Outcome in Stroke Patients Is Associated with Age and Fractional Anisotropy in the Cerebral Peduncles: A Multivariate Regression Study
Tetsuo Koyama1,2, Yuki Uchiyama2, Kazuhisa Domen2
1Department of Rehabilitation Medicine, Nishinomiya Kyoritsu Neurosurgical Hospital, Nishinomiya, Hyogo, Japan.
Objectives:
Diffusion tensor fractional anisotropy (FA) in the corticospinal tracts has been used to assess the long-term outcome in stroke patients. Patient age and the type of stroke may also affect outcomes. In this study, we investigated the associations of age, type of stroke, and FA in the ipsilesional and contralesional cerebral peduncles with stroke outcomes.
Methods:
This study involved 80 patients with stroke (40 hemorrhagic, 40 ischemic) that we had investigated previously. Diffusion tensor FA images were obtained between 14 and 21 days post-stroke. FA values in the ipsilesional and contralesional cerebral peduncles were extracted and their ratio (rFA) was calculated. Outcome was assessed using the Brunnstrom stage, the motor component of the Functional Independence Measure (FIM-motor) at discharge, and the length of stay until discharge from rehabilitation. Using forward stepwise multivariate regression, we assessed the associations of rFA, contralesional FA, age, and type of stroke with outcome measures.
Results:
rFA and contralesional FA were included in the final model for the Brunnstrom stage in the upper limbs. There was a strong association between hemorrhagic stroke and poorer lower extremity function. rFA, contralesional FA, and age were included in the final model for FIM-motor and length of stay. The effect of rFA on all outcome measures was stronger than that of contralesional FA. The effect of age on FIM-motor was as strong as that of rFA.
Conclusions:
Neural damage in the corticospinal tracts (indicated by rFA) had the strongest effect on outcome measures, whereas the level of disability (measured by FIM-motor) was associated with a broader range of factors, including age.
