학술논문
White Matter Hyperintensity Volume and Poststroke Cognition: An Individual Patient Data Pooled Analysis of 9 Ischemic Stroke Cohort Studies.
Document Type
Academic Journal
Author
de Kort FAS; Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, the Netherlands (F.A.S.d.K., M.C., N.A.W., G.C., I.M.C.H.W., C.M.V., J.M.B., G.J.B.).; Coenen M; Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, the Netherlands (F.A.S.d.K., M.C., N.A.W., G.C., I.M.C.H.W., C.M.V., J.M.B., G.J.B.).; Weaver NA; Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, the Netherlands (F.A.S.d.K., M.C., N.A.W., G.C., I.M.C.H.W., C.M.V., J.M.B., G.J.B.).; Kuijf HJ; Image Sciences Institute, University Medical Center Utrecht, the Netherlands (H.J.K.).; Aben HP; Department of Neurology, Elisabeth Tweesteden Hospital, Tilburg, the Netherlands (H.P.A., P.L.M.d.K.).; Bae HJ; Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea (H.-J.B., J.K., B.J.K.).; Bordet R; Lille Neuroscience & Cognition (LilNCog) U1172, Université Lille, Inserm, CHU Lille, France (R.B., R.L.).; Cammà G; Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, the Netherlands (F.A.S.d.K., M.C., N.A.W., G.C., I.M.C.H.W., C.M.V., J.M.B., G.J.B.).; Chen CPLH; Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore (C.P.L.H.C., S.H., C.N.K., X.X.).; Memory, Aging and Cognition Center, National University Health System, Singapore (C.P.L.H.C., S.H., C.N.K., X.X.).; Dewenter A; Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Germany (A.D., M.D., R.F.).; Duering M; Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Germany (A.D., M.D., R.F.).; Medical Image Analysis Center (MIAC) and Department of Biomedical Engineering, University of Basel, Switzerland (M.D.).; Fang R; Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Germany (A.D., M.D., R.F.).; van der Giessen RS; Department of Neurology, Erasmus Medical Center, Rotterdam, the Netherlands (R.S.v.d.G., P.J.K.).; Hamilton OKL; Neuroimaging Sciences, Centre for Clinical Brain Sciences, University of Edinburgh, United Kingdom (O.K.L.H., J.M.W.).; UK Dementia Research Institute at the University of Edinburgh, United Kingdom (O.K.L.H., J.M.W.).; MRC/CSO Social and Public Health Sciences Unit, School of Health and Wellbeing, University of Glasgow, United Kingdom (O.K.L.H.).; Hilal S; Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore (C.P.L.H.C., S.H., C.N.K., X.X.).; Memory, Aging and Cognition Center, National University Health System, Singapore (C.P.L.H.C., S.H., C.N.K., X.X.).; Saw Swee Hock School of Public Health, National University of Singapore and National University Health System (S.H.).; Huenges Wajer IMC; Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, the Netherlands (F.A.S.d.K., M.C., N.A.W., G.C., I.M.C.H.W., C.M.V., J.M.B., G.J.B.).; Experimental Psychology, Helmholtz Institute, Utrecht University, the Netherlands (I.M.C.H.W.).; Kan CN; Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore (C.P.L.H.C., S.H., C.N.K., X.X.).; Memory, Aging and Cognition Center, National University Health System, Singapore (C.P.L.H.C., S.H., C.N.K., X.X.).; Kim J; Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea (H.-J.B., J.K., B.J.K.).; Kim BJ; Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea (H.-J.B., J.K., B.J.K.).; Köhler S; Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, the Netherlands (S.K., F.R.J.V.).; de Kort PLM; Department of Neurology, Elisabeth Tweesteden Hospital, Tilburg, the Netherlands (H.P.A., P.L.M.d.K.).; Koudstaal PJ; Department of Neurology, Erasmus Medical Center, Rotterdam, the Netherlands (R.S.v.d.G., P.J.K.).; Lim JS; Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea (J.-S.L.).; Lopes R; Lille Neuroscience & Cognition (LilNCog) U1172, Université Lille, Inserm, CHU Lille, France (R.B., R.L.).; Mok VCT; Division of Neurology, Department of Medicine and Therapeutics (V.C.T.M.), The Chinese University of Hong Kong.; Lau Tat-Chuen Research Centre of Brain Degenerative Diseases in Chinese, Li Ka Shing Institute of Health Sciences, Gerald Choa Neuroscience Institute, Lui Chi Woo Institute of Innovative Medicine (V.C.T.M.), The Chinese University of Hong Kong.; Staals J; Department of Neurology, Maastricht University Medical Center, the Netherlands (J.S.).; Venketasubramanian N; Raffles Neuroscience Centre, Raffles Hospital, Singapore (N.V.).; Verhagen CM; Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, the Netherlands (F.A.S.d.K., M.C., N.A.W., G.C., I.M.C.H.W., C.M.V., J.M.B., G.J.B.).; Verhey FRJ; Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, the Netherlands (S.K., F.R.J.V.).; Wardlaw JM; Neuroimaging Sciences, Centre for Clinical Brain Sciences, University of Edinburgh, United Kingdom (O.K.L.H., J.M.W.).; UK Dementia Research Institute at the University of Edinburgh, United Kingdom (O.K.L.H., J.M.W.).; Xu X; Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore (C.P.L.H.C., S.H., C.N.K., X.X.).; Memory, Aging and Cognition Center, National University Health System, Singapore (C.P.L.H.C., S.H., C.N.K., X.X.).; Yu KH; Department of Neurology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea (K.-H.Y.).; Biesbroek JM; Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, the Netherlands (F.A.S.d.K., M.C., N.A.W., G.C., I.M.C.H.W., C.M.V., J.M.B., G.J.B.).; Department of Neurology, Diakonessenhuis Hospital, Utrecht, the Netherlands (J.M.B.).; Biessels GJ; Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, the Netherlands (F.A.S.d.K., M.C., N.A.W., G.C., I.M.C.H.W., C.M.V., J.M.B., G.J.B.).
Source
Publisher: Lippincott Williams & Wilkins Country of Publication: United States NLM ID: 0235266 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1524-4628 (Electronic) Linking ISSN: 00392499 NLM ISO Abbreviation: Stroke Subsets: MEDLINE
Subject
Language
English
Abstract
Background: White matter hyperintensities (WMH) are associated with cognitive dysfunction after ischemic stroke. Yet, uncertainty remains about affected domains, the role of other preexisting brain injury, and infarct types in the relation between WMH burden and poststroke cognition. We aimed to disentangle these factors in a large sample of patients with ischemic stroke from different cohorts.
Methods: We pooled and harmonized individual patient data (n=1568) from 9 cohorts, through the Meta VCI Map consortium (www.metavcimap.org). Included cohorts comprised patients with available magnetic resonance imaging and multidomain cognitive assessment <15 months poststroke. In this individual patient data meta-analysis, linear mixed models were used to determine the association between WMH volume and domain-specific cognitive functioning ( Z scores; attention and executive functioning, processing speed, language and verbal memory) for the total sample and stratified by infarct type. Preexisting brain injury was accounted for in the multivariable models and all analyses were corrected for the study site as a random effect.
Results: In the total sample (67 years [SD, 11.5], 40% female), we found a dose-dependent inverse relationship between WMH volume and poststroke cognitive functioning across all 4 cognitive domains (coefficients ranging from -0.09 [SE, 0.04, P =0.01] for verbal memory to -0.19 [SE, 0.03, P <0.001] for attention and executive functioning). This relation was independent of acute infarct volume and the presence of lacunes and old infarcts. In stratified analyses, the relation between WMH volume and domain-specific functioning was also largely independent of infarct type.
Conclusions: In patients with ischemic stroke, increasing WMH volume is independently associated with worse cognitive functioning across all major domains, regardless of old ischemic lesions and infarct type.
Competing Interests: Disclosures Dr H.-J. Bae reports grants from Chong Gun Dang Pharmaceutical Corp and Korean Drug Co, Ltd outside of the submitted work. Dr G.J. Biessels reports grants from The Netherlands Organisation for Health Research and Development (ZonMW), during the conduct of the study. The other authors report no conflicts.
Methods: We pooled and harmonized individual patient data (n=1568) from 9 cohorts, through the Meta VCI Map consortium (www.metavcimap.org). Included cohorts comprised patients with available magnetic resonance imaging and multidomain cognitive assessment <15 months poststroke. In this individual patient data meta-analysis, linear mixed models were used to determine the association between WMH volume and domain-specific cognitive functioning ( Z scores; attention and executive functioning, processing speed, language and verbal memory) for the total sample and stratified by infarct type. Preexisting brain injury was accounted for in the multivariable models and all analyses were corrected for the study site as a random effect.
Results: In the total sample (67 years [SD, 11.5], 40% female), we found a dose-dependent inverse relationship between WMH volume and poststroke cognitive functioning across all 4 cognitive domains (coefficients ranging from -0.09 [SE, 0.04, P =0.01] for verbal memory to -0.19 [SE, 0.03, P <0.001] for attention and executive functioning). This relation was independent of acute infarct volume and the presence of lacunes and old infarcts. In stratified analyses, the relation between WMH volume and domain-specific functioning was also largely independent of infarct type.
Conclusions: In patients with ischemic stroke, increasing WMH volume is independently associated with worse cognitive functioning across all major domains, regardless of old ischemic lesions and infarct type.
Competing Interests: Disclosures Dr H.-J. Bae reports grants from Chong Gun Dang Pharmaceutical Corp and Korean Drug Co, Ltd outside of the submitted work. Dr G.J. Biessels reports grants from The Netherlands Organisation for Health Research and Development (ZonMW), during the conduct of the study. The other authors report no conflicts.