17 1 Vascular risk factors for depression and apathy and visible perivascular spaces 45. Clinically, CSVD can be silent (without observable symptoms) or present as a variety of geriatric syndromes like cognitive impairment, bladder dysfunction, or problems with gait and balance. Individuals with CWVD have a higher incidence of depression, strokes, dementia, disability and death 44 45. Since apathy is associated with CSVD 24, and this association is independent of depression, the nature of this relationship has received increasing attention in the last few decades. This research has generated the vascular apathy hypothesis that expresses the notion that silent CSVD can cause apathy by disrupting the fronto-striatal pathways 46 47 48. Figure 1. Fronto-Striatal Pathway and Reward Network CSVD Cognition Subcortical vascular MCI / Subcortical vascular dementia semantic memory executive/attentional functioning visuospatial functioning perceptual skills Neuropsychiatric Vascular apathy? emotion thoughts initiative Depressive‐executive sutype of depression loss of interest psychomotor retardation paranoia fluency and visual naming Bladder dysfunction Gait Vascular parkinsonism postural instability falls parkinsonian‐ataxic gait Frontal cortex Nucleus accumbens Thalamus Basal ganglia Fronto-striatal pathway Reward network Figure 2. Proposed Clinical Symptoms of CSVD
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