Lower cerebral blood flow predicts cognitive decline in patients with vascular cognitive impairment

INTRODUCTIONChronic cerebral hypoperfusion is one of the assumed pathophysiological mechanisms underlying vascular cognitive impairment (VCI). We investigated the association between baseline cerebral blood flow (CBF) and cognitive decline after 2 years in patients with VCI and reference participants. METHODSOne hundred eighty-one participants (mean age 66.3 & PLUSMN; 7.4 years, 43.6% women) underwent arterial spin labeling (ASL) magnetic resonance imaging (MRI) and neuropsychological assessment at baseline and at 2-year follow-up. We determined the association between baseline global and lobar CBF and cognitive decline with multivariable regression analysis. RESULTSLower global CBF at baseline was associated with more global cognitive decline in VCI and reference participants. This association was most profound in the domain of attention/psychomotor speed. Lower temporal and frontal CBF at baseline were associated with more cognitive decline in memory. DISCUSSIONOur study supports the role of hypoperfusion in the pathophysiological and clinical progression of VCI. HighlightsImpaired cerebral blood flow (CBF) at baseline is associated with faster cognitive decline in VCI and normal aging.Our results suggest that low CBF precedes and contributes to the development of vascular cognitive impairment.CBF determined by ASL might be used as a biomarker to monitor disease progression or treatment responses in VCI.