Clinically accessible neuroimaging predictors of post-stroke neurocognitive disorder: a prospective observational study

Abstract

Background Neurocognitive disorder (NCD) is common in stroke survivors. We aimed to identify clinically accessible imaging markers of stroke and chronic pathology that are associated with early post-stroke NCD. Methods We included 231 stroke survivors from the “Norwegian Cognitive Impairment after Stroke (Nor-COAST)” study who underwent a standardized cognitive assessment 3 months after the stroke. Any NCD (mild cognitive impairment and dementia) and major NCD (dementia) were diagnosed according to “Diagnostic and Statistical Manual of Mental Disorders (DSM-5)” criteria. Clinically accessible imaging findings were analyzed on study-specific brain MRIs in the early phase after stroke. Stroke lesion volumes were semi automatically quantified and strategic stroke locations were determined by an atlas based coregistration. White matter hyperintensities (WMH) and medial temporal lobe atrophy (MTA) were visually scored. Logistic regression was used to identify neuroimaging findings associated with major NCD and any NCD. Results Mean age was 71.8 years (SD 11.1), 101 (43.7%) were females, mean time from stroke to imaging was 8 (SD 16) days. At 3 months 63 (27.3%) had mild NCD and 65 (28.1%) had major NCD. Any NCD was significantly associated with WMH pathology (odds ratio (OR) = 2.73 [1.56 to 4.77], p = 0.001), MTA pathology (OR = 1.95 [1.12 to 3.41], p = 0.019), and left hemispheric stroke (OR = 1.8 [1.05 to 3.09], p = 0.032). Major NCD was significantly associated with WMH pathology (OR = 2.54 [1.33 to 4.84], p = 0.005) and stroke lesion volume (OR (per ml) =1.04 [1.01 to 1.06], p = 0.001). Conclusion WMH pathology, MTA pathology and left hemispheric stroke were associated with the development of any NCD. Stroke lesion volume and WMH pathology were associated with the development of major NCD 3 months after stroke. These imaging findings may be used in the routine clinical setting to identify patients at risk for early post-stroke NCD. Trial registration ClinicalTrials.gov, NCT02650531, Registered 8 January 2016 – Retrospectively registered.

Longitudinal Brain Changes After Stroke and the Association With Cognitive Decline

“…Stroke and dementia both pose risks for each other and share many of the same neurodegenerative and cerebrovascular risk factors (2), with preexisting structural brain pathology being a frequent finding in stroke patients (3). Early onset (<3 months) of post-stroke dementia (PSD) has been found to be primarily associated with stroke lesion volume and white matter hyperintensity (WMH) load (4)(5)(6)(7). The likelihood of developing cognitive impairment after a stroke does however remain elevated for many years after the incident (8), with late onset (>6 months) being mainly associated with the presence of lacunes and a history of ischemic heart disease and stroke (9).…”

Longitudinal brain age prediction and cognitive function after stroke

“…As previously described (Schellhorn et al, 2021a), lesion masks were generated based on the DWI data obtained in the acute/-sub-acute phase, and were semi-automatically labeled and quantified using ITK-Snap snake tool (v. 3.8.0) (Yushkevich et al, 2006). Stroke location was determined using the Talairach lobe atlas (Lancaster et al, 1997; Lancaster et al, 2000).…”

“…Several factors are associated with poorer outcomes after stroke, including old age, lower education, pre-stroke disability, left-sided stroke (Pendlebury, 2012; Pendlebury & Rothwell, 2009), diabetes mellitus, a history of stroke (Lo et al, 2019), larger stroke lesions and vascular factors, such as white matter hyperintensities (WMH) (Schellhorn et al, 2021a; Aamodt et al, 2021). Brain atrophy after stroke (Brodtmann et al, 2020; Levine et al, 2015) is also associated with cognitive decline (Mijajlovic et al, 2017; Haque et al, 2019), particularly if accompanied by hypertension (Sayed et al, 2020) or other vasculopathies (Schellhorn et al, 2021b), with global and medial temporal lobe atrophy and WMH load among the most predictive factors 12 months post-stroke (Jokinen et al, 2020; Casolla, 2019; Wang et al, 2021; Ball et al, 2021; Schellhorn et al, 2021a).…”

Diagnosis and Treatment Effect of Convolutional Neural Network-Based Magnetic Resonance Image Features on Severe Stroke and Mental State

“…In this study, the Montreal cognitive assessment (MOCA) scale was used to evaluate the cognitive level of psychology. It is a high-sensitivity and rapid screening scale for cognitive impairment developed by Schellhorn et al [ 14 ] in 2005 with reference to the setting and scoring standards of mini-mental state evaluation (MMSE) cognitive items, and it is based on clinical experience. The test cognitive domains included attention, visual space and executive function, language, naming, delayed recall, abstraction, and orientation, with a total score of 30.…”