yahr staging. PD-MCI patients had a higher prevalence of diabetes mellitus, hypertension and hyperlipidemia. PD-MCI patients had significantly greater volume of periventricular (6.04 ml vs. 2.66 ml, p = 0.001) and deep subcortical WMH (2.16 vs.1.44, p = 0.002). Regional WMH was significantly greater among PD-MCI in the frontal, parietal and occipital regions. Logistic regression analyses demonstrated WMH to be associated with PD-MCI independent of age, education, and vascular risk factors. Increasing WMH volume was associated with lower performance on executive function, memory and language.ConclusionsWMH is an important risk factor for PD-MCI independent of vascular risk factors. PD patients with WMH should be regularly screened for MCI.     

Patterns of cortical degeneration in an elderly cohort with cerebral small vessel disease

Emerging noninvasive neuroimaging techniques allow for the morphometric analysis of patterns of gray and white matter degeneration in vivo, which may help explain and predict the occurrence of cognitive impairment and Alzheimer's disease. A single center prospective follow‐up study (Radboud University Nijmegen Diffusion tensor and Magnetic resonance imaging Cohort study (RUN DMC)) was performed involving 503 nondemented elderly individuals (50–85 years) with a history of symptomatic cerebral small vessel disease (SVD). Age was associated with a global reduction in cortical thickness, and this relationship was strongest for ventrolateral prefrontal cortex, auditory cortex, Wernicke's area, superior temporal lobe, and primary visual cortex. Right and left hemispheres differed in the thickness of language‐related areas. White matter (WM) lesions were generally negatively correlated with cortical thickness, primarily in individuals over the age of 60, with the notable exception of Brodmann areas 4 and 5, which were positively correlated in age groups 50–60 and 60–70, respectively. The observed pattern of age‐related decline may explain problems in memory and executive functions, which are already well documented in individuals with SVD. The additional gray matter loss affecting visual and auditory cortex, and specifically the head region of primary motor cortex, may indicate morphological correlates of impaired sensory and motor functions. The paradoxical positive relationship between WM lesion volume and cortical thickness in some areas may reflect early compensatory hypertrophy. This study raises a further interest in the mechanisms underlying cerebral gray and white matter degeneration in association with SVD, which will require further investigation with diffusion weighted and longitudinal MR studies. Hum Brain Mapp, 2010. © 2010 Wiley‐Liss, Inc.     

Venous disruption affects white matter integrity through increased interstitial fluid in cerebral small vessel disease

Deep medullary veins (DMVs) participate in the drainage of surrounding white matter. In cerebral small vessel disease (CSVD), disrupted DMVs were often observed together with damaged white matter, but the phenomenon lacked validation and explanation. We hypothesized that venous disruption might cause white matter damage through increased interstitial fluid resulting from hemodynamic alteration, and we designed a comprehensive multi-modality MRI study to testify our hypothesis. Susceptibility-weighted imaging was used to investigate the characteristics of DMVs and derive DMVs scores. Free water elimination diffusion tensor imaging model was used to analyze interstitial fluid fraction (fraction of free water, fFW) and white matter integrity (tissue fractional anisotropy, FAt). Totally, 104 CSVD patients were included. Total DMVs score was associated with FAt of DMVs drainage area. The effect of total DMVs score on FAt was mediated by fFW, after controlling for age, sex, hypertension, regional cerebral blood flow and lacune numbers. The relationships between DMVs score, fFW and FAt were also significant in most DMVs drainage subregions. Therefore, we discovered the DMVs disruption – increased interstitial fluid – white matter damage link in CSVD patients, which was independent of arterial perfusion variations.     

脑小血管病非痴呆患者脑微出血与认知功能相关性研究

目的探讨脑小血管病非痴呆患者脑微出血(CMBs)数量、部位与认知功能损害的相关性。方法收集82例脑小血管病非痴呆伴有CMBs患者的临床资料,行头部MRI及磁敏感加权成像(SWI)检查,记录CMBs部位、数量,并完成MMSE和蒙特利尔认知评估量表(Mo CA)评分。结果 CMBs好发部位是基底节、颞叶及额叶;CMBs数量与Mo CA总分呈负相关(r=-0.293,P=0.014)有关,尤其在注意集中、延迟记忆(r=-0.266,P=0.026;r=-0.237,P=0.048)。额叶CMBs与视结构执行技能呈负相关(r=-0.240,P=0.03)。枕叶CMBs与语言、定向呈负相关(r=-0.218,P=0.049;r=-0.242,P=0.028)。岛叶和基底节区域CMBs与注意集中呈负相关(r=-0.236,P=0.033;r=-0.248,P=0.024)。DPWM区域CMBs与Mo CA总分、注意集中、记忆、语言呈现负相关(r=-0.269,P=0.015;r=-0.219,P=0.048;r=-0.240,P=0.030;r=-0.295,P=0.007)。结论 CMBs作为CSVD的标志物之一,在认知、早期诊断及病程发展中扮演着重要作用。