Cerebral small vessel disease and cognition in older adults across the neurodegenerative spectrum: insights from the COMPASS‐ND study

INTRODUCTION: Imaging-based cerebral small vessel disease (CSVD) summary scores quantify CSVD burden. This study characterized CSVD scores and assessed their cognitive associations in older adults with various neurodegenerative diseases and cognitive profiles. METHODS: Baseline data from 958 Comprehensive Assessment of Neurodegeneration and Dementia (COMPASS-ND) study participants were analyzed (19.4% cognitively normal, 14.9% subjective cognitive decline, 40.3% mild cognitive impairment, 25.4% dementia). MRI markers of cerebral vascular injury (lacunes, microbleeds, white matter hyperintensities WMHs, and enlarged perivascular spaces) were visually rated, and a cumulative CSVD score was generated. Cognition was measured using the Montreal Cognitive Assessment (MoCA), Clinical Dementia Rating-Sum of Boxes (CDR-SB), and a composite neuropsychological battery test z-score. RESULTS: Higher CSVD scores were associated with greater Hachinski ischemic scores, poorer MoCA performance, worse CDR-SB, and lower composite z-scores. Associations were strongest for cognitive domains of executive function, attention, and learning. DISCUSSION: CSVD burden may further contribute to poorer cognition across neurodegenerative conditions and cognitive profiles.