Advanced brain MRI in vascular cognitive impairment (VCI)

VCI is an umbrella term that refers to acquired cognitive impairment attributable to vascular braininjury. VCI has multiple etiologies, of which small vessel disease (SVD) is most common. Manifestations of SVD on brain MRI include white matter hyperintensities, recent small subcortical infarcts, lacunes, perivascular spaces, cerebral microbleeds, and brain atrophy. At the population level these lesions are clearly related to dementia and stroke risk. Yet, in individual patients the link between lesion burden and these clinical manifestations can be less clear, which may cause diagnostic dilemmas. Moreover, the lesions themselves are often an end stage of tissue injury, not necessarily reflecting the underlying disease processes.

In my presentation I will show how we use advanced MRI techniques, mostly at 7T MRI, to get closer to the disease processes in SVD. In particular, I will present recent work that zooms in on small vessel function in patients with SVD.

In our studies we also try to better capture the functional impact of SVD, to support the diagnosis of VCI. I will review work on brain connectivity, white matter structure and lesion symptom mapping.