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Introduction: Small vessel disease (SVD) is a common contributor to dementia. Subtle blood-brain\ud barrier (BBB) leakage may be important in SVD-induced brain damage.\ud Methods: We assessed imaging, clinical variables, and cognition in patients with mild (i.e., nondisabling)\ud ischemic lacunar or cortical stroke. We analyzed BBB leakage, interstitial fluid, and white\ud matter integrity using multimodal tissue-specific spatial analysis around white matter hyperintensities\ud (WMH). We assessed predictors of 1 year cognition, recurrent stroke, and dependency.\ud Results: In 201 patients, median age 67 (range 34–97), BBB leakage, and interstitial fluid were\ud higher in WMH than normal-appearing white matter; leakage in normal-appearing white matter\ud increased with proximity to WMH (P , .0001), with WMH severity (P 5 .033), age (P 5 .03),\ud and hypertension (P , .0001). BBB leakage in WMH predicted declining cognition at 1 year.\ud Discussion: BBB leakage increases in normal-appearing white matter with WMH and predicts worsening\ud cognition. Interventions to reduce BBB leakage may prevent SVD-associated dementia. |
