Severe Perivascular Space Pathology Predictive of Dementia in Older Adults

Human brain scan being analysed in a neurology clinic.
A team of researchers assessed the relationship between severe perivascular space pathology and risk for cognitive decline in older adults.

In adults between 72 and 92 years of age, severe perivascular space (PVS) dilation pathology is predictive of increased risk of cognitive decline and dementia, according to study results published in Neurology.

The study included 414 community dwelling older adults between the ages of 72 and 92 years (mean age, 79.8 years) who were part of the population-based Sydney Memory and Ageing study. Participants underwent cognitive assessments and 3T MRI imaging and were assessed for consensus dementia diagnoses at baseline and once every 2 years for up to 8 years.

The study researchers counted the number of PVS in 2 representative slices in the basal ganglia (BG) and centrum semiovale (CSO), and defined severe PVS pathology as the top quartile. They also examined the effects of severe PVS in either BG or CSO regions, both regions, and in patients with severe BG and/or severe CSO PVS.

Approximately 38% (n=157) of participants in the study had severe PVS pathology in either region, while 7% (n=32) had severe pathology in both regions, 22% (n=90) had severe BG PVS pathology, and 24% (n=99) had severe CSO PVS pathology.

Participants with severe BG PVS had significantly greater white matter hyperintensities volume (P =.004) and were significantly more likely to present with lacunes (17% vs 6%, respectively; P =.002) and multiple cerebral microbleeds (23% vs 9%, respectively; P =.002) compared with participants with absent/mild BG PVS.

In an analysis adjusted for all covariates, participants with severe PVS pathology in both regions had a more rapid decline in global cognition compared with participants with less severe pathology (P =.020).

Participants with severe PVS pathology in both regions were also more likely to have dementia across the 8-year follow-up period (odds ratio [OR], 2.91; 95% CI, 1.43-5.95; P =.003). In addition, the presence of severe PVS pathology was associated with a greater risk of dementia at either 4 years (OR, 4.75; 95% CI, 1.51-14.95; P =.008) or 6 years (OR, 5.44; 95% CI, 1.31-22.61; P =.020) across all groups.

Limitations of this study included the lack of a longer-term follow up as well as the availability of detailed cognitive data for only 4 years compared with the follow-up period of 8 years.

Based on their findings, the study researchers concluded that “further research is needed into the etiology and sequelae of PVS pathology since PVS may be an important potential biomarker to help with early dementia diagnosis, prognosis and subtyping.”


Paradise M, Crawford JD, Lam BCP, et al. The association of dilated perivascular spaces with cognitive decline and incident dementia. Published online January 27, 2021. Neurology. doi:10.1212/WNL.0000000000011537