학술논문
Impact of Small Vessel Disease Progression on Long-term Cognitive and Functional Changes After Stroke.
Document Type
Academic Journal
Author
Clancy U; From the Centre for Clinical Brain Sciences (U.C., S.D.J.M., C.A.M., V.C., F.M.C., M.d.C.V.H., E.S., F.D., J.M.W.), Edinburgh Imaging and the UK Dementia Research Institute, University of Edinburgh; and Centre for Rural Health (S.D.J.M.), Institute of Applied Health Sciences, University of Aberdeen, UK.; Makin SDJ; From the Centre for Clinical Brain Sciences (U.C., S.D.J.M., C.A.M., V.C., F.M.C., M.d.C.V.H., E.S., F.D., J.M.W.), Edinburgh Imaging and the UK Dementia Research Institute, University of Edinburgh; and Centre for Rural Health (S.D.J.M.), Institute of Applied Health Sciences, University of Aberdeen, UK.; McHutchison CA; From the Centre for Clinical Brain Sciences (U.C., S.D.J.M., C.A.M., V.C., F.M.C., M.d.C.V.H., E.S., F.D., J.M.W.), Edinburgh Imaging and the UK Dementia Research Institute, University of Edinburgh; and Centre for Rural Health (S.D.J.M.), Institute of Applied Health Sciences, University of Aberdeen, UK.; Cvoro V; From the Centre for Clinical Brain Sciences (U.C., S.D.J.M., C.A.M., V.C., F.M.C., M.d.C.V.H., E.S., F.D., J.M.W.), Edinburgh Imaging and the UK Dementia Research Institute, University of Edinburgh; and Centre for Rural Health (S.D.J.M.), Institute of Applied Health Sciences, University of Aberdeen, UK.; Chappell FM; From the Centre for Clinical Brain Sciences (U.C., S.D.J.M., C.A.M., V.C., F.M.C., M.d.C.V.H., E.S., F.D., J.M.W.), Edinburgh Imaging and the UK Dementia Research Institute, University of Edinburgh; and Centre for Rural Health (S.D.J.M.), Institute of Applied Health Sciences, University of Aberdeen, UK.; Hernández MDCV; From the Centre for Clinical Brain Sciences (U.C., S.D.J.M., C.A.M., V.C., F.M.C., M.d.C.V.H., E.S., F.D., J.M.W.), Edinburgh Imaging and the UK Dementia Research Institute, University of Edinburgh; and Centre for Rural Health (S.D.J.M.), Institute of Applied Health Sciences, University of Aberdeen, UK.; Sakka E; From the Centre for Clinical Brain Sciences (U.C., S.D.J.M., C.A.M., V.C., F.M.C., M.d.C.V.H., E.S., F.D., J.M.W.), Edinburgh Imaging and the UK Dementia Research Institute, University of Edinburgh; and Centre for Rural Health (S.D.J.M.), Institute of Applied Health Sciences, University of Aberdeen, UK.; Doubal F; From the Centre for Clinical Brain Sciences (U.C., S.D.J.M., C.A.M., V.C., F.M.C., M.d.C.V.H., E.S., F.D., J.M.W.), Edinburgh Imaging and the UK Dementia Research Institute, University of Edinburgh; and Centre for Rural Health (S.D.J.M.), Institute of Applied Health Sciences, University of Aberdeen, UK.; Wardlaw JM; From the Centre for Clinical Brain Sciences (U.C., S.D.J.M., C.A.M., V.C., F.M.C., M.d.C.V.H., E.S., F.D., J.M.W.), Edinburgh Imaging and the UK Dementia Research Institute, University of Edinburgh; and Centre for Rural Health (S.D.J.M.), Institute of Applied Health Sciences, University of Aberdeen, UK. joanna.wardlaw@ed.ac.uk.
Source
Publisher: Lippincott Williams & Wilkins Country of Publication: United States NLM ID: 0401060 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1526-632X (Electronic) Linking ISSN: 00283878 NLM ISO Abbreviation: Neurology Subsets: MEDLINE
Subject
Language
English
Abstract
Background and Objectives: The severity of white matter hyperintensities (WMH) at presentation with stroke is associated with poststroke dementia and dependency. However, WMH can decrease or increase after stroke; prediction of cognitive decline is imprecise; and there are few data assessing longitudinal interrelationships among changing WMH, cognition, and function after stroke, despite the clinical importance.
Methods: We recruited patients within 3 months of a minor ischemic stroke, defined as NIH Stroke Scale (NIHSS) score <8 and not expected to result in a modified Rankin Scale (mRS) score >2. Participants repeated MRI at 1 year and cognitive and mRS assessments at 1 and 3 years. We ran longitudinal mixed-effects models assessing change in Addenbrooke's Cognitive Examination-Revised (ACE-R) and mRS scores. For mRS score, we assessed longitudinal WMH volumes (cube root; percentage intracranial volume [ICV]), adjusting for age, NIHSS score, ACE-R, stroke subtype, and time to assessment. For ACE-R score, we additionally adjusted for ICV, mRS, premorbid IQ, and vascular risk factors. We then used a multivariate model to jointly assess changing cognition/mRS score, adjusted for prognostic variables, using all available data.
Results: We recruited 264 patients; mean age was 66.9 (SD 11.8) years; 41.7% were female; and median mRS score was 1 (interquartile range 1-2). One year after stroke, normalized WMH volumes were associated more strongly with 1-year ACE-R score (β = -0.259, 95% CI -0.407 to -0.111 more WMH per 1-point ACE-R decrease, p = 0.001) compared to subacute WMH volumes and ACE-R score (β = 0.105, 95% CI -0.265 to 0.054, p = 0.195). Three-year mRS score was associated with 3-year ACE-R score (β = -0.272, 95% CI -0.429 to -0.115, p = 0.001). Combined change in baseline-1-year jointly assessed ACE-R/mRS scores was associated with fluctuating WMH volumes ( F = 9.3, p = 0.03).
Discussion: After stroke, fluctuating WMH mean that 1-year, but not baseline, WMH volumes are associated strongly with contemporaneous cognitive scores. Covarying longitudinal decline in cognition and independence after stroke, central to dementia diagnosis, is associated with increasing WMH volumes.
(Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology.)
Methods: We recruited patients within 3 months of a minor ischemic stroke, defined as NIH Stroke Scale (NIHSS) score <8 and not expected to result in a modified Rankin Scale (mRS) score >2. Participants repeated MRI at 1 year and cognitive and mRS assessments at 1 and 3 years. We ran longitudinal mixed-effects models assessing change in Addenbrooke's Cognitive Examination-Revised (ACE-R) and mRS scores. For mRS score, we assessed longitudinal WMH volumes (cube root; percentage intracranial volume [ICV]), adjusting for age, NIHSS score, ACE-R, stroke subtype, and time to assessment. For ACE-R score, we additionally adjusted for ICV, mRS, premorbid IQ, and vascular risk factors. We then used a multivariate model to jointly assess changing cognition/mRS score, adjusted for prognostic variables, using all available data.
Results: We recruited 264 patients; mean age was 66.9 (SD 11.8) years; 41.7% were female; and median mRS score was 1 (interquartile range 1-2). One year after stroke, normalized WMH volumes were associated more strongly with 1-year ACE-R score (β = -0.259, 95% CI -0.407 to -0.111 more WMH per 1-point ACE-R decrease, p = 0.001) compared to subacute WMH volumes and ACE-R score (β = 0.105, 95% CI -0.265 to 0.054, p = 0.195). Three-year mRS score was associated with 3-year ACE-R score (β = -0.272, 95% CI -0.429 to -0.115, p = 0.001). Combined change in baseline-1-year jointly assessed ACE-R/mRS scores was associated with fluctuating WMH volumes ( F = 9.3, p = 0.03).
Discussion: After stroke, fluctuating WMH mean that 1-year, but not baseline, WMH volumes are associated strongly with contemporaneous cognitive scores. Covarying longitudinal decline in cognition and independence after stroke, central to dementia diagnosis, is associated with increasing WMH volumes.
(Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology.)