Iron leakage owing to blood-brain barrier disruption in small vessel disease CADASIL.

Objective: To assess the relationship between iron accumulation, blood-brain barrier (BBB) damage, and cognitive function in patients with cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL). Methods: We enrolled 21 patients with NOTCH3 mutations and 21 age-matched healthy controls in this cross-sectional study. All participants underwent global physical and cognitive assessments and brain MRI, using voxel-based quantitative susceptibility mapping (QSM; iron deposition measure) and dynamic contrast enhanced MRI (DCE-MRI; BBB permeability measure). We compared behavioral and imaging data between the groups and analyzed the correlations in each group. Results: Among 21 NOTCH3 mutation carriers, 10 were symptomatic and 11 asymptomatic. Montreal Cognitive Assessment scores were significantly different among the groups (symptomatic Conclusions: This study showed that cerebral iron burden was associated with regional BBB permeability and cognitive dysfunction in patients with CADASIL, highlighting the potential of these imaging techniques as auxiliary biomarkers to monitor the course of small vessel disease.