EXPRESS: Autonomic Function and Cerebral Hemodynamics in Relation to Cognitive Function in Cerebral Small Vessel Disease

BACKGROUND: Cerebral small vessel disease (CSVD) is linked to cognitive impairment. This study examined associations of autonomic function and cerebral hemodynamics with cognitive function in patients with CSVD. METHODS: In this cross-sectional study, patients with white matter hyperintensity and recent subcortical small infarction were recruited from January 2020 to March 2022. Cognitive function was assessed using education-adjusted Montreal Cognitive Assessment (MoCA), autonomic function using heart rate variability (HRV), and cerebral hemodynamics including cerebral autoregulation (CA), cerebrovascular reactivity, and neurovascular coupling (NVC). Logistic and linear regression and ROC analyses were performed. RESULTS: Among 206 patients (median age 63 years; 130 men), 167 (81.1%) had cognitive impairment. Patients with cognitive impairment showed reduced HRV and impaired cerebral hemodynamics, including dynamic CA and NVC. Mean Holding LF Phase and Mean Holding CBFv remained significantly associated with cognitive impairment in multivariable models. Hemodynamics-based models showed AUCs of 0.776-0.850 for LF Phase-based models and 0.917-0.924 for CBFv-based models. In sensitivity analyses excluding HFnu, Mean Holding CBFv remained significantly associated with cognitive impairment. CONCLUSIONS: Impaired autonomic function and cerebral hemodynamic responses may contribute to cognitive dysfunction in CSVD. Assessing parasympathetic function and cerebral hemodynamics may help identify cognitive impairment.