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A study published in Brain sheds new light on cerebral small vessel disease (SVD). Using data from the Radboud University Nijmegen Diffusion Tensor and Magnetic Resonance Cohort (RUN DMC) study, Hao Li, Anil M. Tuladhar, and colleagues at the Department of Neurology explored the neural mechanisms underlying three core SVD symptoms: cognitive impairment, apathy, and gait dysfunction.
SVD refers to conditions affecting the small blood vessels in the brain, leading to damage in white matter—the brain's communication highways. Commonly seen in aging and vascular-related conditions, SVD can cause a range of symptoms, including memory and thinking difficulties (cognitive impairment), reduced motivation and emotional engagement (apathy), and walking problems (gait dysfunction). These symptoms often co-occur but have historically been studied as separate issues, making it unclear if they share a common cause.
The study used advanced imaging techniques and principal component analysis to establish that these symptoms are interconnected and share a common neural mechanism. Further analysis, including advanced neuroimaging and fiber tracking, revealed that damage to the dopaminergic meso-cortical pathway—a key network involved in cognitive and emotional regulation—correlates with these symptoms both individually and collectively. Damage was assessed using diffusion metrics, which measure changes in white matter structure.
This study reveals how cognitive impairment, apathy, and gait dysfunction in SVD are fundamentally linked, with damage to dopaminergic meso-cortical white matter as a potential common neural basis for these symptoms. These findings significantly advance our understanding of the mechanisms driving these symptoms and offer a promising new direction for treating SVD by targeting the dopamine system.
About the publication
Li H, Jacob MA, Cai M, et al. Meso-cortical pathway damage in cognition, apathy and gait in cerebral small vessel disease. Brain. 2024;147(11):3804-3816.
