Cognitive impairment and functional outcome after stroke associated with small vessel disease

Mok, Vincent; Wong, Adrian; Lam, Wynnie W. M.; Fan, Yu; Tang, Wai Kwong; Kwok, Tsz-Ho; Hui, A C F; Wong, Ka Sing

doi:10.1136/jnnp.2003.015107

Cited by 195 publications

(186 citation statements)

References 43 publications

(35 reference statements)

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“…Because outcome has often been related to cognitive impairment and stroke severity, the association between National Institutes of Health Stroke Scale and CDF at the same time (Day 15) in this study was expected. 18,29 The association between depression and CDF is consistent with prior studies, 30,31 because depression is common after stroke and has been directly related to cognitive impairment. [32][33][34] It has been argued that CDF could reflect depression or fatigue.…”

Section: Discussionsupporting

confidence: 85%

Hidden Dysfunctioning in Subacute Stroke

Jaillard

Naëgelé

Trabucco-Miguel

et al. 2009

Stroke

150

116

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Background and Purpose-Determining cognitive dysfunctioning (CDF) after stroke is an important issue because it influences choices for management in terms of return to previous activities. Because previous research in subacute stroke has shown important variations in CDF rates, we aimed to describe the frequency and neuropsychological profile of CDF in subacute stroke outside dementia. We used a large battery of tests to screen any potentially hidden CDF. Methods-Patients with Mini-Mental State Examination scores Ն23 were prospectively and consecutively included 2 weeks after a first-ever ischemic brain infarct. Stroke features were based on MRI. Four domains were evaluated: instrumental and executive functions, episodic memory, and working memory (WM). Patients were scored using means and compared with education-and age-matched control subjects. Then we attributed Z-scores for each test and each domain. The most relevant cognitive tests characterizing CDF were determined using logistic regression.

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Section: Discussionsupporting

confidence: 85%

Hidden Dysfunctioning in Subacute Stroke

Jaillard

Naëgelé

Trabucco-Miguel

et al. 2009

Stroke

150

116

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“…Studies among patients with small vessel disease have shown that executive function is closely associated with the performance of activities of daily living [22]. Interestingly, although WMH progression was associated with executive dysfunction in the univariate analysis, it was not significant in the multivariate analysis.…”

Section: Discussionmentioning

confidence: 76%

Prestroke Statins, Progression of White Matter Hyperintensities, and Cognitive Decline in Stroke Patients with Confluent White Matter Hyperintensities

et al. 2014

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Cerebral white matter hyperintensities (WMH) are a consequence of cerebral small vessel disease. Statins have been shown to reduce recurrent stroke among patients with various stroke subtypes, including lacunar stroke, which also arises from small vessel disease. In this study, we investigated the hypothesis that prestroke statin use would reduce the progression of WMH and/or cognitive decline among stroke patients with confluent WMH. Patients (n=100) were participants of the VITAmins To Prevent Stroke magnetic resonance imaging substudy. All patients had confluent WMH on magnetic resonance imaging at baseline. Eighty-one patients completed the 2-year follow-up. We assessed general cognition and executive function using the mini-mental state examination and Mattis dementia rating scale-initiation/perseveration subscale, respectively. We compared the change in volume of WMH and cognition between prestroke statin use and prestroke nonstatin use groups. We also evaluated the effects of prestroke statin use on incident lacunes and microbleeds. The prestroke statin use group (n=51) had less WMH volume progression (1.54±4.52 cm 3 vs 5.01±6.00 cm 3 , p=0.02) compared with the prestroke nonstatin use group (n=30). Multivariate linear regression modeling identified prestroke statin use as an independent predictor of WMH progression (β=-0.31, p=0.008). Prestroke statin use was also associated with less decline (Mattis dementia rating scale-initiation/ perseveration subscale; β=0.47, p=0.001). No association was observed with changes in mini-mental state examination scores. There were no between group differences on incident lacunes or incident microbleeds. Prestroke statin use may reduce WMH progression and decline in executive function in stroke patients with confluent WMH.

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“…Stroke is one of the most common causes of cognitive impairment (2)(3)(4). According to different subtypes and diagnostic criteria of stroke, 17-92% of patients present with cognitive impairment 3 months after a stroke (5).…”

Section: Introductionmentioning

confidence: 99%

Electro-acupuncture ameliorates cognitive impairment via improvement of brain-derived neurotropic factor-mediated hippocampal synaptic plasticity in cerebral ischemia-reperfusion injured rats

Lin

et al. 2017

Experimental and Therapeutic Medicine

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Abstract.A previous study by our group found that electro-acupuncture (EA) at the Shenting (DU24) and Baihui (DU20) acupoints ameliorates cognitive impairment in rats with cerebral ischemia-reperfusion (I/R) injury. However, the precise mechanism of action has remained largely unknown. The present study investigated whether brain-derived neurotropic factor (BDNF) mediates hippocampal synaptic plasticity as the underlying mechanism. Rats were randomly divided into three groups: The sham operation control (Sham) group, the focal cerebral ischemia-reperfusion (I/R) group, and the I/R with EA treatment (I/R+EA) group. The I/R+EA group received EA treatment at the Shenting (DU24) and Baihui (DU20) acupoints after the operation. EA treatment was found to ameliorate neurological deficits (P<0.05) and reduce the cerebral infarct volume (P<0.01). In addition, EA improved cognitive function in cerebral I/R-injured rats (P<0.05). Furthermore, EA treatment promoted synaptic plasticity. Simultaneously, EA increased the hippocampal expression of BDNF, its high-affinity tropomyosin receptor kinase B (TrkB) and post-synaptic density protein-95 (PSD-95) in the rats with cerebral I/R injury. Collectively, the findings suggested that BDNF-mediated hippocampal synaptic plasticity may be one mechanism via which EA treatment at the Shenting (DU24) and Baihui (DU20) acupoints improves cognitive function in cerebral I/R injured rats. IntroductionIn 2011, an estimated 795,000 individuals experienced a stroke event in the United States of America (1). Stroke is one of the most common causes of cognitive impairment (2-4). According to different subtypes and diagnostic criteria of stroke, 17-92% of patients present with cognitive impairment 3 months after a stroke (5). Cognitive impairment can cause a variety of symptoms, such as a decline in attention, memory and problem-solving capability (6); therefore, prevention and treatment of stroke with cognitive impairment has become a priority in the global health sector.Acupuncture at the Shenting (DU24) and Baihui (DU20) acupoints has been used in China to treat cognitive impairment for thousands of years. They are located on a branch of the Du Meridian that runs over the head, which are associated with cognitive function in Traditional Chinese Medicine. Previous studies by our group have confirmed the efficacy of electro-acupuncture (EA) on the Shenting (DU24) and Baihui (DU20) acupoints in the rehabilitation of cognitive impairment in experimental settings (7,8).Although the pathogenic mechanisms of post-stoke cognitive impairment are complex, decreased hippocampal synaptic plasticity has been suggested to be one of the key elements (9,10). Modulation of synaptic plasticity is highly controlled by brain-derived neurotropic factor (BDNF) protein binding to specific tropomyosin receptor kinase B (TrkB) Electro-acupuncture ameliorates cognitive impairment via improvement of brain-derived neurotropic factor-mediated hippocampal synaptic plasticity in cerebral ischemia-reperfusion injured rats

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Cognitive impairment and functional outcome after stroke associated with small vessel disease

Cited by 195 publications

References 43 publications

Hidden Dysfunctioning in Subacute Stroke

Hidden Dysfunctioning in Subacute Stroke

Prestroke Statins, Progression of White Matter Hyperintensities, and Cognitive Decline in Stroke Patients with Confluent White Matter Hyperintensities

Electro-acupuncture ameliorates cognitive impairment via improvement of brain-derived neurotropic factor-mediated hippocampal synaptic plasticity in cerebral ischemia-reperfusion injured rats

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