Dementia Tied to Large Perivascular Spaces

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Dementia Tied to Large Perivascular Spaces

Enlarged spaces around cerebral small blood vessels linked to cognitive decline over time

by Judy George, Senior Staff Writer, MedPage Today January 27, 2021

Enlarged fluid-filled spaces around cerebral small blood vessels were linked to cognitive decline, a prospective study of older adults showed.

Severe perivascular space pathology in both the basal ganglia and the centrum semiovale, or in the centrum semiovale alone, was tied to a greater drop in global cognition over 4 years, reported Matthew Paradise, MBChB, MSc, of the University of New South Wales in Sydney, Australia, and co-authors.

Large perivascular space dilation in both brain regions was an independent predictor of dementia across 8 years of follow-up (adjusted OR 2.91, 95% CI 1.43-5.95, P=0.003), with stronger effects at either year 4 or 6, the researchers wrote in Neurology.

Dilated perivascular spaces are a common MRI finding especially in older patients, but their clinical relevance is unclear, Paradise noted. "Our study suggests that dilated perivascular spaces should no longer be considered just an incidental finding but have an important role in evaluating cognitive decline," he told MedPage Today.

"Cerebrovascular disease is increasingly recognized not only as an inmportant cause of cognitive impairment and dementia directly, but also as an important contributor to the risk and progression of Alzheimer's disease," Paradise added. "Despite this, we're not very good at assessing the overall burden from cerebrovascular disease which can make diagnosis of, say, vascular dementia, difficult."

As people get older, and in some diseases, perivascular spaces around cerebral small vessels can enlarge, noted David Werring, PhD, of UCL Queen Square Institute of Neurology in London, England, who wasn't involved with the study. "This raises the possibility that perivascular spaces could be a marker of disease process affecting these small vessels," he said.