Abstract TP105: Association of Cerebral Small Vessel Disease Burden and Cognitive Impairment in Patients with Unruptured Intracranial Aneurysms

Objective: Patients with unruptured intracranial aneurysms (UIAs) often experience cognitive decline. Cerebral small vessel disease is one of the important causes of cognitive impairment. This study investigates the clinical factors and magnetic resonance imaging (MRI) characteristics of cerebral small vessel disease (SVD) burden associated with cognitive impairment in patients with UIAs. Methods: We retrospectively analyzed patients with UIAs treated at our hospital between 2018 and 2023. Clinical data, MRI, and cognitive function assessments were evaluated. MRI sequences included T1-weighted, T2-weighted, fluid-attenuated inversion recovery, diffusion-weighted imaging, and susceptibility-weighted imaging. Cerebral MRIs were assessed for lacunes, white matter hyperintensities (WMH), cerebral microbleeds (CMBs), and perivascular spaces (PVS). The total SVD score was calculated using the presence of each SVD feature. Cognitive impairment was defined as a Montreal Cognitive Assessment (MoCA) score of less than 26. We explored the associations between clinical features, aneurysm characteristics, MRI-based SVD markers, and total SVD scores with cognitive impairment. Results: The study included 171 patients with UIAs who underwent both multimodal MR imaging and cognitive assessments. The average age was 58.0 years, with 59% being women. The mean aneurysm size was 4.9 mm, and 43 patients had aneurysms larger than 7 mm. Among the participants, 156 had saccular aneurysms, 59 had irregular aneurysm morphology, and 38 had multiple aneurysms. The SVD markers of lacunes, WMH, CMBs, and PVS were present in 43.9%, 18.7%, 13.5%, and 28.1% of patients, respectively. The total SVD score was 1.00 (0.00-2.00). Cognitive impairment was observed in 74.9% of patients. Multivariate logistic regression identified lacunes (OR 4.805, 95% CI 2.069-11.162, p<0.001), WMH (OR 6.276, 95% CI 1.433-27.487, p=0.015), and PVS (OR 3.012, 95% CI 1.179-7.696, p=0.021) and CSVD score (OR 2.163, 95% CI 1.401-3.341, p=0.001) as independent risk factors for cognitive impairment. Linear regression showed that hypertension and age were positively correlated with CSVD score. Conclusions: Total SVD score on MRI is an independent risk factor for cognitive impairment in patients with UIAs. Hypertension positively correlates with cerebral small vessel disease burden, indicating its importance in preventing cognitive impairment in the UIA patient population.