cerebral small vessel disease, vascular cognitive impairment
Conditions
Interventions
observational study
none
Sponsors
Maastricht University Medical Center
Eligibility
Inclusion criteria
Inclusion criteria: Inclusion criteria for VCI VCI due to cSVD defined as: o visiting a memory clinic or outpatient clinic Neurology; o cognitive complaints; o demonstration of a cognitive deficit: MoCA<26 or impairment in at least 1 cognitive domain in neuropsychological assessment o imaging evidence of cerebral small vessel disease: ? - extensive leukoaraiosis on CT, or ? - (early) confluent WMH on MRI (Fazekas score = 2), or ? - multiple punctate WMH on MRI (Fazekas 1) in combination with lacunar infarcts or microbleeds. o Age 18 years or older o Ability to undergo MRI o Capacity to give written informed consent o Clinical dementia rating scale =1 Inclusion criteria for controls • visiting the outpatient clinic Neurology with complaints related to the peripheral nervous system (e.g. chronic polyneuropathy, carpal tunnel syndrome or neurogenic claudicatio intermittens). • No cognitive complaints • No objective cognitive deficit • Ability to undergo MRI • Capacity to give written informed consent
Exclusion criteria
Exclusion criteria: Exclusion criteria for both VCI and controls: • Inclusion criteria are not met • Unwillingness or inability to give written consent • Contraindications to MRI, among which: pacemaker, metallic foreign body, claustrophobia, pregnancy, neurostimulator, other kinds of implanted devices or insulin pump • Contraindications to gadolinium contrast agent used for MRI, among which allergy or severe renal impairment (eGFR <30 ml/min) • Other major neurological or psychiatric conditions affecting the brain and interfering with the study design, among which: multiple sclerosis, Parkinson’s disease, alcohol/drug abuse, major cortical stroke, major neuro-trauma, brain tumors. Exclusion criteria for cardiac MRI (VCI only) • Asthma and/or COPD • Slow heart rhythm (<50 beats per minute) • Irregular heart rhythm (i.e. atrial fibrillation) • AV-block II-III • Sick sinus syndrome • Prolonged QT-interval • Hypotension defined as systolic blood pressure less than 90 mmHg • Decompensatio cordis
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| • Advanced brain MRI markers for microvascular hypoperfusion and dysfunction: -BBB leakage rate and fractional volume (DCE-MRI) -grey matter perfusion (ASL-CBF) -microvascular perfusion volume (IVIM) -parenchymal diffusivity/microstructural integrity (IVIM) -macrovascular perfusion (GE-DSC-MRI) -microvascular perfusion (capillary transit time heterogeneity on GE-DCS-MRI or SE-DSC-MRI) •Cognitive function: overall and domains of memory, information processing speed, executive function | — |
Secondary
| Measure | Time frame |
|---|---|
| VCI patients only • Cardiac: - echocardiography: Left ventricular (LV) end-diastolic and -systolic diameters, LV mass and the LV mass index, and left atrial volume and left atrial volume index, LV ejection fraction, global and regional longitudinal strain - MRI: ejection fraction, diastolic volume, end systolic function, cardiac output, left ventricular mass, diastolic function (early to late ventricular filling ; E/A ratio), left atrial volume as measure for diastolic function. Myocardial perfusion from the adenosine stress test • Serum markers of cardiac damage/strain (NT-proBNP, hs-TNT), fibrosis (PICP, CITP:MMP-1) and inflammation (Gal-3, sST-2) • Microvesicles: RNA content of endothelial derived microvesicles • Vascular density on OCT angiography of the eyes • Sublingual flow-related capillary density (GlycoCheck) | — |
Contacts
Public ContactRobert Jan van Oostenbrugge
Maastricht UMC+
Outcome results
None listed