The professor of applied neuroimaging at the University of Edinburgh discusses emerging imaging, blood-based, and functional biomarkers for tracking cerebral small vessel disease progression and evaluating treatment response. [WATCH TIME: 3 minutes]
Cerebral small vessel disease (cSVD) is a major contributor to stroke, vascular cognitive impairment, and age-related disability, with manifestations ranging from white matter hyperintensities and lacunes to cerebral microbleeds and enlarged perivascular spaces. Although MRI has become central to identifying and characterizing cSVD, measuring progression and determining whether investigational therapies meaningfully alter disease activity remain significant challenges.¹
Recent research has focused on refining imaging markers and identifying endpoints that can capture treatment effects before substantial clinical deterioration occurs. The updated STRIVE-2 recommendations have helped standardize neuroimaging terminology and assessment, while investigators continue exploring blood-based biomarkers, cognitive testing, gait assessments, and other functional measures.1,2 Despite these advances, questions remain about the sensitivity, accessibility, and reproducibility of these approaches across clinical trial settings.
“Your brain is a very sophisticated organ. Any one scan or any one blood test is only telling you one part of a very complicated 3D matrix. Whereas the brain, when it's actually doing something, is telling you quite a lot about that.”
At the
In a conversation with NeurologyLive®, Wardlaw discussed how close the field is to establishing reliable measures of disease progression and treatment response. She examined the current strengths and limitations of imaging and blood biomarkers, the potential value of physical and cognitive assessments, and how emerging digital technologies could influence future trial design.
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