Abstract / Summary
Cerebral small vessel disease (CSVD) is a leading cause of stroke, dementia, and age-related cognitive decline, with white matter hyperintensities (WMH) being a key imaging feature in MRI. This review aims to evaluate the association between multimodal magnetic resonance imaging markers of white matter hyperintensities and cognition in cerebral small vessel disease. A systematic search of PubMed, Scopus, Embase, and Web of Science (2016-2026) was done. Studies involving adults with MRI visible CSVD markers who underwent MRI standardized cognitive assessment were eligible. Fifteen studies were included with a total of 5752 participants. Included studies used conventional and advanced MRI techniques to evaluate the association of WMH with cognitive function. The findings were synthesized narratively according to MRI techniques. Conventional MRI studies showed that greater WMH burden and CSVD severity were associated with poorer cognition, particularly processing speed and global cognition, with individual studies reporting β values of - 0.371 (p < 0.001) and - 0.363 (p < 0.001), with good predictive accuracy reported in one study (AUC = 0.800, 95% CI: 0.710-0.891). While Advanced MRI also showed associations with microstructural and microvascular damage in white matter and with reduced blood flow was associated with poorer cognitive performance, individual studies reported β values of 0.268-0.273, moderate-to-strong associations (r = 0.310-0.441), good diagnostic accuracy (AUC = 0.86-0.89), and significantly lower scores on cognitive assessments (Mini-Mental State Examination: p < 0.001; Montreal Cognitive Assessment: p < 0.05). These findings suggest that WMH burden and disrupted white matter microstructure are associated with cognitive impairment. Larger, standardized studies are needed to determine the clinical value of MRI markers as reliable biomarkers for early detection and monitoring of cognitive impairment in CSVD.