Cerebral microbleeds and vascular cognitive impairment

MRI manifestations of small vessel diseases including white matter hyperintensities and lacunes have been recognized as potential substrates of vascular cognitive impairment for many years. Cerebral microbleeds (CMBs) – small, perviascular haemorrhages seen as small, well-demarcated, hypointense, rounded lesions on MRI sequences sensitive to magnetic susceptibility effects – are also now recognized as an imaging marker for small vessel pathology, but their clinical impact on cognition remains uncertain. CMBs are present in about a third of patients with ischaemic stroke, and in a high proportion of patients with Alzheimer's disease, cerebral amyloid angiopathy, and vascular dementia. They have also been increasingly found in normal elderly populations, particularly using sequences optimized for their detection. Some recent studies have suggested an effect of CMBs on cognition, which could relate directly to focal damage to or dysfunction of adjacent brain tissues; alternatively, CMBs may be a more general marker for the severity of small vessel pathology related to hypertension or cerebral amyloid angiopathy. CMBs may therefore play a role in understanding the underlying mechanisms of vascular cognitive impairment, in diagnosis, and in assessing its severity and prognosis; this review considers recent evidence on this topic.