Cerebral small vessel disease (SVD) accounts for 20% of ischaemic stroke (lacunar stroke) and is also the most common pathology underlying vascular dementia. Furthermore recent evidence suggests it interacts with Alzheimer’s pathology to increase the chance of clinical dementia. Our Department has a particular interest in this disease and we use a wide variety of techniques with the aim of improving understanding of pathogenesis and optimising treatment.

In collaboration with Professor Robin Morris (Neuropsychology, Institute of Psychiatry, KCL) we are developing better methods of screening for cognitive impairment in this patient group. Conventional tests have been largely developed for Alzheimer’s disease and are not sensitive to vascular cognitive impairment caused by SVD. We have developed the BMET (Brief Memory Executive Test) which appears to perform well in clinical practice and will shortly be made available on an open basis for clinical and research use.

We use a variety of techniques, particularly Diffusion Tensor Imaging, to help us understand why some patients with SVD suffer cognitive impairment while others do not. Our work to date has demonstrated that whether there is disruption of white matter pathways within the brain is important, and in more recent analysis we have shown a key factor is whether the disease disrupts distributed white matter networks.

Work to understand pathophysiology ranges from genetic studies in both the monogenic form of SVD CADASIL, and also in more sporadic SVDs.

We are investigating therapy in SVD in the PRESERVE study which is looking at whether standard or intensive blood pressure control is associated with better cognitive outcome, and less damage determined on MRI, in patients with lacunar stroke and confluent leukoariosis.