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Abstract
Background: Cerebral small vessel disease (CSVD) is a leading cause of stroke, cognitive decline, and functional impairment in older adults. White matter hyperintensities (WMH) and cerebral atrophy are key MRI markers of small vessel injury, yet their interrelationship remains incompletely understood, especially in South Asian populations.
Objective: To evaluate the association between cerebral atrophy and white matter disease burden in patients with MRI evidence of CSVD.
Methods: This retrospective cross-sectional study included 208 consecutive patients with CSVD on brain MRI at Lady Reading Hospital, Peshawar (Sep 2022–Dec 2023). Exclusion criteria included large territorial infarcts, mass lesions, or demyelinating disease. WMH were graded using the Fazekas scale (1–3), and cerebral atrophy was categorized as mild, moderate, or severe. Demographic and clinical data, including age, sex, hypertension, and diabetes mellitus, were recorded. Associations between atrophy grade and Fazekas score were assessed using chi-square and Spearman correlation. Ordinal logistic regression adjusted for age and vascular risk factors.
Results: Among 208 patients (mean age 64.3 ± 11.8 years; 53.8% males), cerebral atrophy was present in 124 (59.6%) and moderate-to-severe WMH (Fazekas 2–3) in 130 (62.5%). Fazekas score was significantly associated with atrophy grade (χ² = 20.23, df = 6, p = 0.003) and showed a weak but positive monotonic correlation (Spearman’s rs = 0.195, p = 0.005). On multivariable ordinal logistic regression, higher Fazekas scores and increasing age independently predicted more severe atrophy (adjusted OR for Fazekas 1 vs 3 = 0.36, 95% CI: 0.18–0.74; Fazekas 2 vs 3 = 0.44, 95% CI: 0.23–0.88; age OR per year = 1.06, p < 0.001), whereas hypertension and diabetes were not independently associated.
Conclusion: Cerebral atrophy is significantly associated with WMH burden in CSVD, supporting a shared microvascular pathophysiology. Assessment of both markers on MRI may facilitate early identification of patients at risk for vascular cognitive decline.