Neuroimaging Determinants of Poststroke Cognitive Performance

Puy, Laurent; Barbay, Mélanie; Roussel, Martine; Canaple, Sandrine; Lamy, Chantal; Arnoux, Audrey; Leclercq, Claire; Mas, Jean‐Louis; Tasseel‐Ponche, Sophie; Constans, Jean-Marc; Godefroy, Olivier

doi:10.1161/strokeaha.118.021981

Cited by 53 publications

(38 citation statements)

References 41 publications

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“…Neuroimaging characteristics including strategic stroke, stroke lesion volume, total brain tissue volume, temporal lobe atrophy, WMHs, and microbleeds were reported to be associated with PSCI. 22 In the current study, stroke lesion volume and WMHs were not associated with PSCI, and lobar microbleeds, but not deep or infratentorial types, were associated with PSCI. This discrepancy might be explained by the patient characteristics in the current study.…”

Section: Discussioncontrasting

confidence: 43%

Impaired cerebral autoregulation is associated with poststroke cognitive impairment

Chi

Chan

et al. 2020

Ann Clin Transl Neurol

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Objective: To investigate whether dynamic cerebral autoregulation (CA) and neuroimaging characteristics are determinants of poststroke cognitive impairment (PSCI). Methods: Eighty patients within 7 days of acute ischemic stroke and 35 age-and sex-matched controls were enrolled. In the patients with stroke, brain magnetic resonance imaging and dynamic CA were obtained at baseline, and dynamic CA was followed up at 3 months and 1 year. Montreal Cognitive Assessment (MoCA) was performed at 3 months and 1 year. Patients with a MoCA score <23 at 1 year were defined as having PSCI, and those with a MoCA score that decreased by 2 points or more between the 3-month and 1year assessments were defined as having progressive cognitive decline. Results: In total, 65 patients completed the study and 16 developed PSCI. The patients with PSCI exhibited poorer results for all cognitive domains than did those without PSCI. The patients with PSCI also had poorer CA (lower phase shift between cerebral blood flow and blood pressure waveforms in the very low frequency band) compared with that of the patients without PSCI and controls at baseline and 1 year. CA was not different between the patients without PSCI and controls. In the multivariate analysis, low education level, lobar microbleeds, and impaired CA (very low frequency phase shift [≤46°] within 7 days of stroke), were independently associated with PSCI. In addition, impaired CA was associated with progressive cognitive decline. Interpretation: Low education level, lobar microbleeds, and impaired CA are involved in the pathogenesis of PSCI.

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Section: Discussioncontrasting

confidence: 43%

Impaired cerebral autoregulation is associated with poststroke cognitive impairment

Chi

Chan

et al. 2020

Ann Clin Transl Neurol

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“…Infarct volume has been known as a significant risk factor for cognitive impairment following ischemic stroke [ 46 – 48 ]. In the present study, we found that larger infarct volume detected by the head CT scan was more frequently associated with PSCI, thus in accordance with previous studies.…”

Section: Discussionmentioning

confidence: 99%

Higher level of acute serum VEGF and larger infarct volume are more frequently associated with post-stroke cognitive impairment

et al. 2020

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“…These regions sustain many essential brain functions which contribute to critical symptomatology of acute stroke patients. They appear to be more frequently injured in the literature 4,8,9,13,[19][20][21][22][23][24] than any other brain areas. Several studies have connected the insula to stroke severity.…”

Section: Discussionmentioning

confidence: 99%

Boundary and vulnerability estimation of the internal borderzone using ischemic stroke lesion mapping

Grange

Garnier

et al. 2020

Sci Rep

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Distinction between deep and superficial middle cerebral artery (MCA) territories and their junctional vascular area (the internal borderzone or IBZ) constitutes a predictor of stroke patient outcome. However, the IBZ boundaries are not well-defined because of substantial anatomical variance. Here, we built a statistical estimate of the IBZ and tested its vulnerability to ischemia using an independent sample. First, we used delineated lesions of 122 patients suffering of chronic ischemic stroke grouped in deep, superficial and territorial topographies and statistical comparisons to generate a probabilistic estimate of the IBZ. The IBZ extended from the insular cortex to the internal capsule and the anterior part of the caudate nucleus head. The IBZ showed the highest lesion frequencies (~30% on average across IBZ voxels) in our chronic stroke patients but also in an independent sample of 87 acute patients. Additionally, the most important apparent diffusion coefficient reductions (−6%), which reflect stroke severity, were situated within our IBZ estimate. The IBZ was most severely injured in case of a territorial infarction. Then, our results are in favour of an increased IBZ vulnerability to ischemia. Moreover, our probabilistic estimates of deep, superficial and IBZ regions can help the everyday spatial classification of lesions.Identifying factors that can predict the clinical outcome of the patients is a major concern for acute stroke management. This is of particular importance in the context of reperfusion therapy. Diffusion weighted imaging (DWI) has driven considerable interest as a biomarker of patient functional outcome. Indeed, larger DWI lesion volumes are associated with worse outcome 1,2 . Besides ischemic volume and diffusion-perfusion mismatching, early neurological predictors are limited. Nevertheless, the spatial arrangement of injuries identified on DWI can be a surrogate as it is correlated with the pathogenic mechanisms of stroke and patient outcome 3,4 ; after intravenous thrombolysis 5 or not 4,6 . Indeed, infarct location within the middle cerebral artery (MCA) territory reflects stroke severity 7,8 and may be more influential than lesion volume 9 . Consequently, the lesion topography can motivate diverse therapeutic strategies either at the acute 5 , sub-acute or chronic stages of the illness. Moreover, working with spatial lesion pattern has several practical advantages in the emergency setup compared to volume analysis which is more complex and time consuming. MCA infarctions are commonly categorized according to the territories of the deep and the superficial perforating arteries. Additionally, it has been suggested to distinguish stroke situated in the borderzone between these two vascular fields, that is the Internal Borderzone or IBZ, from other infarct types 10,11 . Pure IBZ watershed infarcts are relatively rare 3 and underlying physiopathological mechanisms appear to be different from other strokes 6,12 . Because of their distal situation, IBZ infarcts are likely to reflect an ar...

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Neuroimaging Determinants of Poststroke Cognitive Performance

Cited by 53 publications

References 41 publications

Impaired cerebral autoregulation is associated with poststroke cognitive impairment

Impaired cerebral autoregulation is associated with poststroke cognitive impairment

Higher level of acute serum VEGF and larger infarct volume are more frequently associated with post-stroke cognitive impairment

Boundary and vulnerability estimation of the internal borderzone using ischemic stroke lesion mapping

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