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Research paper
Prevalence, risk factors and consequences of cerebral small vessel diseases: data from three Asian countries
  1. Saima Hilal1,2,
  2. Vincent Mok3,
  3. Young Chul Youn4,
  4. Adrian Wong3,
  5. Mohammad Kamran Ikram5,
  6. Christopher Li-Hsian Chen1,2
  1. 1 Memory Aging and Cognition Center, National University Health System, Singapore
  2. 2 Department of Pharmacology, National University of Singapore, Singapore
  3. 3 Therese Pei Fong Chow Research Center for Prevention of Dementia, LuiChe Woo Institute of Innovative Medicine, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
  4. 4 Department of Neurology, Chung-Ang University Hospital, Seoul, South Korea
  5. 5 Departments of Neurology and Epidemiology, Erasmus MC, Rotterdam, The Netherlands
  1. Correspondence to Professor Christopher Li-Hsian Chen, Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Level 4, Block MD3, 16 Medical Drive, Singapore 117600, Singapore; phccclh{at}


Background Cerebral small vessel disease (SVD) has been suggested to be more common in Asians compared with Caucasians. However, data from population-based studies in Asia are lacking. We report on the prevalence, risk factors and consequences of SVD from contemporary studies in three Asian countries using 3-Tesla MRI for the evaluation of SVD.

Methods Clinical, cognitive and 3-Tesla brain MRI assessments were performed among participants of three studies from Singapore, Hong Kong and Korea. SVD markers include white matter hyperintensities (WMHs) using the modified Fazekas scale, lacunes and microbleeds. Cognition was assessed using the Mini Mental Status Examination (MMSE) and Montreal Cognitive Assessment (MoCA). Adjustments were made for age, sex and cardiovascular risk factors.

Results A total of 1797 subjects were available for analysis (mean age: 70.1±6.3 years and 57% women). The prevalence of confluent WMH was 36.6%, lacunes, 24.6% and microbleeds, 26.9%. Presence of all three SVD markers showed a steeper increase with increasing age rising from 1.9% in the lowest to 46.2% in the highest 5-year age strata. The major risk factors for the increased severity of SVD markers were advancing age and hypertension. Moreover, increasing severity of SVD markers was independently associated with worse performance on MMSE and MoCA.

Conclusion Elderly Asians have a high burden of SVD which was associated with cognitive dysfunction. This suggests that SVD markers should be a potential target for treatment in clinical trials so as to delay progression of cerebrovascular disease and potentially cognitive decline.

  • Cerebral Small Vessel Disease
  • Asians
  • Cognitive impairment
  • Magnetic Resonance Imaging

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  • Contributors SH was responsible for the study concept and design, data acquisition, performed statistical analysis, drafting and revising the manuscript.

    YCY, AW and MKI participated in data acquisition and revised the manuscript for intellectual content.

    CL-HC and VM were responsible for the study concept and design, obtaining funding, drafting and revising the manuscript.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval Institutional review board.

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