Background: Progressive cognitive impairment (CI) is a common symptom in cerebral small vessel disease (CSVD). Emerging evidence has suggested that CI is associated with altered brain function. However, there is little known about the changing patterns on brain function in the development of CSVD patients. 
Methods: Ninety-four subjects were recruited in this study, including 29 non-CSVD with cognitively normal (CN), 17 non-CSVD with CI, 24 CSVD with CN and 24 CSVD with CI. All participants underwent multimodal MRI and a series of neuropsychological tests. 
Results: The parietal cortex (i.e., inferior parietal lobule and precuneus) are vulnerable to the interactive effects of disease status (non-CSVD versus CSVD) and cognition status (CN versus CI). Post-hoc analysis revealed that these interactive regions showed an inverse U-shaped pattern in these four groups: CSVD with CN patients exhibited continuously greater brain activity compared to non-CSVD groups, followed by decreased activation with progression of cognitive impairment in CSVD with CI patients. Furthermore, the changing brain function was associated with MoCA scores in these interactive regions. Interestingly, the present study further found the lacunar numbers may participate in the regulation of brain function in CSVD with CI patients. 
Conclusion: These findings suggested the dynamic changes of inferior parietal lobule and precuneus may be considered as the neuroimaging biomarkers indicating the procession of CSVD. Our results also indicated that the vital role of lacunes in brain function and anti-lacunes therapy may slow down the advancing of CI in CSVD patients.

The resting-state functional pattern of parietal cortex in progressive cognitive impairment of cerebral small vessel disease