Strategic white matter hyperintensity locations associated with post-stroke cognitive impairment: A multicenter study in 1568 stroke patients

Mirthe Coenen ¹, Floor As de Kort ¹, Nick A Weaver ¹

¹Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands.
²Image Sciences Institute, University Medical Center Utrecht, Utrecht, The Netherlands.
³Department of Neurology, Elisabeth Tweesteden Hospital, Tilburg, The Netherlands.
⁴Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea.
⁵Lille Neuroscience & Cognition (LilNCog)-U1172, Université Lille, Inserm, CHU Lille, Lille, France.
⁶Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
⁷Memory, Ageing and Cognition Center, National University Health System, Singapore.
⁸Institute for Stroke and Dementia Research (ISD), LMU University Hospital, LMU Munich, Munich, Germany.
⁹Medical Image Analysis Center (MIAC), Department of Biomedical Engineering, University of Basel, Basel, Switzerland.
¹⁰Department of Neurology, Erasmus Medical Center, Rotterdam, The Netherlands.
¹¹Department of Neurology, School of Medicine, Inha University, Incheon, Republic of Korea.
¹²Department of Neurology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea.
¹³Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
¹⁴Department of Neurology, Maastricht University Medical Center, Maastricht, The Netherlands.
¹⁵Department of Neurology, Diakonessenhuis Hospital, Utrecht, The Netherlands.

⁰Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands.

International Journal of Stroke : Official Journal of the International Stroke Society +

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April 23, 2024

View abstract on PubMed

Summary

White matter hyperintensities (WMH) in specific brain tracts are linked to post-stroke cognitive impairment (PSCI). This study found that WMH location, not just volume, impacts cognitive function after stroke.

Area Of Science

Neuroscience
Radiology
Cognitive Science

Background

Post-stroke cognitive impairment (PSCI) affects up to 50% of stroke survivors.
Pre-existing white matter hyperintensities (WMH) worsen cognitive outcomes, but the impact of WMH location is unclear.

Purpose Of The Study

To investigate if WMH in strategic white matter tracts predict cognitive performance after ischemic stroke.
To determine the role of WMH location in the association with cognitive decline.

Main Methods

Harmonized individual patient data from nine ischemic stroke cohorts (n=1568) using MRI.
Assessed WMH volumes in specific tracts (anterior thalamic radiation, forceps major, etc.) and cognitive domains (executive function, processing speed, etc.).
Employed linear mixed models and lasso regression, controlling for demographic factors and total infarct volume.

Main Results

Total WMH volume strongly correlated with all cognitive domains.
WMH in the left anterior thalamic radiation associated with attention, executive functioning, and processing speed.
WMH in the forceps major linked to processing speed, independent of total WMH volume.

Conclusions

Tract-specific WMH volumes show independent relations with cognitive performance post-stroke.
The concept of strategic lesions in PSCI includes pre-existing WMH in critical locations.
WMH location is a significant factor in cognitive outcomes after ischemic stroke.

Keywords:

White matter hyperintensities post-stroke cognition strategic lesion location

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