Work

Combination of brain injury and brain reserve promotes the neuroimaging evaluation of small vessel disease related cognitive impairment

Year: 2026

Type: article

Abstract: OBJECTIVES: To investigate the advantage of combining brain injury and reserve in evaluation of cerebral small vessel disease (CSVD) related cognitive impairment. DESIGN, SETTINGS, PARTICIPANTS AND MEASUREMENTS: This was a single-center cross-sectional study. A total of 483 CSVD patients underwent structural MRI and cognitive testing. CSVD related imaging biomarkers including white matter hyperintensities (WMH), lacunar infarctions (LI), cerebral microbleeds (CMBs), and brain atrophy were quantitated. Brain reserve was assessed by intracranial volume (ICV). Structural network characteristics, including sparseness, redundancy, global efficiency (Eg), and local efficiency (Eloc) were calculated. High and low brain reserve were defined using the quartile method on ICV. RESULTS: The MoCA scores between the high and low reserve groups has a difference(23.35 ± 4.06 vs 21.73 ± 5.20, t = 2.38, p = 0.037). All of the CSVD related imaging biomarkers, ICV and brain structural network characteristics were significantly correlated with MoCA(r = 0.156, p = 0.002). ICV was positively associated with MoCA after controlling the other related variables(r = 0.145, p = 0.012; r = 0.128, p = 0.049). Compared with the low brain reserve group, the high brain reserve group had similar macroscopic brain damages, but better network configuration and better cognitive performance. Most brain injury biomarkers were significantly associated with cognitive function in the low brain reserve group, but not in the high brain reserve group. The mediation analysis shows that brain structural network sparseness(indirect effect = 0.0196, p < 0.05), redundancy(indirect effect = 0.0155, p < 0.05), and Eg(indirect effect = 0.0355, p < 0.05) could play significant role in mediating effects on the relationship between ICV and MoCA, while Eloc(no significant mediating effect, p > 0.05) did not show a significant mediating effect. Education, grey matter volume, ICV and network sparseness were significant contributors to MoCA within the best regression model. CONCLUSIONS: Brain reserve protects cognitive function, potentially mediated in part through an optimized configuration of the brain structural network. The incorporation of conventional MRI biomarkers and brain structural network characteristics, encompassing both aspects of brain injury and reserve, holds promise for enhancing the clinical assessment of cognitive impairment related to CSVD.

Source: Progress in Neuro-Psychopharmacology and Biological Psychiatry

DOI: 10.1016/j.pnpbp.2026.111615