Neurovascular dysfunction in cerebral small vessel disease: impact on cognition and depression using arterial spin labeling and resting-state fMRI.

To investigate the neurovascular coupling (NVC) differences in cerebral small vessel disease (CSVD) with or without cognitive impairment, using arterial transit time corrected cerebral blood flow, dynamic and static regional homogeneity, and explore underlying mechanisms through stepwise multiple linear regression and mediation analysis. Sixty-five CSVD patients and 36 healthy controls underwent resting-state fMRI and arterial spin labeling imaging. Cerebral blood flow, dynamic and static regional homogeneity, and NVC metrics were calculated. Cognitive, depression, and anxiety assessments were conducted. Stepwise multiple linear regression and mediation analysis were performed to understand the relationship between CSVD pathology and cognition status. Altered NVC was mainly distributed in the prefrontal cortex and basal ganglia. Reduced cross-voxel-correlation-coefficients within the whole brain in CSVD were observed. Positive predictors for cognition score included NVC-related metrics in default mode network, precentral gyrus, the whole gray matter and education. Finally, mediation analysis revealed the role of NVC in the relationship between depression and cognitive performance. NVC dysfunction is observed in CSVD. NVC-related abnormality in default mode network, precentral gyrus, the whole gray matter, and education level contribute to global cognition in CSVD. NVC may mediate depression and global cognition.