Neuropsychiatric symptoms as a sign of small vessel disease progression in cognitive impairment

Una Clancy, Joel Ramirez*, Francesca M. Chappell, Fergus N. Doubal, Joanna M. Wardlaw, Sandra E. Black

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Background: Neuropsychiatric symptoms associate cross-sectionally with cerebral small vessel disease but it is not clear whether these symptoms could act as early clinical markers of small vessel disease progression. We investigated whether longitudinal change in Neuropsychiatric Inventory (NPI) scores associated with white matter hyperintensity (WMH) progression in a memory clinic population. Material and methods: We included participants from the prospective Sunnybrook Dementia Study with Alzheimer's disease and vascular subtypes of mild cognitive impairment and dementia with two MRI and ≥ 1 NPI. We conducted linear mixed-effects analyses, adjusting for age, atrophy, vascular risk factors, cognition, function, and interscan interval. Results: At baseline (n=124), greater atrophy, age, vascular risk factors and total NPI score were associated with higher baseline WMH volume, while longitudinally, all but vascular risk factors were associated. Change in total NPI score was associated with change in WMH volume, χ2 = 7.18, p = 0.007, whereby a one-point change in NPI score from baseline to follow-up was associated with a 0.0017 change in normalized WMH volume [expressed as cube root of (WMH volume cm³ as % intracranial volume)], after adjusting for age, atrophy, vascular risk factors and interscan interval. Conclusions: In memory clinic patients, WMH progression over 1–2 years associated with worsening neuropsychiatric symptoms, while WMH volume remained unchanged in those with stable NPI scores in this population with low background WMH burden.

Original languageEnglish
Article number100041
Pages (from-to)100041
JournalCerebral Circulation—Cognition and Behavior
Early online date19 Jan 2022
Publication statusPublished - 21 Jan 2022


  • Cerebral small vessel disease
  • Cognitive dysfunction
  • Dementia
  • Longitudinal studies
  • Neurobehavioral Manifestations
  • White matter hyperintensities


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