Magnetic Resonance Imaging- Derived Cerebral Small Vessel Disease Burden and Association with Domain-Specific Cognition: A Cross-Sectional Study

Abstract Background and Objectives: Cerebral small vessel disease (CSVD) is a leading contributor to vascular cognitive impairment; yet, its domain-specific correlates remain underexplored. The study aims to examine the relationship between magnetic resonance imaging (MRI)-defined CSVD burden and neuropsychological performance across cognitive domains in a middle-aged Indian cohort. Methods: A total of 45 participants were enrolled and underwent standardized brain MRI and neuropsychological testing. White matter hyperintensity severity was rated using the Fazekas scale, simple and amended CSVD (aSVD) scores. Cognitive assessment spanned Mini-Mental State Examination, Montreal Cognitive Assessment (MoCA), attention and vigilance, processing speed, working memory, executive control, inhibitory control, verbal fluency (category, lexical, ideational, design), verbal learning and memory, visuospatial construction, and motor domains. The associations between MRI indices and cognitive performance were analyzed using Pearson and partial correlations adjusted for age and education. Vascular risk-factor effects were assessed using Mann–Whitney U tests and multivariable linear regression. Results: Mean ± standard deviation values for Fazekas, simple CSVD, and aSVD scores were 1.78 ± 0.9, 1.18 ± 1.0, and 3.44 ± 1.8, respectively. Hypertension was significantly associated with a higher lesion burden across all indices ( P < 0.05). The aSVD score demonstrated the strongest correlations with MoCA (r = −0.68), verbal memory (r = −0.62), and executive fluency measures (r = –0.60), whereas design fluency showed weaker associations (r ≈ −0.30). Conclusions: Even modest MRI-visible CSVD in mid-life was associated with early, domain-specific inefficiencies, particularly in executive, processing speed, and memory-related functions, consistent with frontal– subcortical disconnection. When compared to traditional scales, the small vessel disease (SVD ) scores increased sensitivity, offering a useful MRI-based indicator of early cognitive vulnerability. These findings highlight the importance of early identification and vascular risk profiling in individuals with CSVD.