ORIGINAL RESEARCH article
Front. Neurol.
Sec. Cognitive and Behavioral Neurology
White matter microstructural damage and its effect on cognitive impairment in patients with metabolic syndrome and cerebral small vessel disease
Provisionally accepted
Han Liu1,2He Feng1Bo Tian1Kaigui Wang1Yali Chen1Xia Zhou1Wenhui Zheng1
Wei Zhang1Yu Xia3Daping Lv1,2
Xiaoqun Zhu1
Zhongwu Sun1*- 1First Affiliated Hospital of Anhui Medical University, Hefei, China
- 2Anhui Public Health Clinical Center, Hefei, China
- 3the Third People’s Hospital of Hefei, Hefei, China
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Background: Metabolic syndrome (MetS) is linked to cerebral small vessel disease (CSVD) and cognitive impairment in the elderly, but the underlying mechanisms remain unclear. This study investigated whether white matter (WM) microstructural damage mediates the relationship between CSVD severity and cognitive function in patients with MetS. Methods: A total of 170 right-handed participants aged 50-80 years were recruited, including 75 with MetS and 95 healthy controls (HC). MetS participants were divided into MetS without CSVD (MetS-NCSVD, n=22) and MetS with CSVD (MetS-CSVD, n=53). Cognitive function was assessed using Montreal cognitive assessment, Stroop color word test (SCWT), trail making test (TMT) and geriatric depression scale. WM integrity was evaluated using diffusion tensor imaging, including fractional anisotropy (FA) and mean diffusivity (MD). Mediation analysis was performed to examine the role of WM microstructural damage in the relationship between CSVD severity and cognitive impairment. Results: The MetS-CSVD group had significantly lower FA and higher MD in core WM fiber tracts compared to MetS-NCSVD and HC groups (P < 0.001). In the MetS group, FA in these tracts were inversely correlated with cognitive test scores (TMT-B and SCWT-C, P < 0.001). Multiple linear regression analyses confirmed these associations (P ≤ 0.045). Mediation analysis revealed that FA values in WM fiber tracts may mediate the relationship between CSVD severity and cognitive function. Conclusions: Our findings suggest that WM microstructural damage may account for the association between CSVD and cognitive impairment, acting as a potential mediator in MetS patients. Future longitudinal studies are needed to validate these findings and explore causal mechanisms.
Keywords: Cerebral small vessel disease, cognitive impairment, Diffusion Tensor Imaging, metabolic syndrome, white matter
Received: 03 Sep 2025; Accepted: 18 Nov 2025.
Copyright: © 2025 Liu, Feng, Tian, Wang, Chen, Zhou, Zheng, Zhang, Xia, Lv, Zhu and Sun. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Zhongwu Sun, sunzhwu@126.com
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