NEUROLOGY / SYSTEMATIC REVIEW/META-ANALYSIS
The associations between Enlarged Perivascular Spaces and partial Clinical symptoms: a meta-analysis
More details
Hide details
1
Hebei General Hospital, China
Submission date: 2022-05-12
Final revision date: 2022-07-23
Acceptance date: 2022-08-24
Online publication date: 2022-09-09
Publication date: 2026-07-31
KEYWORDS
TOPICS
ABSTRACT
Introduction:
Enlarged perivascular spaces (EPVS) are ubiquitous in the elderly and have insidious onset characteristics. Its correlation with clinical symptoms is easily overlooked and controversial. The related clinical symptoms that EPVS may cause were studied using Meta-analysis.
Material and methods:
Relevant studies up to April 2022 were extracted from PubMed, Embase, Cochrane, OVID, and Web of Science. Odds ratios (ORs) and 95% confidence interval (CI) were used to estimate the strength of the correlation.
Results:
Of the 6622 articles identified, 32 studies were eligible, enrolling a total of 19987 people. EPVS was associated with the risk of cognitive impairment (OR: 1.60, 95 % CI: 1.39- 1.81), motor impairment (OR: 2.24, 95 % CI: 1.22- 3.25), sleep disturbance (OR: 1.81, 95% CI: 1.34-2.28), depressive symptoms (OR: 1.54, 95 % CI: 1.14- 1.95), but was not significantly associated with the occurrence of stroke ( OR: 0.97, 95 % CI: 0.74-1.21). Results of subgroup analysis showed that basal ganglia (BG) EPVS were more associated with cognitive impairment (OR: 2.19, 95% CI: 1.72- 2.65) and sleep disturbance(OR: 1.74, 95 % CI: 1.20- 2.29).
Conclusions:
Our findings suggested that people with EPVS may be at a greater risk for cognitive impairment, motor impairment, sleep disturbance, and depressive symptoms. This will inform future treatments.
REFERENCES (59)
1.
BROWN R, BENVENISTE H, BLACK S E, et al. Understanding the role of the perivascular space in cerebral small vessel disease [J]. Cardiovasc Res, 2018, 114(11): 1462-1473.
2.
WANG X, CHAPPELL F M, VALDES HERNANDEZ M, et al. Endothelial Function, Inflammation, Thrombosis, and Basal Ganglia Perivascular Spaces in Patients with Stroke [J]. J Stroke Cerebrovasc Dis, 2016, 25(12): 2925-2931.
3.
DEBETTE S, SCHILLING S, DUPERRON M G, et al. Clinical Significance of Magnetic Resonance Imaging Markers of Vascular Brain Injury: A Systematic Review and Meta-analysis [J]. JAMA Neurol, 2019, 76(1): 81-94.
4.
WARDLAW J M, SMITH E E, BIESSELS G J, et al. Neuroimaging standards for research into small vessel disease and its contribution to ageing and neurodegeneration [J]. Lancet Neurol, 2013, 12(8): 822-838.
5.
RUDIE J D, RAUSCHECKER A M, NABAVIZADEH S A, et al. Neuroimaging of Dilated Perivascular Spaces: From Benign and Pathologic Causes to Mimics [J]. J Neuroimaging, 2018, 28(2): 139-149.
6.
DUBOST F, YILMAZ P, ADAMS H, et al. Enlarged perivascular spaces in brain MRI: Automated quantification in four regions [J]. Neuroimage, 2019, 185: 534-544.
7.
POTTER G M, CHAPPELL F M, MORRIS Z, et al. Cerebral perivascular spaces visible on magnetic resonance imaging: development of a qualitative rating scale and its observer reliability [J]. Cerebrovasc Dis, 2015, 39(3-4): 224-231.
8.
JIE W, LIN G, LIU Z, et al. The Relationship Between Enlarged Perivascular Spaces and Cognitive Function: A Meta-Analysis of Observational Studies [J]. Front Pharmacol, 2020, 11: 715.
9.
HEILAND E G, WELMER A K, KALPOUZOS G, et al. Cerebral small vessel disease, cardiovascular risk factors, and future walking speed in old age: a population-based cohort study [J]. BMC Neurol, 2021, 21(1): 496.
10.
LIANG Y, CHAN Y L, DENG M, et al. Enlarged perivascular spaces in the centrum semiovale are associated with poststroke depression: A 3-month prospective study [J]. J Affect Disord, 2018, 228: 166-172.
11.
RAMIREZ J, HOLMES M F, BEREZUK C, et al. MRI-visible perivascular space volumes, sleep duration and daytime dysfunction in adults with cerebrovascular disease [J]. Sleep Med, 2021, 83: 83-88.
12.
BURNETT M S, WITTE R J, AHLSKOG J E. Swiss cheese striatum: clinical implications [J]. JAMA Neurol, 2014, 71(6): 735-741.
13.
CHARIDIMOU A, MEEGAHAGE R, FOX Z, et al. Enlarged perivascular spaces as a marker of underlying arteriopathy in intracerebral haemorrhage: a multicentre MRI cohort study [J]. J Neurol Neurosurg Psychiatry, 2013, 84(6): 624-629.
14.
IADECOLA C. The pathobiology of vascular dementia [J]. Neuron, 2013, 80(4): 844-866.
15.
POSTRZECH-ADAMCZYK K, NAHORECKI A, JACKóW-NOWICKA J, et al. Magnetic resonance white matter changes in patients with obstructive sleep apnoea. The subset of the PURE-MIND (Prospective Urban and Rural Epidemiological) cohort study [J]. 2021.
16.
WARDLAW J M, BENVENISTE H, NEDERGAARD M, et al. Perivascular spaces in the brain: anatomy, physiology and pathology [J]. Nat Rev Neurol, 2020, 16(3): 137-153.
17.
FRANCIS F, BALLERINI L, WARDLAW J M. Perivascular spaces and their associations with risk factors, clinical disorders and neuroimaging features: A systematic review and meta-analysis [J]. Int J Stroke, 2019, 14(4): 359-371.
18.
VAN SLOTEN T T, SIGURDSSON S, VAN BUCHEM M A, et al. Cerebral Small Vessel Disease and Association With Higher Incidence of Depressive Symptoms in a General Elderly Population: The AGES-Reykjavik Study [J]. Am J Psychiatry, 2015, 172(6): 570-578.
19.
ZHANG X, TANG Y, XIE Y, et al. Total magnetic resonance imaging burden of cerebral small-vessel disease is associated with post-stroke depression in patients with acute lacunar stroke [J]. Eur J Neurol, 2017, 24(2): 374-380.
20.
YANG S, YIN J, QIN W, et al. Poor Sleep Quality Associated With Enlarged Perivascular Spaces in Patients With Lacunar Stroke [J]. Front Neurol, 2021, 12: 809217.
21.
ARBA F, QUINN T J, HANKEY G J, et al. Enlarged perivascular spaces and cognitive impairment after stroke and transient ischemic attack [J]. Int J Stroke, 2018, 13(1): 47-56.
22.
SIM J E, PARK M S, SHIN H Y, et al. Correlation Between Hippocampal Enlarged Perivascular Spaces and Cognition in Non-dementic Elderly Population [J]. Front Neurol, 2020, 11: 542511.
23.
BAKKER E N, BACSKAI B J, ARBEL-ORNATH M, et al. Lymphatic Clearance of the Brain: Perivascular, Paravascular and Significance for Neurodegenerative Diseases [J]. Cell Mol Neurobiol, 2016, 36(2): 181-194.
24.
STANG A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses [J]. Eur J Epidemiol, 2010, 25(9): 603-605.
25.
HIGGINS J P, THOMPSON S G. Quantifying heterogeneity in a meta-analysis [J]. Stat Med, 2002, 21(11): 1539-1558.
26.
ZHU Y C, DUFOUIL C, SOUMARE A, et al. High degree of dilated Virchow-Robin spaces on MRI is associated with increased risk of dementia [J]. J Alzheimers Dis, 2010, 22(2): 663-672.
27.
YAO M, ZHU Y C, SOUMARE A, et al. Hippocampal perivascular spaces are related to aging and blood pressure but not to cognition [J]. Neurobiol Aging, 2014, 35(9): 2118-2125.
28.
ARBA F, QUINN T, HANKEY G J, et al. Cerebral small vessel disease, medial temporal lobe atrophy and cognitive status in patients with ischaemic stroke and transient ischaemic attack [J]. Eur J Neurol, 2017, 24(2): 276-282.
29.
RIBA-LLENA I, NAFRIA C, MUNDET X, et al. Assessment of enlarged perivascular spaces and their relation to target organ damage and mild cognitive impairment in patients with hypertension [J]. Eur J Neurol, 2016, 23(6): 1044-1050.
30.
SHAMS S, MARTOLA J, CHARIDIMOU A, et al. Topography and Determinants of Magnetic Resonance Imaging (MRI)-Visible Perivascular Spaces in a Large Memory Clinic Cohort [J]. J Am Heart Assoc, 2017, 6(9): 6(9): e006279.
31.
YILMAZ P, IKRAM M K, NIESSEN W J, et al. Practical Small Vessel Disease Score Relates to Stroke, Dementia, and Death [J]. Stroke, 2018, 49(12): 2857-2865.
32.
XIONG L, BOULOUIS G, CHARIDIMOU A, et al. Dementia incidence and predictors in cerebral amyloid angiopathy patients without intracerebral hemorrhage [J]. J Cereb Blood Flow Metab, 2018, 38(2): 241-249.
33.
BANERJEE G, CHAN E, AMBLER G, et al. Effect of small-vessel disease on cognitive trajectory after atrial fibrillation-related ischaemic stroke or TIA [J]. J Neurol, 2019, 266(5): 1250-1259.
34.
PARADISE M, CRAWFORD J D, LAM B C P, et al. Association of Dilated Perivascular Spaces With Cognitive Decline and Incident Dementia [J]. Neurology, 2021, 96(11): e1501-e1511.
35.
LIOUTAS V A, WU B, NORTON C, et al. Cerebral small vessel disease burden and functional and radiographic outcomes in intracerebral hemorrhage [J]. J Neurol, 2018, 265(12): 2803-2814.
36.
WAN Y, HU W, GAN J, et al. Exploring the association between Cerebral small-vessel diseases and motor symptoms in Parkinson's disease [J]. Brain Behav, 2019, 9(4): e01219.
37.
DEL BRUTTO O H, PEINADO C D, MERA R M, et al. Neuroimaging signatures of cerebral small vessel disease and risk of falls in stroke-free older adults living in rural Ecuador. The Atahualpa Project [J]. J Neurol Sci, 2019, 402: 133-135.
38.
SONG T J, PARK J H, CHOI K H, et al. Moderate-to-severe obstructive sleep apnea is associated with cerebral small vessel disease [J]. Sleep Med, 2017, 30: 36-42.
39.
DEL BRUTTO O H, MERA R M, DEL BRUTTO V J, et al. Enlarged basal ganglia perivascular spaces and sleep parameters. A population-based study [J]. Clin Neurol Neurosurg, 2019, 182: 53-57.
40.
DEL BRUTTO O H, MERA R M, DEL BRUTTO V J, et al. Lack of Association between Periodic Limb Movements during Sleep and Neuroimaging Signatures of Cerebral Small Vessel Disease in Stroke-Free Community-Dwelling Older Adults. The Atahualpa Project [J]. J Stroke Cerebrovasc Dis, 2020, 29(2): 104497.
41.
ARIBISALA B S, RIHA R L, VALDES HERNANDEZ M, et al. Sleep and brain morphological changes in the eighth decade of life [J]. Sleep Med, 2020, 65: 152-158.
42.
WANG J, CHEN X, LIAO J, et al. Non breathing-related sleep fragmentation and imaging markers in patients with atherosclerotic cerebral small vessel disease (CSVD): a cross-sectional case-control study [J]. BMC Neurol, 2020, 20(1): 98.
43.
GUTIERREZ J, ELKIND M S V, DONG C, et al. Brain Perivascular Spaces as Biomarkers of Vascular Risk: Results from the Northern Manhattan Study [J]. AJNR Am J Neuroradiol, 2017, 38(5): 862-867.
44.
LAU K K, LI L, LOVELOCK C E, et al. Clinical Correlates, Ethnic Differences, and Prognostic Implications of Perivascular Spaces in Transient Ischemic Attack and Ischemic Stroke [J]. Stroke, 2017, 48(6): 1470-1477.
45.
ZHANG J, HAN F, LIANG X, et al. Lacune and Large Perivascular Space: Two Kinds of Cavities Are of Different Risk Factors and Stroke Risk [J]. Cerebrovasc Dis, 2020, 49(5): 522-530.
46.
XU M, CHENG Y, ZHANG S, et al. Higher cerebral small vessel disease burden is associated with smaller hematoma volume in mixed-location intracerebral hemorrhage [J]. Microcirculation, 2021, 28(6): e12705.
47.
SONG Q, CHENG Y, WANG Y, et al. Enlarged perivascular spaces and hemorrhagic transformation after acute ischemic stroke [J]. Ann Transl Med, 2021, 9(14): 1126.
48.
LIM J S, KIM N, JANG M U, et al. Cortical hubs and subcortical cholinergic pathways as neural substrates of poststroke dementia [J]. Stroke, 2014, 45(4): 1069-1076.
49.
RASMUSSEN M K, MESTRE H, NEDERGAARD M. The glymphatic pathway in neurological disorders [J]. Lancet Neurol, 2018, 17(11): 1016-1024.
50.
XIE L, KANG H, XU Q, et al. Sleep drives metabolite clearance from the adult brain [J]. Science, 2013, 342(6156): 373-377.
51.
KANG M K, KOO D L, SHIN J H, et al. Association between periodic limb movements during sleep and cerebral small vessel disease [J]. Sleep Med, 2018, 51: 47-52.
52.
BEREZUK C, RAMIREZ J, GAO F, et al. Virchow-Robin Spaces: Correlations with Polysomnography-Derived Sleep Parameters [J]. Sleep, 2015, 38(6): 853-858.
53.
ILIFF J J, LEE H, YU M, et al. Brain-wide pathway for waste clearance captured by contrast-enhanced MRI [J]. J Clin Invest, 2013, 123(3): 1299-1309.
54.
ILIFF J J, WANG M, LIAO Y, et al. A paravascular pathway facilitates CSF flow through the brain parenchyma and the clearance of interstitial solutes, including amyloid β [J]. Sci Transl Med, 2012, 4(147): 147ra111.
55.
PINTER D, RITCHIE S J, DOUBAL F, et al. Impact of small vessel disease in the brain on gait and balance [J]. Sci Rep, 2017, 7: 41637.
56.
PATANKAR T F, BALDWIN R, MITRA D, et al. Virchow-Robin space dilatation may predict resistance to antidepressant monotherapy in elderly patients with depression [J]. J Affect Disord, 2007, 97(1-3): 265-270.
57.
SHI Y, XIANG Y, YANG Y, et al. Depression after minor stroke: Prevalence and predictors [J]. J Psychosom Res, 2015, 79(2): 143-147.
58.
ZHANG Y, WANG C, SUN C, et al. Neural complexity in patients with poststroke depression: A resting EEG study [J]. J Affect Disord, 2015, 188: 310-318.
59.
BOESPFLUG E L, SCHWARTZ D L, LAHNA D, et al. MR Imaging-based Multimodal Autoidentification of Perivascular Spaces (mMAPS): Automated Morphologic Segmentation of Enlarged Perivascular Spaces at Clinical Field Strength [J]. Radiology, 2018, 286(2): 632-642.