Associations between structural brain alterations and dysfunction across cognitive domains in cerebral small vessel disease: A systematic review and meta-analysis

Cerebral small vessel disease (CSVD) is a primary contributor to vascular cognitive impairment. Although extensive research has examined white matter alterations in CSVD, cortical mechanisms underlying cognitive dysfunction remain incompletely characterized. To address this gap, we conducted a systematic review and meta-analysis of 26 studies investigating whether structure-cognition relationships in CSVD could be interpreted through biologically defined functional brain networks. By mapping structural features to the Yeo-7 functional atlas, we offer a network-based perspective on cognitive impairment in this population. Our integrated results demonstrate significant associations between structural alterations and all cognitive domains in CSVD patients. Notably, higher-order cognitive processes (e.g., executive function, attention and processing speed) involved more extensive functional networks than other domains. These findings help synthesize heterogeneous neuroanatomical literature on CSVD through contemporary network neuroscience frameworks, suggesting structure-cognition relationships may align with functional network architecture.