Neuropsychological and Event-Related Potential Abnormalities Three Months After Brainstem Lacunar Infarction: An Exploratory Case-Control Study
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Published on: September 1, 2023
Xinyao Wang1,2, Yan Yang1,2, Shuo Zhao3
1Department of Geriatrics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, 250021, People's Republic of China.
Background:
Though smaller in size, lacunar infarction was reported to cause cognitive impairment. As a common infarction location, brainstem interacts extensively with cortical structures. However, whether brainstem infarction affected cognition and involved cognitive domains remained elusive. In this study, we aimed to comprehensively investigate cognitive changes after brainstem infarction by using neuropsychological and neurophysiological measures.
Methods:
The study was designed as an exploratory case-control analysis and modest sample size was included. Altogether, 29 patients with brainstem lacunar infarction (17 males, mean age 61.83 years) and 24 healthy controls (14 males, mean age 60.25 years) were recruited. Multiple neuropsychological scales and a sensitive visual oddball paradigm comprising standard, target and novel stimuli were employed for cross-sectional assessment of cognitive processing at 3 months following acute infarction. The event-related potential (ERP) components N1, P2, N2 and P3 were measured and analyzed. Primary cognitive outcomes including neuropsychological scores and P3 amplitude/latency were evaluated.
Results:
Brainstem infarction patients exhibited lower scores or longer reaction time in Montreal Cognitive Assessment, Stroop Color and Word Test, Shape Trail Test and Rey-Osterrieth Complex Figure Test. Compared with healthy controls, P3b/P3a amplitudes were attenuated and latencies were prolonged in infarction group, and these changes still existed in subtraction-derived difference waveforms. Moreover, exploratory analyses showed that cognitive data including ERP parameters were significantly correlated with infarction diameter and white matter hyperintensity grade.
Conclusions:
Patients with brainstem lacunar infarction exhibited multi-domain cognitive impairments, with executive function, visuospatial function, memory, attention allocation, orienting response and processing speed involved. These abnormalities should be validated by comparisons with vascular-risk or non-brainstem stroke controls. The cognitive decline after lacunar infarction should be paid critical attention, especially for patients with severe imaging lesions.
