Enlarged perivascular spaces in subcortical white matter are linked to amyloid–tau depositions and cognitive decline: Data from a memory clinic in Thailand

INTRODUCTION Enlarged perivascular spaces (EPVSs) have been implicated in Alzheimer's disease (AD) pathogenesis, but their relationships with amyloid beta (Aβ) and tau pathology remain unclear. METHODS We conducted a cross‐sectional study of 51 patients with amnestic mild cognitive impairment or mild dementia from a memory clinic in Thailand. EPVS severity in centrum semiovale (CSO) and basal ganglia (BG) was rated on T1‐weighted magnetic resonance imaging. Aβ burden and tau deposition were assessed using positron emission tomography imaging. Cognitive change was measured using longitudinal Montreal Cognitive Assessment (MoCA) scores. RESULTS Higher CSO‐EPVS severity was associated with greater Aβ and tau burden, particularly when CSO‐EPVS exceeded BG‐EPVS severity. No significant associations were observed for BG‐EPVS. Greater CSO‐EPVS severity was also linked to greater decline in follow‐up MoCA scores. DISCUSSION CSO‐EPVS may reflect region‐specific processes linked to AD pathology, while their association with cognitive decline may be mediated by underlying amyloid and tau burden.