Structural and functional alterations in cerebral small vessel disease: an ALE-based meta-analysis

Cerebral small vessel disease (CSVD) is one of the most important causes of stroke and dementia. Although increasing studies have reported alterations of brain structural or neuronal functional activity exhibited in patients with CSVD, it is still unclear which alterations are reliable. Here, we performed a meta-analysis to establish which brain structural or neuronal functional activity changes in those studies were consistent. Activation likelihood estimation revealed that changes in neuronal functional activity in the left angular gyrus, bilateral anterior cingulate cortex/left medial prefrontal cortex, right rolandic operculum, and alterations of gray structure in the left insular cortex/superior temporal gyrus/claustrum were reliable in sporadic CSVD. Decreased neuronal functional activity in the caudate head, anterior cingulate cortex, and reduced gray matter volume in the insular cortex/superior temporal gyrus/claustrum were associated with CSVD-related cognitive impairment. Furthermore, unlike sporadic CSVD, the reliable alterations of neuronal functional activity in cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy were concentrated in the left parahippocampal gyrus. The current study presents stable brain structural and neuronal functional abnormalities within the brain, which can help further understand the pathogenesis of CSVD and CSVD-cognitive impairment and provide an index to evaluate the effectiveness of treatment protocols.

Highlights: • Default mode network and salience network are reliable networks affected in sporadic CSVD in resting-state.• Altered corticostriatal circuitry is associated with cognitive decline.• Decreased gray matter volume in the insular cortex is stable "remote effects" of sporadic CSVD.• The parahippocampal gyrus may be a reliable affected brain region in CADASIL.