Cerebrovascular disease is prevalent in aging populations and is associated with cognitive impairment. In this Brazilian population-based clinicopathological study (recruitment 2004–2024) published in the Stroke, investigators assessed vascular phenotypes and their association with cognition among decedents aged ≥18 years with available informant data.

Among 2418 participants, 834 were excluded due to missing data, resulting in 1584 individuals (mean age 74.3±13.4 years; 49% women; 62% White). Hyaline arteriolosclerosis (HA) in 13 brain regions defined microvascular disease (Micro[+]) when moderate or severe. Intracranial atherosclerosis defined macrovascular disease (Macro[+]). Microvascular disease was present in 31% and macrovascular disease in 29%. Vascular profiles included Micro[−]/Macro[−] (50%), Micro[+]/Macro[−] (21%), Micro[−]/Macro[+] (19%), and Micro[+]/Macro[+] (10%).

Micro[+] participants were older, more frequently women, and demonstrated worse cognitive abilities. In adjusted linear regression models, HA was associated with worse cognition (β 0.81; 95% CI 0.25–1.36; P=0.004). The combined Micro[+]/Macro[+] phenotype was also associated with worse cognitive performance compared with Micro[−]/Macro[−] (β 1.25; 95% CI 0.38–2.12; P=0.005).

HA was as frequent as intracranial atherosclerosis in this cohort. Both microvascular pathology and combined vascular phenotypes were associated with worse cognitive abilities.