ABSTRACT NUMBER: ESOC2026A1860 DISTINCT HEMODYNAMIC TRAJECTORIES TO TRANSCRANIAL DOPPLER SONOGRAPHY IN PATIENTS WITH VASCULAR COGNITIVE IMPAIRMENT AND IN COGNITIVELY INTACT ELDERLY SUBJECTS WITH WHITE MATTER LESIONS

Abstract Background and aims Cerebral small vessel disease underlies both vascular cognitive impairment (VCI) and the common occurrence of white matter lesions (WMLs) to MRI in subjects without overt cognitive deficits. However, distinguishing pathological progression from age-related changes remains a diagnostic challenge. We compared longitudinal cognitive and transcranial Doppler (TCD) hemodynamics in VCI patients and in cognitively intact elderly subjects with WMLs (non-VCI). Methods 127 VCI and 83 non-VCI with MRI-documented WMLs underwent baseline and follow-up evaluations after 23.1 ± 6.5 months, including clinical assessment, neuropsychological testing focusing on executive functions and depressive symptoms, and TCD. Mean blood flow velocity (MBFV), peak systolic velocity (PSV), end-diastolic velocity (EDV), pulsatility index (PI), and resistivity index (RI) were measured. Repeated-measures ANOVA tested longitudinal changes and group interactions. Results Both groups exhibited cognitive decline over time, although with significantly worse performance in VCI. MBFV and EDV decreased in both groups, with a steeper decline in non-VCI, resulting in convergence with VCI values at follow-up. PSV showed opposite trajectories, decreasing in non-VCI and increasing in VCI. PI increased similarly in both groups, whereas RI showed a significantly greater and persistent increase in VCI. Significant group-by-time interactions were observed across major hemodynamic parameters. Conclusions Overall, TCD changes were more pronounced in VCI than those simply expected by age in cognitively intact subjects with WMLs. Persistent elevation of RI reflects sustained microvascular resistance and might represent an early marker of cognitive progression in VCI. TCD is a valuable diagnostic tool for identifying VCI-related hemodynamic dysfunction beyond the presence of WMLs without cognitive impairment. Conflict of interest Mariagiovanna Cantone: nothing to disclose; Francesco Fisicaro: nothing to disclose; Manuela Pennisi: nothing to disclose; Klizia Cortese: nothing to disclose; Giuseppe Lanza: nothing to disclose; Rita Bella: nothing to disclose.