Baseline Cerebral Small Vessel Disease Predicting Long-Term Cognitive Decline in Transient Ischemic Attack Patients.

At least one CSVD imaging biomarker was present in more than half of TIA patients at baseline.

• 58.5% of the 246 TIA patients had at least one CSVD imaging biomarker on baseline 3T MRI.
• Lacunes were the most common biomarker (36.6%), followed by enlarged perivascular spaces (PVS) (28.1%), white matter hyperintensities (WMH) (19.5%), and cerebral microbleeds (CMBs) (17.9%).
• Patients were from the INSPiRE-TMS study (ClinicalTrials.gov: NCT01586702).
• CSVD was assessed using a composite score (0-4) including WMH, lacunes, CMBs, and enlarged PVS.

Higher CSVD composite score was independently associated with greater cognitive decline over 3 years.

• The association was statistically significant (β = -0.52, 95% CI -0.95 to -0.08, p = 0.020).
• Cognitive performance was evaluated using the Montreal Cognitive Assessment (MoCA) at baseline and annually for 3 years.
• Older age was also independently associated with greater cognitive decline (β = -0.08, 95% CI -0.13 to -0.03, p = 0.001).
• The association between CSVD-score and cognitive decline was independent of other covariates in adjusted analyses.

Cerebral microbleed (CMB) burden was the strongest individual predictive component of the CSVD composite score for cognitive decline.

• CMB burden showed the strongest association among CSVD components (β = 0.42, 95% CI -0.63 to -0.22, p < 0.001).
• CMBs were present in 17.9% of the study population at baseline.
• The paper notes that whether CMBs are the strongest predictive imaging biomarker of cognitive decline in TIA patients requires confirmation in further studies.

CSVD-score was particularly associated with decline in the memory cognitive domain.

• The association with memory domain decline was statistically significant (adjusted β = -0.18, 95% CI -0.32 to -0.04, p = 0.015).
• Domain-specific cognitive analyses were performed to identify which cognitive functions were most affected.
• Memory was identified as the domain with the strongest effect from CSVD burden over the 3-year follow-up period.