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Research paper
Cerebral microbleeds and neuropsychiatric symptoms in an elderly Asian cohort
  1. Xin Xu1,2,
  2. Qun Lin Chan1,2,
  3. Saima Hilal1,2,
  4. Win King Goh1,2,
  5. Mohammad Kamran Ikram3,
  6. Tien Yin Wong4,5,
  7. Ching-Yu Cheng5,
  8. Christopher Li-Hsian Chen1,2,
  9. Narayanaswamy Venketasubramanian2,6
  1. 1Department of Pharmacology, National University of Singapore, Singapore, Singapore
  2. 2Memory Aging and Cognition Centre, National University Health System, Singapore, Singapore
  3. 3Departments of Epidemiology & Neurology, Erasmus Medical Centre, Rotterdam, The Netherlands
  4. 4Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
  5. 5Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
  6. 6Raffles Neuroscience Centre, Raffles Hospital, Singapore, Singapore
  1. Correspondence to Dr Christopher Li-Hsian Chen, Department of Pharmacology, National University Health System, Clinical Research Centre, MD3, #04-01, 16 Medical Drive, Singapore 117600, Singapore; phccclh{at}


Objectives Neuropsychiatric symptoms (NPS) are commonly found in patients with cerebral small vessel disease such as white matter hyperintensities and lacunar infarcts. However, the association between cerebral microbleeds (CMBs) and NPS has not been examined. Hence the present study sought to investigate the relation between CMBs and NPS in an elderly population.

Methods This is a cross-sectional study of elderly Asians living in the community, who were assessed on a comprehensive neuropsychological battery and underwent clinical examinations as well as brain MRI scans. The 12-item neuropsychiatric inventory (NPI) was administered to a reliable informant. Total scores for individual symptoms and for NPI global performance were calculated and compared across three groups: no CMB, presence of 1 CMB and presence of multiple CMBs, controlling for demographics, vascular risk factors and other MRI markers.

Results A total of 802 participants were included in the analysis. Participants with multiple CMBs had higher NPI total score compared to those with no CMB (1.06 vs 2.66, p=0.03). On individual symptom scores, higher score on depression (0.16 vs 0.53, p=0.02) and disinhibition (0.01 vs 0.14, p=0.04) was found in those elderly with multiple CMBs, independent of demographic and vascular risk factors, history of stroke, and other small vessel and large vessel disease markers.

Conclusions The presence of multiple CMBs is associated with high global neuropsychiatric disorder burden, in particular symptoms of depression and disinhibition. Future studies are recommended to investigate the importance of CMBs in the pathogenesis and longitudinal progression of neuropsychiatric disorders in the general elderly population.

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  • Contributors XX designed the study, analysed the data and drafted the manuscript. QLC, SH and WKG participated in the data acquisition and revised the paper. MKI, TYW and C-YC revised the paper. CL-HC and NV designed the study, provided supervision and were involved in critical revision of the manuscript.

  • Funding National Medical Research Council (NMRC/CG/NUHS/2010, NMRC/CSA/038/2013).

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval National Healthcare Group Domain-Specific Review Board and Singapore Eye Research Institute.

  • Provenance and peer review Not commissioned; externally peer reviewed.