Publication:

Cerebral small vessel disease in an Indian cohort: magnetic resonance imaging burden, clinical profiles and risk factor associations

Background Cerebral small vessel disease (CSVD) is a major contributor to stroke, cognitive impairment, gait disturbances, and disability. Given its high burden and multifaceted clinical impact, CSVD has emerged as a critical public health concern. There is limited understanding of how radiological markers of CSVD correlate with clinical manifestations in Indian populations, which may differ from Western cohorts due to genetic, lifestyle, and environmental influences.

Methods This observational, cross-sectional study included 85 adults with magnetic resonance imaging (MRI) evidence of at least one CSVD marker. Clinical assessment included cognition, gait, Parkinsonism, vascular risk factors, and stroke subtypes. MRI markers were classified per STRIVE criteria, and cumulative burden quantified using the total SVD score. Associations between radiological markers and clinical outcomes were evaluated using appropriate statistical tests.

Results Lacunes (76.5%) and WMH (75.3%) were the most frequent markers, followed by CMB (42.4%), PVERSUS (30.6%), and RSSI (14.1%). Dementia was significantly more common in patients with lacunes (26.1% versus 5%; p=0.043) and WMH (25.6% versus 4.7%; p=0.034). CMB were strongly associated with Parkinsonism (36.1% versus 14.3%; p=0.019) and gait abnormalities (27.8% versus 10.2%; p=0.036). Higher SVD scores correlated with cerebral atrophy (68.9% versus 32.5%; p=0.001) and greater clinical impairment. Acute infarcts clustered with RSSI (50% versus 21.9%) and high SVD burden.

Conclusion This study demonstrates substantial CSVD burden in an Indian cohort and highlights strong clinical–radiological correlations. Findings reinforce CSVD as a whole-brain, cumulative microvascular disorder with significant cognitive and motor implications.