Background: Lacunes and white matter hyperintensities (WMH) are two common findings seen on neuroimaging in patients with
cerebral small vessel disease (cSVD). Clinically we observed that some patients with cSVD have aphasia through the language
assessment scale. Our study aimed to explore the underlying risk factors for aphasia in cSVD patients.
Methods: This study retrospectively analyzed 38 patients, with and without aphasia, aged 50 or over, Chinese Han population,
diagnosed as cSVD with lacunes and/or WMH. We collected demographic characteristics and vascular risk factors. The severity of
WMH was assessed by the Age Related White Matter Changes (ARWMC) rating scale.
Results: Risk factors associated with aphasia were lower education (p = 0.029), higher total cholesterol (TC) level (p = 0.023) and
higher low-density lipoprotein cholesterol (LDL-C) level (p = 0.027). After controlling for age and sex, level of TC (odds ratios, 1.96;
95% confidence interval, 1.06-3.62; p = 0.032) remained associated with aphasia independently.
Conclusion: High level of TC was significantly associated with a higher risk of aphasia in clinically silent cSVD patients. Early
interventions including lipid-lowering treatment, cranial MRI and ARWMC rating scale should be performed. Further studies are
needed to explore proper methods of prevention and treatment for aphasia in clinically silent cSVD patients, in addition to
understanding the pathophysiological mechanism.