CEREBRAL MICROANGIOPATHY BY MRI DATA: PREDICTION OF COGNITIVE IMPAIRMENTS AND RISK OF RECURRENT VASCULAR EVENTS IN THE LONG-TERM PERIOD OF ISCHEMIC STROKE (LITERATURE REVIEW)
Keywords:
cerebral microangiopathy, ischemic stroke, magnetic resonance imaging, cognitive impairment, vascular dementia, lacunar infarcts, white matter hyperintensity, microbleeds, prediction, secondary preventionAbstract
Objective: To systematize data on the role of MRI-detected markers of cerebral microangiopathy (CMA) in predicting cognitive impairment and risk of recurrent vascular events in patients during the long-term period after ischemic stroke.
Materials and Methods: Analyzed 33 publications (2015–2025) on CMA pathogenesis, validation of MRI markers (lacunar infarcts, white matter hyperintensity, microbleeds, atrophy), and their prognostic significance. Focus on the "CMA burden" concept and advanced MRI techniques (DTI, blood-brain barrier permeability assessment).
Results: CMA is an independent predictor of adverse outcomes: "CMA burden" increases vascular dementia risk 3.5–4.2-fold and recurrent vascular events risk 3.2-fold. Key MRI markers for cognitive impairment risk: white matter hyperintensity volume >10 cm³ (OR 3.5), lacunar infarcts >3 (OR 4.0), multiple microbleeds (>5, OR 1.6). For recurrence prediction, the SVDss scale (AUC 0.78) and lobar microbleeds (hemorrhagic stroke risk up to 15%/year) are significant. Advanced MRI techniques detect preclinical CMA stages: reduced frontal lobe fractional anisotropy precedes cognitive decline by 2–3 years.
Conclusion: MRI markers of CMA are critically important for risk stratification. Incorporating "CMA burden" assessment (SVDss scale) into patient management algorithms is recommended. Personalized secondary prevention (BP control <130/80 mmHg, differentiated antithrombotic therapy) and early neuroprotection improve long-term outcomes.
References
Адамбаев З.И., Киличев И.А., Худойберганов Н.Ю., Самиев А.С., Пазылова А.С. Коррекция когнитивных нарушений при хронической ишемии головного мозга в амбулаторных условиях // Журнал Биомедицины и практики, 2025;10(1):185-191.
Адамбаев З.И., Пазылова А.С. Взаимосвязь данных МРТ и когнитивными нарушениями при заболеваниях мелких сосудов головного мозга// Xalqaro ilmiy-amaliy anjumani “Тibbiy psixologiya, nevrologiya va psixiatriyaning dolzarb muammolariga innovatsion yechimlar” 2025 yil 24-25 aprel Termiz, С.32.
Адамбаев З.И., Пазылова А.С. Коррекция когнитивных нарушений при заболеваниях мелких сосудов головного мозга // Xalqaro ilmiy-amaliy anjumani “Тibbiy psixologiya, nevrologiya va psixiatriyaning dolzarb muammolariga innovatsion yechimlar” 2025 yil 24-25 aprel Termiz, С.33.
Верещагин Н.В., Пирадов М.А., Суслина З.А., ред. Сосудистые заболевания головного мозга. В 2-х томах. Том 1: Эпидемиология, патогенез, факторы риска, диагностика. Москва: Атмосфера; 2018. 464 с.
Гулевская Т.С., Котов С.В. Современные подходы к визуализации церебральной микроангиопатии. Мед визуализация. 2022;(2):78–
Гулевская Т.С., Котов С.В., Яхно Н.Н. Церебральная микроангиопатия: факторы риска, диагностика, клиническое значение. Журн
неврол и психиат им. С.С. Корсакова. 2018;118(9):88–94.
Пизова Н.В. Антитромботическая терапия при церебральной микроангиопатии: баланс эффективности и риска. РМЖ. 2023;(31):4–
Пизова Н.В. Вторичная профилактика ишемического инсульта: фокус на церебральную микроангиопатию. РМЖ. 2021;(29):4–8.
Суслина З.А., Фонякин А.В., Герасимова Т.Н. и др. Диагностика и лечение когнитивных нарушений при цереброваскулярной
болезни. Consensus statement. Анн клин и эксперим неврол. 2016;10(3):4–17.
Танрывердиев А.М., Яхно Н.Н. Нарушения исполнительных функций при церебральной мелкососудистой болезни. Журн неврол и психиат им. С.С. Корсакова. 2022;122(10):72–78.
Федин А.В., Пирадов М.А. Современные представления о патогенезе, диагностике и лечении церебральной мелкососудистой болезни. Журн неврол и психиат им. С.С. Корсакова. 2020;120(10):84–91.
Шамалов Н.А., Пирадов М.А., Суслина З.А. Церебральная мелкососудистая болезнь: современные представления о патогенезе и диагностике. Неврол журн. 2023;28(2):5–13.
Яхно Н.Н., Захаров В.В., Дамулин И.В. Сосудистые когнитивные расстройства: диагностика и лечение. Неврол журн. 2019;24(5):5–12.
Arba F, et al. Cerebral Small Vessel Disease Burden and Risk of Recurrent Stroke After a Lacunar Stroke: A Cohort Study. Stroke. 2022;53(2):475–482.
Arba F, et al. The SVDs@stroke score for predicting recurrent vascular events after cerebral small vessel disease stroke. Neurology. 2023;101(15):e1513–e1522.
Charidimou A, et al. Cerebral Microbleeds and Recurrent Stroke Risk: A Pooled Individual Patient Data Analysis. Stroke. 2023;54(4):1021– 1029.
Dichgans M, et al. Genetics of cerebral small vessel disease and its impact on stroke and dementia risk. Brain. 2023;146(1):1–15.
European Stroke Organisation (ESO) Guidelines for Cerebral Small Vessel Disease. Eur Stroke J. 2023;8(3):287–311.
Gorelick PB, et al. Vascular Contributions to Cognitive Impairment and Dementia: A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2019;50(12):e505–e523.
Jokinen H, et al. Cognitive trajectories in cerebral small vessel disease: a 10-year follow-up study. Alzheimers Dement. 2023;19(7):1053– 1062.
Jokinen H, et al. Longitudinal cognitive changes after lacunar stroke: a MRI substudy of the Secondary Prevention of Small Subcortical Strokes (SPS3) trial. Stroke. 2020;51(2):548–555.
Kim S, et al. Vascular Depression in Cerebral Small Vessel Disease: MRI Correlates and Cognitive Outcomes. J Affect Disord. 2024;338:118–126.
Liu W, et al. Sex Differences in the Association Between Cerebral Small Vessel Disease Burden and Recurrent Stroke Risk. Stroke. 2024;55(2):e42–e50.
Pantoni L, et al. Cerebral Small Vessel Disease as a Predictor of Recurrent Stroke and Dementia: A Systematic Review and Meta-Analysis. Stroke. 2023;54(3):e88–e98.
Pantoni L, et al. Controversies in Cerebral Small Vessel Disease: A Delphi Consensus. Cerebrovasc Dis. 2024;53(1):1–10.
Pantoni L. Cerebral Small Vessel Disease: From Pathogenesis and Clinical Characteristics to Therapeutic Challenges. Lancet Neurol. 2020;19(9):756–771.
Prins ND, Scheltens P. White matter hyperintensities, cognitive impairment and dementia: an update. Nat Rev Neurol. 2015;11(3):157– 165.
Ter Telgte A, et al. Microbleeds, Microinfarcts, and White Matter Hyperintensities Increase the Risk of Stroke Recurrence. Ann Neurol. 2018;83(1):200–209.
van Leijsen EMC, et al. Hippocampal Microinfarcts, Small Vessel Disease, and Cognitive Decline: The RUN DMC Study. Neurology. 2020;95(14):e1928–e1938.
van Leijsen EMC, et al. The Role of Cerebral Small Vessel Disease in Cognitive Decline: A Diffusion Tensor Imaging Study. J Alzheimers Dis. 2022;88(3):1221–1233.
Wardlaw JM, et al. Mechanisms of sporadic cerebral small vessel disease: insights from neuroimaging. Nat Rev Neurol. 2023;20(2):89– 103.
Wardlaw JM, et al. Neuroimaging standards for research into small vessel disease and its contribution to ageing and neurodegeneration. Lancet Neurol. 2019;18(4):404–418.
Zhang C, et al. Blood-Brain Barrier Disruption in Cerebral Small Vessel Disease: Pathophysiology, Neuroimaging, and Clinical Implications. Transl Stroke Res. 2024;15(1):15–31.
