11 Feb 21. Featured Paper
Neuropsychiatric symptoms associated with cerebral small vessel disease: a systematic review & meta-analysis.
However, some individuals have subtle symptoms associated with acute MRI lesions.
We aimed to determine whether neuropsychiatric & cognitive symptoms vary according to small vessel disease burden.
Methods: In this systematic review & meta-analysis, we searched MEDLINE, EMBASE, & PsycINFO for articles published in any language from database inception to Jan 24, 2020.
We searched for studies assessing anxiety, apathy, delirium, emotional lability, fatigue, personality change, psychosis, dementia-related behavioural symptoms or cognitive symptoms (including subjective memory complaints), & radiological features of cerebral small vessel disease.
We extracted reported odds ratios (OR), standardised mean differences (SMD), & correlations, stratified outcomes by disease severity or symptom presence or absence, & pooled data using random-effects meta-analyses, reporting adjusted findings when possible.
We assessed the bias on included studies using the Risk of Bias for Non-randomized Studies tool.
This study is registered with PROSPERO, CRD42018096673.
Findings: Of 7119 papers identified, 81 studies including 79 cohorts in total were eligible for inclusion (n=21 730 participants, mean age 69·2 years).
Of these 81 studies, 45 (8120 participants) reported effect estimates.
We found associations between worse white matter hyperintensity (WMH) severity & apathy (OR 1·41, 95% CI 1·05–1·89) & the adjusted SMD in apathy score between WMH severities was 0·38 (95% CI 0·15–0·61).
Worse WMH severity was also associated with delirium (adjusted OR 2·9, 95% CI 1·12–7·55) & fatigue (unadjusted OR 1·63, 95% CI 1·20–2·22).
WMHs were not consistently associated with subjective memory complaints (OR 1·34, 95% CI 0·61–2·94) & unadjusted SMD for WMH severity between these groups was 0·08 (95% CI −0·31 to 0·47).
Anxiety, dementia-related behaviours, emotional lability, & psychosis were too varied or sparse for meta-analysis; these factors were reviewed narratively.
Overall heterogeneity varied from 0% to 79%.
Only five studies had a low risk of bias across all domains.
Interpretation: Apathy, fatigue, & delirium associated independently with worse WMH, whereas subjective cognitive complaints did not.
These symptoms should be assessed longitudinally to improve early clinical detection of small vessel disease & enable prevention trials to happen early in the disease course, long before cognition declines.
- Cerebral small vessel disease
- Neuropsychiatric symptoms
- Systematic review
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Featured paper: Neuropsychiatric symptoms associated with cerebral small vessel disease: a systematic review & meta-analysis.
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