Basal Ganglia Perivascular Spaces Predict Long-Term Executive and Visuospatial Decline

Cerebral small vessel disease is a leading vascular contributor to dementia, often identified through imaging markers like white matter hyperintensities and lacunes [1, 2]. While these markers are well-established predictors of cognitive impairment, the clinical significance of magnetic resonance imaging-visible perivascular spaces, which are fluid-filled cavities surrounding small cerebral vessels, has remained less clear [3, 4]. Historically, these spaces were often overlooked or considered incidental, yet evidence suggests they may reflect underlying endothelial dysfunction and impaired waste clearance [5, 6]. As the prevalence of small vessel disease rises globally with aging populations, understanding the independent prognostic value of each imaging feature is essential for accurate risk assessment [7]. A longitudinal analysis now clarifies how these specific vascular markers correlate with cognitive trajectories over a decade of follow-up, offering clinicians a more precise tool for evaluating dementia risk.