학술논문
Strategic infarct locations for post-stroke cognitive impairment: a pooled analysis of individual patient data from 12 acute ischaemic stroke cohorts.
Document Type
Academic Journal
Author
Weaver NA; Department of Neurology and Neurosurgery, University Medical Centre (UMC) Utrecht Brain Center, Utrecht, Netherlands.; Kuijf HJ; Image Sciences Institute, UMC Utrecht, Utrecht, Netherlands.; Aben HP; Department of Neurology, Elisabeth Tweesteden Hospital, Tilburg, Netherlands.; Abrigo J; Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China.; Bae HJ; Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea.; Barbay M; Department of Neurology, Amiens University Hospital, Laboratory of Functional Neurosciences, Jules Verne Picardy University, Amiens, France.; Best JG; Stroke Research Centre, Department of Brain Repair and Rehabilitation, University College London Queen Square Institute of Neurology, London, UK.; Bordet R; Université Lille, Inserm, CHU Lille, U1172-LilNCog-Lille Neuroscience and Cognition, Lille, France.; Chappell FM; Neuroimaging Sciences, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK; UK Dementia Research Institute at the University of Edinburgh, Edinburgh, UK.; Chen CPLH; Department of Pharmacology, National University of Singapore, Singapore; Memory, Aging and Cognition Center, National University Health System, Singapore.; Dondaine T; Université Lille, Inserm, CHU Lille, U1172-LilNCog-Lille Neuroscience and Cognition, Lille, France.; van der Giessen RS; Department of Neurology, Erasmus Medical Center, Rotterdam, Netherlands.; Godefroy O; Department of Neurology, Amiens University Hospital, Laboratory of Functional Neurosciences, Jules Verne Picardy University, Amiens, France.; Gyanwali B; Department of Pharmacology, National University of Singapore, Singapore; Memory, Aging and Cognition Center, National University Health System, Singapore.; Hamilton OKL; Neuroimaging Sciences, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK; UK Dementia Research Institute at the University of Edinburgh, Edinburgh, UK.; Hilal S; Department of Pharmacology, National University of Singapore, Singapore; Memory, Aging and Cognition Center, National University Health System, Singapore; Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore.; Huenges Wajer IMC; Department of Neurology and Neurosurgery, University Medical Centre (UMC) Utrecht Brain Center, Utrecht, Netherlands; Experimental Psychology, Helmholtz Institute, Utrecht University, Netherlands.; Kang Y; Department of Psychology, Hallym University, Chuncheon, South Korea.; Kappelle LJ; Department of Neurology and Neurosurgery, University Medical Centre (UMC) Utrecht Brain Center, Utrecht, Netherlands.; Kim BJ; Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea.; Köhler S; Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands.; de Kort PLM; Department of Neurology, Elisabeth Tweesteden Hospital, Tilburg, Netherlands.; Koudstaal PJ; Department of Neurology, Erasmus Medical Center, Rotterdam, Netherlands.; Kuchcinski G; Université Lille, Inserm, CHU Lille, U1172-LilNCog-Lille Neuroscience and Cognition, Lille, France.; Lam BYK; Division of Neurology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Therese Pei Fong Chow Research Centre for Prevention of Dementia, Margaret Kam Ling Cheung Research Centre for Management of Parkinsonism, Gerald Choa Neuroscience Centre, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China.; Lee BC; Department of Neurology, Hallym University Sacred Hospital, Hallym Neurological Institute, Hallym University College of Medicine, Anyang, South Korea.; Lee KJ; Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea.; Lim JS; Department of Neurology, Asan Medical Center, Seoul, South Korea.; Lopes R; Université Lille, Inserm, CHU Lille, U1172-LilNCog-Lille Neuroscience and Cognition, Lille, France.; Makin SDJ; Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.; Mendyk AM; Université Lille, Inserm, CHU Lille, U1172-LilNCog-Lille Neuroscience and Cognition, Lille, France.; Mok VCT; Division of Neurology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Therese Pei Fong Chow Research Centre for Prevention of Dementia, Margaret Kam Ling Cheung Research Centre for Management of Parkinsonism, Gerald Choa Neuroscience Centre, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China.; Oh MS; Department of Neurology, Hallym University Sacred Hospital, Hallym Neurological Institute, Hallym University College of Medicine, Anyang, South Korea.; van Oostenbrugge RJ; Department of Neurology, Maastricht University Medical Center, Maastricht, Netherlands.; Roussel M; Department of Neurology, Amiens University Hospital, Laboratory of Functional Neurosciences, Jules Verne Picardy University, Amiens, France.; Shi L; Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; BrainNow Research Institute, Shenzhen, China.; Staals J; Department of Neurology, Maastricht University Medical Center, Maastricht, Netherlands.; Del C Valdés-Hernández M; Neuroimaging Sciences, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK; UK Dementia Research Institute at the University of Edinburgh, Edinburgh, UK.; Venketasubramanian N; Raffles Neuroscience Centre, Raffles Hospital, Singapore.; Verhey FRJ; Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands.; Wardlaw JM; Neuroimaging Sciences, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK; UK Dementia Research Institute at the University of Edinburgh, Edinburgh, UK.; Werring DJ; Stroke Research Centre, Department of Brain Repair and Rehabilitation, University College London Queen Square Institute of Neurology, London, UK.; Xin X; Department of Pharmacology, National University of Singapore, Singapore; Memory, Aging and Cognition Center, National University Health System, Singapore.; Yu KH; Department of Neurology, Hallym University Sacred Hospital, Hallym Neurological Institute, Hallym University College of Medicine, Anyang, South Korea.; van Zandvoort MJE; Department of Neurology and Neurosurgery, University Medical Centre (UMC) Utrecht Brain Center, Utrecht, Netherlands; Experimental Psychology, Helmholtz Institute, Utrecht University, Netherlands.; Zhao L; BrainNow Research Institute, Shenzhen, China.; Biesbroek JM; Department of Neurology and Neurosurgery, University Medical Centre (UMC) Utrecht Brain Center, Utrecht, Netherlands.; Biessels GJ; Department of Neurology and Neurosurgery, University Medical Centre (UMC) Utrecht Brain Center, Utrecht, Netherlands. Electronic address: g.j.biessels@umcutrecht.nl.
Source
Publisher: Lancet Pub. Group Country of Publication: England NLM ID: 101139309 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1474-4465 (Electronic) Linking ISSN: 14744422 NLM ISO Abbreviation: Lancet Neurol Subsets: MEDLINE
Subject
Language
English
Abstract
Background: Post-stroke cognitive impairment (PSCI) occurs in approximately half of people in the first year after stroke. Infarct location is a potential determinant of PSCI, but a comprehensive map of strategic infarct locations predictive of PSCI is unavailable. We aimed to identify infarct locations most strongly predictive of PSCI after acute ischaemic stroke and use this information to develop a prediction model.
Methods: In this large-scale multicohort lesion-symptom mapping study, we pooled and harmonised individual patient data from 12 cohorts through the Meta-analyses on Strategic Lesion Locations for Vascular Cognitive Impairment using Lesion-Symptom Mapping (Meta VCI Map) consortium. The identified cohorts (as of Jan 1, 2019) comprised patients with acute symptomatic infarcts on CT or MRI (with available infarct segmentations) and a cognitive assessment up to 15 months after acute ischaemic stroke onset. PSCI was defined as performance lower than the fifth percentile of local normative data, on at least one cognitive domain on a multidomain neuropsychological assessment or on the Montreal Cognitive Assessment. Voxel-based lesion-symptom mapping (VLSM) was used to calculate voxel-wise odds ratios (ORs) for PSCI that were mapped onto a three-dimensional brain template to visualise PSCI risk per location. For the prediction model of PSCI risk, a location impact score on a 5-point scale was derived from the VLSM results on the basis of the mean voxel-wise coefficient (ln[OR]) within each patient's infarct. We did combined internal-external validation by leave-one-cohort-out cross-validation for all 12 cohorts using logistic regression. Predictive performance of a univariable model with only the location impact score was compared with a multivariable model with addition of other clinical PSCI predictors (age, sex, education, time interval between stroke onset and cognitive assessment, history of stroke, and total infarct volume). Testing of visual ratings was done by three clinicians, and accuracy, inter-rater reliability, and intra-rater reliability were assessed with Cohen's weighted kappa.
Findings: In our sample of 2950 patients (mean age 66·8 years [SD 11·6]; 1157 [39·2%] women), 1286 (43·6%) had PSCI. We achieved high lesion coverage of the brain in our analyses (86·9%). Infarcts in the left frontotemporal lobes, left thalamus, and right parietal lobe were strongly associated with PSCI (after false discovery rate correction, q<0·01; voxel-wise ORs >20). On cross-validation, the location impact score showed good correspondence, based on visual assessment of goodness of fit, between predicted and observed risk of PSCI across cohorts after adjusting for cohort-specific PSCI occurrence. Cross-validations showed that the location impact score by itself had similar performance to the combined model with other PSCI predictors, while allowing for easy visual assessment. Therefore the univariable model with only the location impact score was selected as the final model. Correspondence between visual ratings and actual location impact score (Cohen's weighted kappa: range 0·88-0·92), inter-rater agreement (0·85-0·87), and intra-rater agreement (for a single rater, 0·95) were all high.
Interpretation: To the best of our knowledge, this study provides the first comprehensive map of strategic infarct locations associated with risk of PSCI. A location impact score was derived from this map that robustly predicted PSCI across cohorts. Furthermore, we developed a quick and reliable visual rating scale that might in the future be applied by clinicians to identify individual patients at risk of PSCI.
Funding: The Netherlands Organisation for Health Research and Development.
Competing Interests: Declaration of interests H-JB reports grants from Bristol-Myers Squibb Korea, Chong Kun Dang Pharmaceutical, Dong-A Pharmaceutical, AstraZeneca Korea, Bayer, Daiichi Sankyo, Yuhan, Jeil Pharmaceutical, Korean Drug, Shinpoong Pharmaceutical, Servier Korea, JLK Inspection, and Samjin Pharmaceutical, grants and personal fees from Shire Korea and Eisai Korea, and personal fees from Amgen Korea and Otsuka Korea, outside the submitted work. DJW reports personal fees from Bayer, Alnylam Pharmaceuticals, and Portola, outside the submitted work. OG reports grants from Amiens University Hospital and the French Ministry of Health, during the conduct of the study; and during the last 5 years OG has served on scientific advisory boards and as a speaker for Novartis, CSL-Behring, Biogen, Genzyme, Lilly, Bristol-Myers Squibb, Boehringer-Ingelheim, Covidien, Teva Santé, and Astra Zeneca, outside the submitted work. MB has received funding for travel and meetings from Teva Santé, Bristol-Myers Squibb, Roche, Pfizer, Sanofi-Aventis France, Isis Perfusion Nord, and Amgen. GJB reports grants from The Netherlands Organisation for Health Research and Development (ZonMW), during the conduct of the study. JMW reports grants from the Wellcome Trust, Row Fogo Charitable Trust, Chest Heart Stroke Scotland, and the UK Medical Research Council, during the conduct of the study; and grants from Fondation Leducq, EU Horizon 2020 (SVDs@target project, grant agreement number 666881), the British Heart Foundation, and the UK Stroke Association, outside the submitted work. HPA reports grants from ZonMW (grant number 842003011), during the conduct of the study. All other authors declare no competing interests.
(Copyright © 2021 Elsevier Ltd. All rights reserved.)
Methods: In this large-scale multicohort lesion-symptom mapping study, we pooled and harmonised individual patient data from 12 cohorts through the Meta-analyses on Strategic Lesion Locations for Vascular Cognitive Impairment using Lesion-Symptom Mapping (Meta VCI Map) consortium. The identified cohorts (as of Jan 1, 2019) comprised patients with acute symptomatic infarcts on CT or MRI (with available infarct segmentations) and a cognitive assessment up to 15 months after acute ischaemic stroke onset. PSCI was defined as performance lower than the fifth percentile of local normative data, on at least one cognitive domain on a multidomain neuropsychological assessment or on the Montreal Cognitive Assessment. Voxel-based lesion-symptom mapping (VLSM) was used to calculate voxel-wise odds ratios (ORs) for PSCI that were mapped onto a three-dimensional brain template to visualise PSCI risk per location. For the prediction model of PSCI risk, a location impact score on a 5-point scale was derived from the VLSM results on the basis of the mean voxel-wise coefficient (ln[OR]) within each patient's infarct. We did combined internal-external validation by leave-one-cohort-out cross-validation for all 12 cohorts using logistic regression. Predictive performance of a univariable model with only the location impact score was compared with a multivariable model with addition of other clinical PSCI predictors (age, sex, education, time interval between stroke onset and cognitive assessment, history of stroke, and total infarct volume). Testing of visual ratings was done by three clinicians, and accuracy, inter-rater reliability, and intra-rater reliability were assessed with Cohen's weighted kappa.
Findings: In our sample of 2950 patients (mean age 66·8 years [SD 11·6]; 1157 [39·2%] women), 1286 (43·6%) had PSCI. We achieved high lesion coverage of the brain in our analyses (86·9%). Infarcts in the left frontotemporal lobes, left thalamus, and right parietal lobe were strongly associated with PSCI (after false discovery rate correction, q<0·01; voxel-wise ORs >20). On cross-validation, the location impact score showed good correspondence, based on visual assessment of goodness of fit, between predicted and observed risk of PSCI across cohorts after adjusting for cohort-specific PSCI occurrence. Cross-validations showed that the location impact score by itself had similar performance to the combined model with other PSCI predictors, while allowing for easy visual assessment. Therefore the univariable model with only the location impact score was selected as the final model. Correspondence between visual ratings and actual location impact score (Cohen's weighted kappa: range 0·88-0·92), inter-rater agreement (0·85-0·87), and intra-rater agreement (for a single rater, 0·95) were all high.
Interpretation: To the best of our knowledge, this study provides the first comprehensive map of strategic infarct locations associated with risk of PSCI. A location impact score was derived from this map that robustly predicted PSCI across cohorts. Furthermore, we developed a quick and reliable visual rating scale that might in the future be applied by clinicians to identify individual patients at risk of PSCI.
Funding: The Netherlands Organisation for Health Research and Development.
Competing Interests: Declaration of interests H-JB reports grants from Bristol-Myers Squibb Korea, Chong Kun Dang Pharmaceutical, Dong-A Pharmaceutical, AstraZeneca Korea, Bayer, Daiichi Sankyo, Yuhan, Jeil Pharmaceutical, Korean Drug, Shinpoong Pharmaceutical, Servier Korea, JLK Inspection, and Samjin Pharmaceutical, grants and personal fees from Shire Korea and Eisai Korea, and personal fees from Amgen Korea and Otsuka Korea, outside the submitted work. DJW reports personal fees from Bayer, Alnylam Pharmaceuticals, and Portola, outside the submitted work. OG reports grants from Amiens University Hospital and the French Ministry of Health, during the conduct of the study; and during the last 5 years OG has served on scientific advisory boards and as a speaker for Novartis, CSL-Behring, Biogen, Genzyme, Lilly, Bristol-Myers Squibb, Boehringer-Ingelheim, Covidien, Teva Santé, and Astra Zeneca, outside the submitted work. MB has received funding for travel and meetings from Teva Santé, Bristol-Myers Squibb, Roche, Pfizer, Sanofi-Aventis France, Isis Perfusion Nord, and Amgen. GJB reports grants from The Netherlands Organisation for Health Research and Development (ZonMW), during the conduct of the study. JMW reports grants from the Wellcome Trust, Row Fogo Charitable Trust, Chest Heart Stroke Scotland, and the UK Medical Research Council, during the conduct of the study; and grants from Fondation Leducq, EU Horizon 2020 (SVDs@target project, grant agreement number 666881), the British Heart Foundation, and the UK Stroke Association, outside the submitted work. HPA reports grants from ZonMW (grant number 842003011), during the conduct of the study. All other authors declare no competing interests.
(Copyright © 2021 Elsevier Ltd. All rights reserved.)