Intracranial Atherosclerotic Stenosis is Related to Post-stroke Cognitive Impairment: A Cross-sectional Study of Minor Stroke

Abstract

Background: Intracranial Atherosclerotic Stenosis (ICAS) is an important risk factor for cognitive impairment. However, it is unclear whether patients with ICAS are more likely to develop cognitive impairment after an acute, non-disabling ischemic stroke (minor stroke). Objective: We aimed to investigate the association between ICAS and post-stroke cognitive impairment. Methods: In this cross-sectional study, patients with acute, non-disabling ischemic stroke underwent two cognitive tests and imaging evaluation for ICAS, within two weeks after the stroke. To determine the association between ICAS and post-stroke cognitive impairment, we performed a multivariate logistic regression analysis adjusted for several demographic and vascular risk factors. Results: Of the 164 patients with minor stroke in this study, 98 (59.76%) were diagnosed with poststroke cognitive impairment (Montreal Cognitive Assessment score<26). After adjusting for potential confounders, we found that patients with ICAS were more likely to develop cognitive impairment after an acute, non-disabling ischemic stroke, compared to patients without ICAS (Odds Ratio: 2.13; 95% Confidence Interval: 1.07-4.26), and underperformed in the tests of visuospatial and executive function. Conclusion: In this cross-sectional study of a population that has experienced a minor stroke, our findings demonstrated a positive association between ICAS and post-stroke cognitive impairment.

Carotid Atherosclerotic Calcification Characteristics Relate to Post-stroke Cognitive Impairment

“…Moreover, we found that carotid calcification, artery stenosis and soft plaque density each had different effects on performance in each cognitive domain. In agreement with others studies, carotid artery stenosis and soft plaque density were significantly associated with impaired execution and visuospatial function ( Bos et al, 2012 ; Gong et al, 2020 ). These associations could be explained by the disruption of anterior and posterior watershed areas caused by hypoperfusion.…”

Nomogram to Predict Cognitive Dysfunction After a Minor Ischemic Stroke in Hospitalized-Population

“…Consistent with existing findings, demographic variables (age, sex, years of education) played important roles in predicting PSCI (Ojala-Oksala et al, 2012;Gong et al, 2020). In addition, imaging variables are corroborated by the existing literature identified as being important risk factors for PSCI.…”

“…First, repeated evaluation of cognitive status by MoCA scale within relatively short time, such as 3 months, may be affected by the learning effect, which commonly results in false negative outcome. Second, our previous finding shows incidence of PSCI at acute phase has reached a high level (>50%) (Gong et al, 2020). Therefore, we chose the 6 to 12 months as time point to evaluate PSCI for consideration that the cognitive condition of survivors may be in a relatively stable status during this time.…”

“…The demographic and clinical data were collected at the admission as our previously published study (Gong et al, 2020). Several neuroimaging variables were also evaluated: intracranial stenosis as a narrowing exceeding 50% of the luminal diameter by MRA, severity white matter hyperintensity (WMH) by Fazekas scores, and the distribution of lesions (cortical, subcortical, deep area, and sub-tentorium).…”

“…Post-stroke cognitive impairment (PSCI) causes a great burden to stroke survivors. Even minor stroke survivors are at increased risk of developing cognitive impairment (Gong et al, 2020), affecting executive function, speech ability. However, due to the absence of disabling conditions, they are more likely to be neglected for their cognitive dysfunction.…”