Mapping the contribution and strategic distribution patterns of neuroimaging features of small vessel disease in poststroke cognitive impairment

Shi, Lin; Zhao, Lei; Yeung, Fu Ki; Wong, Shun Yiu; Chan, Ronald K T; Tse, Ming Fai; Chan, Sze-Chun; Kwong, Yee Ching; Li, Ka Chun; Li, Kai; Abrigo, Jill; Lau, Alexander; Wong, Adrian; Lam, Bonnie Yin Ka; Leung, Thomas W.; Fu, Jing; Chu, Winnie Cw; Mok, Vincent

doi:10.1136/jnnp-2017-317817

Cited by 19 publications

(14 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…better than a single acute infarct or SVD marker at 3 to 6 months after ischemic stroke. 10 Similar observations were made in cross-sectional, population-based studies of older adults, in which the concurrence of multiple SVD markers, compared with a single marker, was associated with poorer cognitive ability. 22,23 Taken together, these findings suggest that SVD burden is a risk factor for poststroke cognitive dysfunction.…”

Section: Discussionsupporting

confidence: 67%

“…9 A recent cross-sectional study reported that a combination of lacunes, WMHs, and perivascular spaces, modeled with a machine learning tool, was a better predictor of cognitive performance at 3 to 6 months after stroke than the stroke lesion itself or one SVD marker. 10 In contrast, the (Tel-Aviv Brain Acute Stroke Cohort) TABASCO study demonstrated that a combination of all SVD markers did not significantly predict cognitive performance at 1 year after stroke or transient ischemic attack (TIA). 11 The above studies either recruited diagnostically mixed populations, 8,9,11 had cross-sectional designs, 8,10 failed to use all 4 SVD markers, 10 or lacked information on cognitive changes.…”

Section: Introductionmentioning

confidence: 98%

See 1 more Smart Citation

Cerebral Small Vessel Disease Burden Is Associated With Accelerated Poststroke Cognitive Decline: A 1-Year Follow-Up Study

Liang

Chen

Liu

et al. 2019

J Geriatr Psychiatry Neurol

View full text Add to dashboard Cite

Objective: This study investigated the association between small vessel disease (SVD) burden, a combination of multiple SVD markers and cognitive dysfunction after stroke. Methods: The study sample comprised 451 patients with first-ever acute ischemic stroke. Cognitive functions were assessed with the Mini-Mental State Examination (MMSE) at 3, 9, and 15 months after the index stroke. Cognitive impairment was defined as an MMSE score of ≤26. A total SVD score, indicating SVD burden, was constructed by summing the scores of the 4 SVD markers (white matter hyperintensities [WMHs], lacunes, cerebral microbleeds, and perivascular spaces) ascertained by magnetic resonance imaging (range: 0-4). The association between SVD burden and cognitive dysfunction was assessed with linear mixed models or generalized estimating equation models, as appropriate. Results: The majority of patients had mild-to-moderate stroke and at least one identifiable SVD marker. Cognitive impairment was found in about one-third of patients. After adjusting for confounding factors, the SVD burden was associated with MMSE scores (β = −0.37, P = .003) and cognitive impairment (odds ratio [OR] = 1.20, 95% confidence interval [CI] = 1.02-1.42). SVD burden was specifically associated with the performance of MMSE subscores including orientation to place and time, calculation, and word recall. Of the SVD markers, WMHs was the most robust predictor of decrease in MMSE scores (β = −0.25, P = .01) and cognitive impairment (OR = 1.14, 95% CI = 1.01-1.29). Conclusion: Cerebral SVD burden is associated with decreased MMSE scores, suggesting cognitive dysfunction during the first year after mild-to-moderate acute ischemic stroke.

show abstract

Section: Discussionsupporting

confidence: 67%

Section: Introductionmentioning

confidence: 98%

Cerebral Small Vessel Disease Burden Is Associated With Accelerated Poststroke Cognitive Decline: A 1-Year Follow-Up Study

Liang

Chen

Liu

et al. 2019

J Geriatr Psychiatry Neurol

View full text Add to dashboard Cite

show abstract

“…25 Another study has also reported that a combination of SVD features contributed more to cognitive performance after stroke than the individual measures. 26 These studies have been limited by relatively small sample sizes and brief cognitive measures. Hippocampal volume has not been included in the measures of global SVD burden before.…”

Section: Discussionmentioning

confidence: 99%

Automated quantification of small vessel disease brain changes on MRI predicts cognitive and functional decline

Jokinen

Koikkalainen

Laakso

et al. 2019

Preprint

View full text Add to dashboard Cite

Background and purpose: Cerebral small vessel disease (SVD) is characterized by a wide range of focal and global brain changes. We used automated MRI segmentation to quantify multiple types of SVD brain changes and examined their individual and combined predictive value on cognitive and functional abilities.Methods: MRI scans of 560 subjects of the Leukoaraiosis and Disability Study (LADIS) were analyzed using automated atlas-and convolutional neural network-based segmentation methods yielding volumetric measures of white matter hyperintensities (WMH), lacunes, cortical infarcts, enlarged perivascular spaces and regional brain atrophy. The subjects were followed up with annual neuropsychological examinations for 3 years and evaluation of instrumental activities of daily living for 7 years. Results:The strongest predictors of cognitive performance and functional outcome over time were total volumes of WMH, grey matter (GM) and hippocampi (p<0.001 for global cognitive function, processing speed, executive functions and memory; and p<0.001 for poor functional outcome).Volumes of lacunes, cortical infarcts and EVPS were significantly associated with part of the outcome measures, but their contribution was weaker. In a multivariable linear mixed model, volumes of WMH, lacunes, GM and hippocampi remained as independent predictors of cognitive impairment. A combined measure of these markers based on z-scores strongly predicted cognitive and functional outcomes (p<0.001) even above the contribution of the individual brain changes. Conclusions:Global burden of SVD-related brain changes as quantified by automated image segmentation is a powerful predictor of long-term cognitive decline and functional disability. A combined measure of WMH, lacunar, GM and hippocampal volumes could be used as an imaging identification model of vascular cognitive impairment.

show abstract

“…All participants underwent T2, T1 turbo field echo, fluid-attenuated inversion recovery (FLAIR) imaging using a 3.0-T MRI scanner (Philips 3.0T Achieva; Philips Healthcare, Andover, MA). Subcortical WMHs were defined according to the study of Mok [13]. A lacune was defined as a round or ovoid lesion ≥3 mm and ≤15 mm in diameter found on T1-weighted and T2-weighted images with a perilesional halo on FLAIR images as defined by Wardlaw et al [14].…”

Section: Methodsmentioning

confidence: 99%

Plasma Lipoprotein-associated Phospholipase A2 and Superoxide Dismutase are Independent Predicators of Cognitive Impairment in Cerebral Small Vessel Disease Patients: Diagnosis and Assessment

Zhu¹,

Wei²,

Yang³

et al. 2019

Aging and disease

Self Cite

View full text Add to dashboard Cite

Lipoprotein-associated phospholipase A2 (Lp-PLA2) and superoxide dismutase (SOD) are linked to regulating vascular/neuro-inflammation and stroke. Using a retrospective design, we investigated whether circulating Lp-PLA2 and SOD in cerebral small vessel disease (CSVD) patients were associated with cognitive impairment. Eighty-seven CSVD patients were recruited. Plasma Lp-PLA2 and SOD were determined, and cognitive status was measured by the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA). The severity of white matter hypoerintensities (WMHs) in CSVD patients was rated according to Fazekas scales, and Lp-PLA2/SOD levels and MMSE/MoCA were compared. Multiple linear regressions were used to evaluate the relationship between Lp-PLA2 and SOD and the cognitive impairment. Ordinal logistic regression and generalized linear models (OLRGLMs) were applied to confirm whether Lp-PLA2 and SOD are independent risk factors for cognitive impairment in CVSD. Lp-PLA2 and SOD with mild or severe cognitive impairment were lower than those with normal congnition. Lp-PLA2 and SOD in CSVD patients with severe WMHs were significantly lower than those with mild or moderate WMH lesions. We noted positive linear associations of Lp-PLA and SOD with cognitive impairment in CSVD, independent of LDL-C. OLRGLMs confirmed that Lp-PLA2 and SOD were independent risk factors of cognitive impairment in CSVD. Lp-PLA2 and SOD are independently associated with cognitive impairment and WMH lesion, and may be useful for the rapid evaluation of cognitive impairment in CSVD. Lp-PLA2/SOD are modifiable factors that may be considered as therapeutic targets for preventing cognitive impairment in CSVD.

show abstract

Mapping the contribution and strategic distribution patterns of neuroimaging features of small vessel disease in poststroke cognitive impairment

Cited by 19 publications

References 28 publications

Cerebral Small Vessel Disease Burden Is Associated With Accelerated Poststroke Cognitive Decline: A 1-Year Follow-Up Study

Cerebral Small Vessel Disease Burden Is Associated With Accelerated Poststroke Cognitive Decline: A 1-Year Follow-Up Study

Automated quantification of small vessel disease brain changes on MRI predicts cognitive and functional decline

Plasma Lipoprotein-associated Phospholipase A2 and Superoxide Dismutase are Independent Predicators of Cognitive Impairment in Cerebral Small Vessel Disease Patients: Diagnosis and Assessment

Contact Info

Product

Resources

About