Incident cerebral lacunes: A review

Abstract

Lacunes on magnetic resonance imaging (MRI) are considered as a key hallmark for evaluating the progression and severity of cerebral small vessel diseases. We aimed to review the MRI diagnostic criteria, frequency, predictors and clinical impact of incident lacunes in the largest longitudinal studies. Analyses were restricted to cohort studies of more than 50 individuals that investigated incident lacunes over a duration of at least one year. We observed that: (1) MRI parameters and definition of lacunes are inconsistent across studies, (2) the frequency of incident lacunes is strongly related to the previous clinical and MRI status at individual level, (3) both age and hypertension diagnosed at onset predict incident lacunes but the exact impact of blood pressure level during follow-up remains undetermined, (4) the clinical correlates of these lesions on cognition are repeatedly observed but the exact consequences on motor or gait performances are not always evaluated. Homogenization of imaging techniques, the use of strict diagnostic criteria and a broader clinical assessment considering motor and gait performances should be recommended in future longitudinal studies of incident lacunes including clinical trials testing preventative treatments in cerebral small vessel diseases.