Cerebral small vessel disease and the risk of dementia: A systematic review and meta‐analysis of population‐based evidence

Abstract Introduction Cerebral small vessel disease is increasingly linked to dementia. Methods We systematically searched Medline, Embase, and Cochrane databases for prospective population‐based studies addressing associations of white matter hyperintensities, covert brain infarcts (i.e., clinically silent infarcts), and cerebral microbleeds with risk of all‐dementia or Alzheimer's disease and performed meta‐analyses. Results We identified 11 studies on white matter hyperintensities, covert brain infarcts, or cerebral microbleeds with risk of all‐dementia or Alzheimer's disease. Pooled analyses showed an association of white matter hyperintensity volume and a borderline association of covert brain infarcts with risk of all‐dementia (hazard ratio: 1.39 [95% confidence interval: 1.00; 1.94], N = 3913, and 1.47 [95% confidence interval: 0.97; 2.22], N = 8296). Microbleeds were not statistically significantly associated with an increased risk of all‐dementia (hazard ratio: 1.25 [95% confidence interval: 0.66; 2.38], N = 8739). Discussion White matter hyperintensities are associated with an increased risk of all‐dementia and Alzheimer's disease in the general population. However, studies are warranted to further determine the role of markers of cerebral small vessel disease in dementia.