Disrupted emotional resilience and neurovisceral integration in early small vessel disease

Background Cerebral small vessel disease (SVD) is a major cause of cognitive decline and late-life depression, yet its early affective markers are poorly understood. Ageing is typically associated with enhanced emotion regulation, including greater differentiation of affective states and a shift toward positivity. Whether SVD disrupts these resilience mechanisms before overt clinical impairment is unknown. Methods Eighty-two adults were studied: young (n=22) and middle-aged (n=23) adults without brain abnormalities, and middle-aged adults with early SVD (n=37). Participants completed an ecologically grounded social emotion fMRI paradigm and self-report questionnaires of interoceptive and emotional awareness. Group differences in emotional differentiation, positivity, and neurovisceral integration were analysed to assess the effects of healthy ageing and early SVD. Results Compared with young adults, middle-aged adults without SVD showed preserved emotional differentiation, positivity bias, and intact neurovisceral integration. In contrast, early SVD was associated with reduced emotional differentiation, loss of the age-related positivity effect, and altered insular encoding of arousal. Impaired neurovisceral integration translated into diminished heart rate adaptation during sustained emotional processing. Self-report alexithymia ratings and interoceptive profiles further indicated reduced emotional awareness and embodied self-regulation in adults with SVD. These effects persisted after adjustment for cognition, cardiovascular risk factors, depression, and anxiety. Conclusions Early SVD is associated with affective–interoceptive disintegration evident across behavioural, neural, and physiological levels. Altered embodied regulation of emotion may constitute an early marker of vascular brain injury and a target for preventative interventions.