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Research paper
Prevalence of hippocampal enlarged perivascular spaces in a sample of patients with hypertension and their relation with vascular risk factors and cognitive function
  1. Joan Jiménez-Balado1,
  2. Iolanda Riba-Llena1,
  3. Edurne Garde1,
  4. Marta Valor1,
  5. Belen Gutiérrez2,
  6. Francesc Pujadas2,
  7. Pilar Delgado1
  1. 1 Neurovascular Research Laboratory, Vall d’Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
  2. 2 Dementia Unit, Neurology Service, Vall d’Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
  1. Correspondence to Dr Pilar Delgado, Neurovascular Research Laboratory, Vall Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, CP 08035, Spain; pilar.delgado{at}


Objectives The clinical importance of hippocampal enlarged perivascular spaces (H-EPVS) remains uncertain. We aimed to study their association with vascular risk factors, cognitive function and mild cognitive impairment (MCI).

Methods Data were obtained from the ISSYS (Investigating Silent Strokes in hYpertensives, a magnetic resonance imaging Study) cohort, which is a prospective study of patients with hypertension aged 50–70 with no prior stroke or dementia. Participants were clinically evaluated and underwent a cognitive screening test, Dementia Rating Scale-2, which includes five cognitive subscales (attention, initiation/perseveration, conceptualisation, construction and memory). Besides, they were diagnosed with MCI or normal ageing following standard criteria. H-EPVS were manually counted on brain MRI according to a previous scale and defined as extensive when H-EPVS count was ≥7 (upper quartile). Multivariate models were created to study the relationship between H-EPVS, vascular risk factors and cognitive function.

Results 723 patients were included; the median age was 64 (59–67) and 51% were male. Seventy-two patients (10%) were diagnosed with MCI and 612 (84.6%) had at least 1 H-EPVS. Older age (OR per year=1.04, 95% CI 1.01 to 1.08) and poor blood pressure treatment compliance (OR=1.50, 95% CI 1.07 to 2.11) were independently associated with extensive H-EPVS. Regarding cognitive function, H-EPVS were independently and inversely correlated with verbal reasoning (β=−0.021, 95% CI −0.038 to −0.003). No association was found between H-EPVS and MCI.

Conclusions H-EPVS are a frequent finding in patients with hypertension and are associated with ageing and poor hypertension treatment compliance. Besides, H-EPVS are associated with worse verbal reasoning function.

  • enlarged perivascular spaces
  • cerebral small vessel disease
  • mild cognitive impairment
  • cognitive function
  • hypertension

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  • JJ-B and IR-L contributed equally.

  • Contributors PD, IR-Ll and JJ-B designed the study and selected the topic. IR-Ll and JJ-B contributed equally to this paper. All authors collaborated in the acquisition of data. PD, IR-Ll and JJ-B analysed and interpreted the data. JJ-B, IR-Ll, MV and EG wrote the manuscript. Finally, all authors have participated in the critical revision and the approval of this manuscript.

  • Funding This research has been funded by Instituto de Salud Carlos III (grant numbers: PI14/01535, ICI14/307, CP15/00010 and JR15/00032) and AGAUR (FI_DGR 2017, grant number 2017FI_B_00064), and cofinanced by the European Regional Development Fund. The neurovascular research lab receive funds from Spanish research stroke network (RD/16/0019/0021).

  • Competing interests None declared.

  • Ethics approval Local ethics committee (PR(IR)87/2010).

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