MRI Predictors of Cognitive Function After Lacunar Infarction
Sara Hassani1, Deborah Koltai2, Timothy J Amrhein3
1Department of Neurology, Division of Stroke and Neurocritical Care, Northwestern Feinberg School of Medicine, Chicago, IL (S.H.).
Background:
Poststroke cognitive impairment is associated with disability and decreased quality of life. We assessed whether individual or collective magnetic resonance imaging (MRI) biomarkers can aid in predicting cognitive impairment after lacunar infarction (LACI).
Methods:
We conducted a retrospective analysis of data from the American Stroke Association Bugher Small Vessel Study, which included 134 patients within 2 years of an acute LACI, enrolled between 2007 and 2012 at 4 North Carolina hospitals. MRI brain measures at the time of the stroke included as follows: 1, total number of LACIs (index LACI and nonindex radiographic lacunes); 2, size of the largest lacune; 3, ventricular size; 4, cerebral atrophy; 5, radiographic locations (supratentorial, infratentorial, or both); and 6, white matter disease (WMD) extent. WMD extent, cerebral atrophy, and ventricular size were graded using the CHS (Cardiovascular Health Study) scores. The primary outcomes were as follows: 1, total score on Short-Form Montreal Cognitive Assessment to assess global cognition; and 2, time to complete TRAIL Making Test Part B (TMT-B) to evaluate executive function. Regression analyses were used to assess the association between the 6 MRI measures and cognitive function adjusting for demographic and clinical variables.
Results:
One hundred thirty-four participants completed Short-Form Montreal Cognitive Assessment testing and 100 completed TMT-B at a mean of 76.5 (SD, 172.7) days from the index LACI. There were no associations between MRI characteristics and Short-Form Montreal Cognitive Assessment. On univariable analyses, cerebral atrophy (β=35 [95% CI, 14.17-55.83]; P=0.0010), ventricular size (β=40.1 [95% CI, 22.24-57.96]; P<0.0001), and WMD extent (β=55.25 [95% CI, 38.52-71.98]; P<0.0001) were each associated with TMT-B time. Extent of WMD was the only MRI measure associated with TMT-B time (β=37.74 [95% CI, 19.04-56.44]; P<0.0001). In adjusted models after performing variable selection, the extent of WMD remained the only MRI measure associated with TMT-B time.
Conclusions:
Among the assessed MRI measures, only the extent of WMD was independently associated with executive function after LACI.
Insights
White matter disease extent is the only MRI biomarker predicting executive function decline after lacunar infarction (LACI). This finding helps identify patients at risk for post-stroke cognitive impairment.
Area of Science:
- Neurology
- Radiology
- Neuroscience
Background:
- Poststroke cognitive impairment significantly impacts disability and quality of life.
- Lacunar infarction (LACI) is a common cause of stroke, often leading to cognitive deficits.
- Identifying predictive biomarkers for cognitive impairment after LACI is crucial for patient management.
Purpose of the Study:
- To evaluate the predictive value of individual and collective magnetic resonance imaging (MRI) biomarkers for cognitive impairment following LACI.
- To determine if specific MRI findings can forecast the development or severity of cognitive decline after LACI.
Main Methods:
- Retrospective analysis of 134 patients with acute LACI from the American Stroke Association Bugher Small Vessel Study.
- Assessed MRI biomarkers included: number/size of lacunes, ventricular size, cerebral atrophy, lesion location, and white matter disease (WMD) extent.
- Cognitive function assessed using the Montreal Cognitive Assessment (global cognition) and Trail Making Test Part B (executive function). Regression analyses were employed.
Main Results:
- No significant associations were found between MRI characteristics and global cognition (Montreal Cognitive Assessment).
- Cerebral atrophy, ventricular size, and WMD extent were initially associated with longer Trail Making Test Part B completion times (executive function).
- After multivariable adjustment, only the extent of white matter disease (WMD) remained significantly associated with executive function impairment.
Conclusions:
- The extent of white matter disease (WMD) on MRI is the sole independent predictor of executive function deficits after lacunar infarction.
- WMD may represent a critical imaging biomarker for identifying LACI patients at higher risk of cognitive impairment, specifically affecting executive functions.
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