Effects of cerebral small vessel disease in the brain beyond the visible lesions

Diseases of the brain’s small blood vessels (cerebral small vessel disease or SVD) are common. SVD is one of the major causes of stroke and dementia. Brain damage due to SVD can be seen on a normal MRI-scan. However, it seems that SVD does more to the brain than what can be seen with the naked eye on a normal MRI-scan. This ‘invisible’ brain damage can be measured using advanced techniques. Detecting ‘invisible’ brain damage offers the possibility to look at the disease process SVD in a different way. In my thesis I have used two different and very sensitive techniques to measure changes in both the gray and the white matter of the brain in patients with SVD. I used these techniques in patients presenting at a memory clinic. My thesis shows that patients with SVD indeed have more brain damage than what can be seen on a normal MRI-scan, namely brain shrinkage and a disruption of the brain network. This ‘invisible’ brain damage can better explain the functional impact of SVD than the visible brain damage alone, as we showed that an increase in visible brain damage due to SVD related to worse cognitive performance through the disruption of the brain network. Measuring and reporting the total amount of brain damage due to SVD can be of added value in a memory clinic, as it can help patients and their caregivers to better understand the impact of SVD on their daily functioning.