Cerebral microbleeds in patients with mild cognitive impairment and small vessel disease: The Vascular Mild Cognitive Impairment (VMCI)-Tuscany study

• Cerebral microbleeds (CMBs) were assessed in small vessel disease MCI patients.
• Microbleed Anatomical Rating Scale reliable for assessment of CMBs in this cohort
• CMBs load is an independent contributor to cognitive impairment.
• The presence of CMBs is associated with specific cognitive domains.

Background and objectivesCerebral microbleeds (CMBs) are a neuroimaging expression of small vessel disease (SVD). We investigated in a cohort of SVD patients with mild cognitive impairment (MCI): 1) the reliability of the Microbleed Anatomical Rating Scale (MARS); 2) the burden and location of CMBs and their association with cognitive performances, independent of other clinical and neuroimaging features.MethodsPatients underwent clinical, neuropsychological (4 cognitive domains), and MRI assessments. CMBs were assessed by three raters.ResultsOut of the 152 patients (57.2% males; mean age ± SD: 75.5 ± 6.7 years) with gradient-echo (GRE) sequences, 41 (27%) had at least one CMB. Inter-rater agreement for number and location of CMBs ranged from good to very good [multi-rater Fleiss kappa (95%CI): 0.70–0.95]. Lacunar infarcts and some clinical variables (e.g., hypertension and physical activity) were associated with CMBs in specific regions. Total number of CMBs and of those in deep and lobar regions were associated with attention/executive and fluency domains.DiscussionMARS is a reliable instrument to assess CMBs in SVD patients with MCI. Nearly one third of these patients had at least one CMB. Total CMBs burden was associated with attention/executive functions and fluency domains impairment, lacunar infarcts, and with some potentially modifiable risk factors.