Cerebral small vessel disease in an Indian cohort: magnetic resonance imaging burden, clinical profiles and risk factor associations
DOI:
https://doi.org/10.18203/2349-3933.ijam20261879Keywords:
Cerebral small vessel disease, MRI markers, Cognitive impairmentAbstract
Background: Cerebral small vessel disease (CSVD) is a major contributor to stroke, cognitive impairment, gait disturbances, and disability. Given its high burden and multifaceted clinical impact, CSVD has emerged as a critical public health concern. There is limited understanding of how radiological markers of CSVD correlate with clinical manifestations in Indian populations, which may differ from Western cohorts due to genetic, lifestyle, and environmental influences.
Methods: This observational, cross-sectional study included 85 adults with magnetic resonance imaging (MRI) evidence of at least one CSVD marker. Clinical assessment included cognition, gait, Parkinsonism, vascular risk factors, and stroke subtypes. MRI markers were classified per STRIVE criteria, and cumulative burden quantified using the total SVD score. Associations between radiological markers and clinical outcomes were evaluated using appropriate statistical tests.
Results: Lacunes (76.5%) and WMH (75.3%) were the most frequent markers, followed by CMB (42.4%), PVERSUS (30.6%), and RSSI (14.1%). Dementia was significantly more common in patients with lacunes (26.1% versus 5%; p=0.043) and WMH (25.6% versus 4.7%; p=0.034). CMB were strongly associated with Parkinsonism (36.1% versus 14.3%; p=0.019) and gait abnormalities (27.8% versus 10.2%; p=0.036). Higher SVD scores correlated with cerebral atrophy (68.9% versus 32.5%; p=0.001) and greater clinical impairment. Acute infarcts clustered with RSSI (50% versus 21.9%) and high SVD burden.
Conclusion: This study demonstrates substantial CSVD burden in an Indian cohort and highlights strong clinical–radiological correlations. Findings reinforce CSVD as a whole-brain, cumulative microvascular disorder with significant cognitive and motor implications.
References
Pantoni L. Cerebral small vessel disease: from pathogenesis and clinical characteristics to therapeutic challenges. Lancet Neurol. 2010;9(7):689-701.
Bhat V, Gs T, Rao SS, Sarma GRK, Deepalam SK. Clinical and Radiological Profile of Cerebrovascular Disease in Polycythemia: Analysis of Neurologic Manifestations from a Tertiary Center in South India. J Stroke Cerebrovasc Dis. 2022;31(1):106167.
Kovbasyuk Z, Tefera E, Li CC, Baete SH, Steriade C. Imaging brain inflammation, and blood brain barrier permeability in neurological and psychiatric diseases: a review. J Neuroinflammation. 2025;22:275.
Wardlaw JM, Smith EE, Biessels GJ, Cordonnier C, Fazekas F, Frayne R, et al. STandards for ReportIng Vascular changes on nEuroimaging (STRIVE v1). Neuroimaging standards for research into small vessel disease and its contribution to ageing and neurodegeneration. Lancet Neurol. 2013;12(8):822-38.
Maillard P, Fletcher E, Carmichael O, Schwarz C, Seiler S, DeCarli C; Alzheimer's Disease Neuroimaging Initiative. Cerebrovascular markers of WMH and infarcts in ADNI: A historical perspective and future directions. Alzheimers Dement. 2024;20(12):8953-68.
Shi Y, Wardlaw JM. Update on cerebral small vessel disease: a dynamic whole-brain disease. Stroke Vasc Neurol. 2016;1(3):83-92.
Wang LL, Williamson BJ, Zhang B, Sriwastawa A, Aziz YN, Antzoulatos E, et al. Microstructural and microvascular features of white matter hyperintensities and their association with small vessel disease markers. Sci Rep. 2025;15(1):18567.
Osman A, Kanaan A, Azeroual S, Abubakr M, Jwayyed J, Bhutta R. Hypertension and Cerebral Small Vessel Disease: A Review of the Pathophysiology, Progression, and Prevention. Cureus. 2025;17(9):e92760.
Joyce OC, McHugh C, Mockler D, Wilson F, Kelly ÁM. Midlife hypertension is a risk factor for some, but not all, domains of cognitive decline in later life: a systematic review and meta-analysis. J Hypertens. 2024;42(2):205-23.
Chen T, Dai Y, Hu C, Lin Z, Wang S, Yang J. Cellular and molecular mechanisms of the blood–brain barrier dysfunction in neurodegenerative diseases. Fluids Barriers CNS. 2024;21:60.
Loitongbam L, Surin WR. The Rising Burden of Cardiovascular Disease and Thrombosis in India: An Epidemiological Review. Cureus. 2024;16(11):e73786.
Mooldijk SS, Ikram MA. Cerebral Small Vessel Disease in Population-Based Research: What are We Looking at - and What not? Aging Dis. 2024;15(4):1438-46.
Camerino I, Sierpowska J, Reid A, Meyer NH, Tuladhar AM, Kessels RPC, et al. White matter hyperintensities at critical crossroads for executive function and verbal abilities in small vessel disease. Hum Brain Mapp. 2021;42(4):993-1002.
Tuladhar AM, Reid AT, Shumskaya E, de Laat KF, van Norden AG, van Dijk EJ, et al. Relationship between white matter hyperintensities, cortical thickness, and cognition. Stroke. 2015;46(2):425-32.
Schmahmann JD, Pandya DN. Disconnection syndromes of basal ganglia, thalamus, and cerebrocerebellar systems. Cortex. 2008;44(8):1037-66.
Mao HJ, Zhang JX, Zhu WC, Zhang H, Fan XM, Han F, et al. Basal Ganglia and Brainstem Located Cerebral Microbleeds Contributed to Gait Impairment in Patients with Cerebral Small Vessel Disease. J Alzheimers Dis. 2023;94(3):1005-12.
Sundaresan V, Zamboni G, Dineen RA, Auer DP, Sotiropoulos SN, Sprigg N, et al. Automated characterisation of cerebral microbleeds using their size and spatial distribution on brain MRI. Eur Radiol Exp. 2025;9(1):5.
Tsai HH, Kim JS, Jouvent E, Gurol ME. Updates on Prevention of Hemorrhagic and Lacunar Strokes. J Stroke. 2018;20(2):167-79.
Vermeer SE, Prins ND, den Heijer T, Hofman A, Koudstaal PJ, Breteler MM. Silent brain infarcts and the risk of dementia and cognitive decline. N Engl J Med. 2003;348(13):1215-22.
Golbidi S, Edvinsson L, Laher I. Smoking and Endothelial Dysfunction. Curr Vasc Pharmacol. 2020;18(1):1-11.
Power MC, Deal JA, Sharrett AR, Jack CR Jr, Knopman D, Mosley TH, et al. Smoking and white matter hyperintensity progression: the ARIC-MRI Study. Neurology. 2015;84(8):841-8.
Song X, Jin C, Luan M, Zheng X. Roles of neuroimaging markers and biomarkers in cerebral small vessel disease and their associations with cognitive function. Front Neurol. 2025;16:1483842.
Downloads
Published
How to Cite
Issue
Section
