Medial Temporal Atrophy and Memory Dysfunction in Poststroke Cognitive Impairment-No Dementia

Abstract

Background and PurposeIt was recently reported that the prevalence of poststroke memory dysfunction might be higher than previously thought. Stroke may exist concomitantly with underlying Alzheimer's disease (AD), and so we determined whether post-stroke memory dysfunction indicates manifestation of underlying subclinical AD.MethodsOf 1201 patients in a prospective cognitive assessment database, we enrolled subjects with poststroke amnestic vascular cognitive impairment-no dementia (aVCIND; n=48), poststroke nonamnestic vascular cognitive impairment-no dementia (naVCIND; n=50), and nonstroke amnestic mild cognitive impairment (aMCI; n=65). All subjects had cognitive deficits, but did not meet the criteria for dementia. A standardized neuropsychological test battery and magnetic resonance imaging were performed at least 90 days after the index stroke (mean, 473 days). Visual assessment of medial temporal atrophy (MTA) was used as a measure of underlying AD pathology.ResultsThe MTA score was significantly lower in the naVCIND group (0.64±0.85, mean±SD) than in the aVCIND (1.10±1.08) and aMCI (1.45±1.13; p<0.01) groups. Multivariable ordinal logistic regression analysis revealed that compared with naVCIND, aVCIND [odds ratio (OR)=2.69; 95% confidence interval (CI)=1.21-5.99] and aMCI (OR=5.20; 95% CI=2.41-11.23) were significantly associated with increasing severity of MTA.ConclusionsOur findings show that compared with poststroke naVCIND, the odds of having more-severe MTA were increased for poststroke aVCIND and nonstroke aMCI.

Mesiotemporal atrophy and hippocampal diffusivity distinguish amnestic from non‐amnestic vascular cognitive impairment

“…This amnestic VCI conceivably might represent a mixed type pre‐manifest dementia with additional pathology of AD. Whilst this remains speculative without evidence for amyloid pathology using CSF or positron emission tomography (PET)‐imaging, our findings are well in line with a previous report of less severe MTA scores in non‐amnestic post‐stroke VCI compared with amnestic subtypes .…”

The impact of cerebrovascular aging on vascular cognitive impairment and dementia

“…In addition, stroke-mediated cognitive deficits are more strongly associated with lesions that affect the dominant hemisphere (Kalaria et al, 2016). The risk factors for post-stroke dementia are multifactorial, and include advanced age, genetic traits, low educational status, stroke severity, presence of diabetes, multiple infarcts, prior transient ischemic attack or recurrent stroke, and depressive illness (Gregoire et al, 2012; Jacquin et al, 2012; Kalaria et al, 2016; Kim et al, 2012; Leys et al, 2005; Lin et al, 2003; Yang et al, 2015). …”

Development and Clinical Validity of a Mild Vascular Cognitive Impairment Assessment Tool for Korean Stroke Patients

“…Few studies have been conducted on the MVCI incidence rate in Korea. Only one study reported an incidence rate of 39.0% (n ¼ 156) for mild cognitive impairment among 396 Korean stroke patients [8].…”