Cerebral perivascular spaces as predictors of dementia risk and accelerated brain atrophy

Motivation: It is unclear whether PVS can predict dementia risk and brain atrophy trajectories in non-demented individuals. The PVS longitudinal evolution is also unexplored. Goal(s): We analyzed PVS count and size on clinical MRI and investigated their relationship with dementia risk and brain atrophy, and their longitudinal evolution. Approach: We analyzed 46,478 clinical measurements of cognitive functioning and 20,845 brain MRI scans from 10,004 participants from three observational studies on aging. Results: Fewer PVS and larger PVS diameter at baseline predicted higher dementia risk and accelerated brain atrophy. Longitudinal trajectories of PVS markers differed significantly in individuals who converted to dementia compared with non-converters. Impact: The early identification of individuals at increased risk of dementia according to our PVS markers may enhance the power of clinical trials targeting cognitive decline and enable clinicians to inform patients about their risk and to implement timely support.