Cognitive impairment after lacunar stroke: systematic review and meta-analysis of incidence, prevalence and comparison with other stroke subtypes

Abstract

BackgroundCognitive impairment and dementia are common after stroke. It is unclear if risk differs between ischaemic stroke subtypes. Lacunar strokes might be less likely to affect cognition than more severe, larger cortical strokes, except that lacunar strokes are associated with cerebral small vessel disease (SVD), which is the commonest vascular cause of dementia.MethodsWe searched MEDLINE and PsychINFO for studies of mild cognitive impairment (MCI) or dementia after lacunar or cortical ischaemic stroke. We calculated the OR for cognitive impairment/dementia in lacunar versus non-lacunar stroke, and their incidence and prevalence in lacunar stroke as a pooled proportion.FindingsWe identified 24 relevant studies of 7575 patients, including 2860 with lacunar stroke; 24% had MCI or dementia post stroke. Similar proportions of patients with lacunar and non-lacunar stroke (16 studies, n=6478) had MCI or dementia up to 4 years after stroke (OR 0.72 (95% CI 0.43 to 1.20)). The prevalence of dementia after lacunar stroke (six studies, n=1421) was 20% (95% CI 9 to 33) and the incidence of MCI or dementia (four studies, n=275) was 37% (95% CI 23 to 53). Data were limited by short follow-up, subtype classification methods and confounding.InterpretationCognitive impairment appears to be common after lacunar strokes despite their small size, suggesting that associated SVD may increase their impact. New prospective studies are required with accurate stroke subtyping to assess long term outcomes while accounting for confounders.

Imaging and Baseline Predictors of Cognitive Performance in Minor Ischemic Stroke and Patients With Transient Ischemic Attack at 90 Days

“…Chronic lacunar infarcts, even silent, has been associated with subtle cognitive deficits, 20 increased risk of future dementia, 21 and poststroke cognitive decline. 22 However, in our study we failed to find an association between previous lacunar stroke and worse cognitive performance, possibly because a small number (19%) of our patients had subclinical lacunar infarcts predating their event. Nor was WMH volume associated with worse cognitive performance in our group.…”

Poststroke cognitive impairment and dementia: prevalence, diagnosis, and treatment

“…A recent review by Makin et al 34 on cognitive impairment after lacunar stroke showed that approximately 30% of patients develop cognitive impairment in the 4 years following a lacunar stroke, a proportion that is comparable to nonlacunar stroke. Accordingly, in the LADIS, 35 the number of new lacunes during a 3-year follow-up was related to progressive cognitive impairment, which was apparent as a decline in executive functions, as well as in speed and motor control.…”

The impact of early-life intelligence quotient on post stroke cognitive impairment

“…2 However, while severe stroke increases cognitive impairment after stroke, prediction of post-stroke cognitive impairment in general remains suboptimal, particularly in patients with less severe stroke subtypes such as lacunar stroke, which is surprising since these strokes are typically small, located in subcortical tissues and the clinical features do not include higher cortical dysfunction. 3 In a previous systematic review focusing on lacunar versus non-lacunar ischaemic stroke, it was unclear whether there were differences between stroke subtypes, there were few studies that assessed cognitive impairment at later times (a year or more) after stroke, and little data on factors that predicted cognitive impairment after stroke. 3 Cognitive decline in the years prior to stroke is a well-established risk factor for post-stroke cognitive impairment and dementia.…”