Mapping the neurovascular landscape in aging and dementia: cerebral small vessel disease markers in a multicenter Latin American cohort

Introduction: Cerebral small vessel disease (CSVD) is a key contributor to cognitive impairment and dementia, yet few studies have compared CSVD across dementia variants, particularly in underrepresented populations.

Methods: In a multicenter cross-sectional study, we analyzed magnetic resonance imaging (MRI) markers of CSVD, including white matter hyperintensities (WMHs), lacunes, and cerebral microbleeds, along with cardiometabolic risk factors and cognitive performance using regression models in 1675 participants (790 healthy controls, 642 with Alzheimer's disease [AD], and 243 with frontotemporal dementia [FTD]) from six Latin American countries.

Results: AD showed the greatest CSVD burden, whereas FTD exhibited an intermediate profile driven by elevated WMHs. Blood pressure and smoking were the strongest correlates of WMHs, while diabetes was associated with microbleeds. WMH burden was linked to global and domain-specific cognitive impairment.

Discussion: This first large-cohort Latin American study identifies WMHs as a key vascular substrate of cognitive impairment, with AD showing the greatest CSVD burden.