Cerebral small vessel disease among rural-dwelling Chinese older adults: prevalence, distribution, and associated factors

Abstract Epidemiological characteristics of cerebral small vessel disease in the general population, especially among rural older adults, are poorly defined. Here, we reported the prevalence, distribution, and associated factors of cerebral small vessel disease in a rural-dwelling older population in China. This population-based cross-sectional study included 1272 older adults (age ≥60 years; mean age 69.43 years; 58.57% women) who underwent structural brain MRI scans (3.0T) in 2018-2020. MRI markers of cerebral small vessel disease were assessed following the Standards for Reporting Vascular Changes on Neuroimaging-1 criteria. We performed descriptive and regression analyses. The overall prevalence was 20.31% for cerebral microbleeds, 26.87% for lacunes, 60.06% for basal ganglia perivascular spaces, 76.31% for centrum semiovale perivascular spaces, 95.74% for deep white matter hyperintensities, and 94.17% for periventricular white matter hyperintensities. The prevalence increased with advancing age for all cerebral small vessel disease markers, except perivascular spaces in the centrum semiovale. The prevalence of moderate-to-severe deep white matter hyperintensities was higher in women than in men (P=0.005). Older age and hypertension were associated with increased likelihoods of all cerebral small vessel disease markers. A higher body mass index was linked to more white matter hyperintensities. Coronary heart disease was associated with white matter hyperintensities, cerebral microbleeds, and lacunes. Our study suggests that cerebral small vessel disease, especially white matter hyperintensities and perivascular spaces, were highly prevalent among rural Chinese older adults. Older age, hypertension, and coronary heart disease are associated with distinct cerebral small vessel diseases. Future prospective cohort studies are warranted to determine incidence and major risk factors of cerebral small vessel disease, which could facilitate preventive interventions to reduce the burden of cerebral small vessel disease in resource-limited settings.