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Updated: Dec 13, 2025
Brain Infarct Segmentation and Registration on MRI or CT for Lesion-symptom Mapping
Published on: September 25, 2019
Associations Between Neuroanatomic Patterns of Cerebral Infarctions and Vascular Dementia
Emre Kumral1, Fatma Ece Bayam1, Hasan Arslan1
1Department of Neurology (Kumral, Ece Bayam, Arslan) and Department of Neuropsychology (Arslan), Ege University Medical School Hospital, Izmir, Turkey; and Department of Administration and Statistics, Ege University, Izmir, Turkey (Orman).
Insights
Multiple acute ischemic lesions after stroke significantly increase the risk of vascular dementia. Early identification of these lesions can guide timely interventions to prevent cognitive decline.
Area of Science:
- Neurology
- Neuroscience
- Vascular Neurology
Background:
- Multiple cerebral infarctions are a known risk factor for vascular dementia.
- The precise risk associated with multiple acute ischemic lesions requires further investigation.
Purpose of the Study:
- To examine the association between multiple acute ischemic lesions and the risk of developing vascular dementia.
- To identify factors influencing dementia risk in stroke patients with multiple lesions.
Main Methods:
- A hospital-based prospective study involving 11,200 first-time stroke patients.
- Magnetic Resonance Imaging (MRI) and global cognitive assessment were utilized.
- Univariate and multivariate logistic regression analyses were performed to estimate dementia risk.
Main Results:
- Multiple lesions significantly increased dementia risk (OR=5.83).
- Severe leukoaraiosis (OR=15.77) and microbleedings (OR=1.31) were significant confounders.
- Lesion location (strategic regions, left hemisphere) and volume were associated with dementia.
Conclusions:
- Multiple anterior or posterior circulation lesions post-stroke elevate dementia risk.
- Recognizing multiple ischemic lesions is crucial for timely therapeutic interventions.
- Targeted interventions may prevent subsequent cognitive deterioration in stroke patients.
Objective:
A history of multiple cerebral infarctions is generally regarded as an important risk factor for vascular dementia. The authors examined the risk of vascular dementia in patients with multiple acute ischemic lesions.
Methods:
The authors conducted a hospital-based prospective study of 11,200 patients with first-time stroke who underwent 1.5 or 3-T MRI and a global cognitive assessment. Univariate and multivariate logistic regression analyses estimated the risk of dementia associated with multiple lesions versus a single lesion.
Results:
Having multiple lesions, compared with having a single lesion, was significantly associated with dementia in patients with stroke (odds ratio=5.83, 95% CI=5.08, 6.70; p<0.001). The apoliproprotein ε4 allele was more frequent in patients with multiple lesions than in those with a single lesion (odds ratio=1.70, 95% CI=1.39, 2.07; p<0.001). Severe leukoaraiosis (odds ratio=15.77, 95% CI=8.38, 29.68; p<0.001) and microbleedings (odds ratio=1.31, 95% CI=1.06, 1.63; p<0.01) were strong confounders for dementia in the multivariate analysis. Multiple logistic regression analysis showed that multiple lesions in one hemisphere versus a single lesion (odds ratio=2.14, 95% CI=1.83, 2.51; p<0.001), involvement of strategic regions (odds ratio=4.73, 95% CI=4.07, 5.49; p<0.001), and stroke lesion volume (odds ratio=1.31, 95% CI=1.03, 1.66; p=0.03) were significantly associated with dementia. There was a preponderance of lesions on the left side in patients with dementia (odds ratio=2.56, 95% CI=2.11, 3.11; p<0.001).
Conclusions:
Multiple spontaneous anterior or posterior circulation lesions after stroke increase a patient's risk of developing dementia. Recognition of multiple ischemic lesions after stroke may allow targeted rapid therapeutic interventions to prevent subsequent cognitive deterioration.
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