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Published on: December 16, 2022
Associations of Peak-Width Skeletonized Mean Diffusivity and Post-Stroke Cognition
Angela C C Jochems1, Susana Muñoz Maniega1, Una Clancy1
1Centre for Clinical Brain Sciences and UK Dementia Research Institute, The University of Edinburgh, Edinburgh EH16 4SB, UK.
Abstract:
Post-stroke cognitive impairment is common and can have major impact on life after stroke. Peak-width of Skeletonized Mean Diffusivity (PSMD) is a diffusion imaging marker of white matter microstructure and is also associated with cognition. Here, we examined associations between PSMD and post-stroke global cognition in an ongoing study of mild ischemic stroke patients. We studied cross-sectional associations between PSMD and cognition at both 3-months (N = 229) and 1-year (N = 173) post-stroke, adjusted for premorbid IQ, sex, age, stroke severity and disability, as well as the association between baseline PSMD and 1-year cognition. At baseline, (mean age = 65.9 years (SD = 11.1); 34% female), lower Montreal Cognitive Assessment (MoCA) scores were associated with older age, lower premorbid IQ and higher stroke severity, but not with PSMD (βstandardized = −0.116, 95% CI −0.241, 0.009; p = 0.069). At 1-year, premorbid IQ, older age, higher stroke severity and higher PSMD (βstandardized = −0.301, 95% CI −0.434, −0.168; p < 0.001) were associated with lower MoCA. Higher baseline PSMD was associated with lower 1-year MoCA (βstandardized = −0.182, 95% CI −0.308, −0.056; p = 0.005). PSMD becomes more associated with global cognition at 1-year post-stroke, possibly once acute effects have settled. Additionally, PSMD in the subacute phase after a mild stroke could help predict long-term cognitive impairment.
Insights
Peak-width of Skeletonized Mean Diffusivity (PSMD), a marker of white matter health, is linked to cognitive function after stroke. Higher PSMD at one year post-stroke predicts lower cognitive scores, suggesting its potential for predicting long-term impairment.
Area of Science:
- Neuroimaging
- Neurology
- Cognitive Science
Background:
- Post-stroke cognitive impairment significantly impacts patient recovery and quality of life.
- Peak-width of Skeletonized Mean Diffusivity (PSMD) is an emerging diffusion imaging biomarker reflecting white matter integrity.
- Understanding factors influencing cognitive decline after stroke is crucial for developing effective interventions.
Purpose of the Study:
- To investigate the association between PSMD and global cognitive function in patients with mild ischemic stroke.
- To examine cognitive changes at 3 months and 1 year post-stroke in relation to PSMD.
- To determine if baseline PSMD can predict cognitive outcomes at 1 year.
Main Methods:
- Cross-sectional analysis of mild ischemic stroke patients (N=229 at 3 months, N=173 at 1 year).
- Assessment of global cognition using the Montreal Cognitive Assessment (MoCA).
- Statistical adjustment for covariates including premorbid IQ, age, sex, stroke severity, and disability.
Main Results:
- At 3 months, PSMD was not significantly associated with MoCA scores.
- At 1 year, higher PSMD was significantly associated with lower MoCA scores (βstandardized = −0.301, p < 0.001).
- Higher baseline PSMD predicted lower MoCA scores at 1 year (βstandardized = −0.182, p = 0.005).
Conclusions:
- The association between PSMD and global cognition strengthens over time after stroke, becoming significant at 1 year.
- PSMD in the subacute phase may serve as a predictor of long-term cognitive impairment following mild ischemic stroke.
- This finding highlights the utility of PSMD as a potential imaging biomarker for cognitive outcomes in stroke survivors.
