Disrupted Neurovisceral Integration and Emotional Processing in Early Cerebral Small Vessel Disease

BackgroundCerebral small vessel disease (cSVD) is a prevalent age-related microangiopathy leading to cognitive decline. Beyond established mechanisms and risk factors, disturbances in neurovisceral integration--the brain-body coordination of emotional and cardiovascular responses--may represent a systems-level pathway relevant to cSVD pathogenesis. We therefore investigated whether early cSVD is characterised by altered neurovisceral integration and emotional processing. MethodsEighty-two adults were studied: middle-aged adults with early cSVD (n=37), age-matched adults without brain abnormalities (n=23), and young healthy adults (n=22). Participants completed an ecologically grounded social emotion fMRI paradigm alongside self-report measures of interoception and emotional processing. Neurovisceral integration was operationalised as arousal-related modulation of right anterior insula activity and concurrent heart rate dynamics during the task. ResultsEarly cSVD, but not healthy ageing, was associated with diminished insular encoding of arousal, altered heart-rate dynamics, reduced emotional differentiation, and loss of the age-related positivity effect. Self-report questionnaires showed parallel alterations in everyday functioning. Effects remained significant after adjustment for cardiovascular risk factors and cognitive performance. ConclusionStudy findings indicate disruptions in neurovisceral integration and emotional processing across neural, physiological, and behavioural levels, identifying them as candidate biomarkers of early cSVD and potential targets for preventive interventions.