CEREBRAL SMALL VESSEL DISEASE IN YOUNG PATIENTS WITH ISCHEMIC STROKE: PREVALENCE OF MARKERS AND IMPACT ON COGNITIVE OUTCOMES

Abstract

Introduction. Cerebral small vessel disease (CSVD) is the leading cause of vascular cognitive impairment, accounting for 10–30% of all strokes. Despite the increasing incidence of ischemic stroke (IS) among young adults (under 50 years of age), the prevalence and pattern of CSVD MRI markers, as well as their role in the development of post-stroke cognitive impairment (PSCI) in this age group, remain poorly understood. Aim of the research. To assess the frequency and structure of CSVD markers using the CSVD total burden scale in young patients with ischemic stroke, and to analyze their correlation with cognitive outcomes in the acute and late recovery periods after ischemic stroke. Materials and methods. A prospective observational cohort study was performed, including 78 patients aged 18–50 years with first-time verified ischemic stroke (IS). MRI markers of CSVD (lacunae, white matter hyperintensities according to the Fazekas scale, cerebral microbleeds, dilated perivascular spaces) were assessed using the STRIVE2 criteria with calculation of the total CSVD score (0–4). Cognitive functions were assessed using the MoCA test in the acute period (T0, 3–7 days from IS onset), after 6 months (T6), and 12 months (T12). Patients were divided into two groups: SVD = 0 (n = 34) and SVD ≥ 1 (n = 44). Statistical analysis included two-way analysis of variance with repeated measures (mixed-effects model, REML), post-hoc analysis with correction for multiple comparisons, and correlation analysis. Results. SVD signs (SVD ≥ 1) were detected in 56.41% of patients. The most common marker was dilated perivascular spaces (39.56%), the least common was cerebral microbleeds (12.09%). The most common paired combination was lacunae and perivascular spaces (12.82%). A moderate negative correlation was found between the total SVD score and MoCA scores at all time points (r from -0.44 to -0.57), most pronounced at 12 months (r = -0.57). In the acute period, no significant intergroup differences in MoCA were found (p = 0.1518), however, after 6 months (mean difference -3.868; p = 0.0285) and 12 months (mean difference -4.387; p = 0.0105), patients with SVD ≥ 1 demonstrated significantly lower cognitive scores. The dynamics of cognitive functions was characterized by improvement in both groups over the course of a year (p = 0.0242). Conclusion. More than half of young patients with ischemic stroke have signs of small vessel disease. Dilated perivascular spaces are the most common and potentially early marker of CSVD in this patient population. The presence of CSVD (SVD ≥ 1) is associated with persistent cognitive deficits late after stroke, justifying the need for routine MRI assessment of perivascular dystonia markers to stratify the risk of cognitive impairment and individualize neurorehabilitation programs in young patients.