Subjective cognitive impairment in patients with cerebral microangiopathy

OBJECTIVE: To assess the prevalence and neuropsychological status and identify tests to differentiate between subjective cognitive disorders (subCDs) in cerebral microangiopathy (CMA). MATERIAL AND METHODS: 330 patients with CMA (STRIVE MRI criteria, 2013) with cognitive symptoms who underwent neurological examination and neuropsychological testing from 2016 to 2024 were included. SubCR (MoCA ≥26 points) was diagnosed in 110 patients. Eighty patients and 44 healthy volunteers underwent extensive neuropsychological testing. ROC analysis and binary logistic regression were used to assess test performance in differentiating subCR patients from controls and to estimate the risk of progression. RESULTS: SubCR patients accounted for 33% of all patients with CMA-related CRs. The Trail Making Test (TMT-B) and the Montreal Cognitive Assessment (MoCA) have shown benefits in differentiating subCR patients from controls. Separation of subCR patients by the TMT-B threshold identified groups with and without abnormalities: subCR (≤89 sec; 31%) and subCR+ (≥90 sec; 69%). Microstructural changes in the corpus callosum showed statistically significant differences from controls and between the subCR and subCR+ groups, with increased severity and prevalence from forceps minor in subCR to forceps major in subCR+. CONCLUSIONS: 33% of CMA patients have SubCR. The MoCA score and the TMT-B test can be used to diagnose these conditions and assess the risk of progression. In subCR patients, the presence of MRI signs of brain damage and microstructural changes that distinguish them from the healthy and increase in severity and prevalence from the group of patients with adequate performance in the test (subCR) to the group with abnormalities (subCR+) are associated with the risks of progression and the need for treatment and follow-up assessment to determine the CR severity and the treatment effectiveness.