Enlarged perivascular spaces in subcortical white matter are linked to amyloid–tau depositions and cognitive decline: Data from a memory clinic in Thailand

INTRODUCTION: Enlarged perivascular spaces (EPVSs) have been implicated in Alzheimer's disease (AD) pathogenesis, but their relationships with amyloid beta (Aβ) and tau pathology remain unclear. METHODS: We conducted a cross-sectional study of 51 patients with amnestic mild cognitive impairment or mild dementia from a memory clinic in Thailand. EPVS severity in centrum semiovale (CSO) and basal ganglia (BG) was rated on T1-weighted magnetic resonance imaging. Aβ burden and tau deposition were assessed using positron emission tomography imaging. Cognitive change was measured using longitudinal Montreal Cognitive Assessment (MoCA) scores. RESULTS: Higher CSO-EPVS severity was associated with greater Aβ and tau burden, particularly when CSO-EPVS exceeded BG-EPVS severity. No significant associations were observed for BG-EPVS. Greater CSO-EPVS severity was also linked to greater decline in follow-up MoCA scores. DISCUSSION: CSO-EPVS may reflect region-specific processes linked to AD pathology, while their association with cognitive decline may be mediated by underlying amyloid and tau burden.