Cerebral small vessel disease, medial temporal lobe atrophy and cognitive status in patients with ischaemic stroke and transient ischaemic attack

Abstract

Background and purpose Small vessel disease (SVD) and Alzheimer's disease (AD) are two common causes of cognitive impairment and dementia, traditionally considered as distinct processes. The relationship between radiological features suggestive of AD and SVD was explored, and the association of each of these features with cognitive status at 1 year was investigated in patients with stroke or transient ischaemic attack. Methods Anonymized data were accessed from the Virtual International Stroke Trials Archive (VISTA). Medial temporal lobe atrophy (MTA; a marker of AD) and markers of SVD were rated using validated ordinal visual scales. Cognitive status was evaluated with the Mini Mental State Examination (MMSE) 1 year after the index stroke. Logistic regression models were used to investigate independent associations between (i) baseline SVD features and MTA and (ii) all baseline neuroimaging features and cognitive status 1 year post‐stroke. Results In all, 234 patients were included, mean (±SD) age 65.7 ± 13.1 years, 145 (62%) male. Moderate to severe MTA was present in 104 (44%) patients. SVD features were independently associated with MTA (P < 0.001). After adjusting for age, sex, disability after stroke, hypertension and diabetes mellitus, MTA was the only radiological feature independently associated with cognitive impairment, defined using thresholds of MMSE ≤ 26 (odds ratio 1.94; 95% confidence interval 1.28–2.94) and MMSE ≤ 23 (odds ratio 2.31; 95% confidence interval 1.48–3.62). Conclusion In patients with ischaemic cerebrovascular disease, SVD features are associated with MTA, which is a common finding in stroke survivors. SVD and AD type neurodegeneration coexist, but the AD marker MTA, rather than SVD markers, is associated with post‐stroke cognitive impairment.

Hemoglobin, anemia, and poststroke cognitive impairment: A cohort study

“…MMSE is the most commonly used cognitive screening instrument and is convenient for clinical use with its high sensitivity and specificity for dementia . Despite of its poor sensitivity for mild cognitive impairment, MMSE has been widely applied to assess the cognitive impairment in stroke patients . The MMSE has been translated into Chinese and validated for reliability and validity as a screening tool for cognitive impairment in the Chinese population.…”

“…22 Despite of its poor sensitivity for mild cognitive impairment, MMSE has been widely applied to assess the cognitive impairment in stroke patients. 23,24 The MMSE has been translated into Chinese and validated for reliability and validity as a screening tool for cognitive impairment in the Chinese population. The maximum score for the MMSE is 30.…”

Imaging Morphologic Substrates and Molecular Changes for Differential Diagnosis of Vascular Dementia

“…On FLAIR images, incomplete infarcts present as hyperintensities, whereas complete infarcts present as lacunae, which are hypointense in relation to the brain and isointense to the cerebrospinal fluid. After stroke, medial temporal lobe atrophy is rather related to cognitive impairment than markers of small vessel disease [19]. When small vessel disease causes subcortical VaD, this is associated with the pathology of Binswanger's disease [20].…”

Medial temporal lobe atrophy is the norm in cerebrovascular dementias

“…Thus, locations of white matter lesions and severity of ultrastructural tract damage particularly in the centrum semiovale region likely contribute to subcortical disconnections in cognitive neural networks. Irrespective, the findings of Arba et al [3] have implications for the design of future clinical trials. Figure 1 Close functional and structural connection between the hippocampus and neocortical areas through medial temporal lobe (MTL) cortex.…”

“…Irrespective, the findings of Arba et al . have implications for the design of future clinical trials.…”