Cerebral small vessel disease and multiple sclerosis: Similarities and differences

At the end of the last century, it was realized that not only damage to the gray matter of the brain causes cognitive decline, but also damage to the white matter can lead to a decrease in cognitive abilities of high severity, up to dementia. Modern neuroimaging has played a crucial role in the recognition of white matter pathology and its association with cognitive impairment. There are over 100 disorders (genetic and acquired) in which white matter dysfunction can potentially cause or contribute to dementia. The most common diseases of the white matter which predict cognitive impairment (white matter dementia) are cerebral small vessel disease and multiple sclerosis. At first glance, diseases have various triggering and pathogenetic factors. But modern science finds significant similarities between “purely vascular” and immune-mediated diseases. This paper provides a review of literature from the databases eLibrary.Ru, CyberLeninka, PubMed, Scopus, Embase, Medline, Web of Science, Cochrane and Google Scholar with the key terms “cognitive impairment”, “dementia”, “white matter diseases”, “cerebral small vessel disease”, “multiple sclerosis”. It has now been established that inflammation is an integral factor in the pathogenesis of cerebral small vessel disease, and the vascular factor is a constant participant in the pathogenesis of multiple sclerosis. These diseases may have similarities in clinical manifestation and neuroimaging. The review analyzes the available data on the coincidences and differences in the clinical picture and instrumental diagnosis of these diseases, which will allow for targeted prevention of disease progression and cognitive decline.