Infarct location and cognitive change in patients after acute ischemic stroke: The ICONS study

Post stroke cognitive impairment is closely related to the quality of life. We aimed to evaluate the association between infarct location and cognitive change over time after acute ischemic stroke (AIS).

Patients were selected from the Impairment of Cognition and Sleep after AIS or transient ischemic attack in Chinese patients (ICONS) study. Infarct location was assessed by brain magnetic resonance imaging. Cognition was screened at two weeks and 12 months by the Montreal Cognitive Assessment (MoCA). The primary outcome was the cognitive change at 12 months compared to two weeks. We tested the associations with cognitive change using logistic regression analysis.

A total of 865 patients were enrolled. The mean age of the study participants was 59.67 ± 10.92 years, and the median National Institutes of Health Stroke Scale was 3 (1-5). In a fully adjusted model, thalamic infarction was significantly associated with cognitive decline after 12 months following an AIS (odds ratio [OR] 4.873, 95% confidence interval [CI] 1.634-14.534; p = 0.005), independent of stroke etiology (p > 0.05).

Thalamic infarction increased the risk of worse cognitive performance, as screened by MoCA in relatively young patients with minor ischemic stroke at 12 months, suggesting the thalamus may be a critical structure in preserving cognition after stroke.