Post-stroke Cognition at 1 and 3 Years Is Influenced by the Location of White Matter Hyperintensities in Patients With Lacunar Stroke

Abstract

Lacunar strokes are a common type of ischemic stroke. They are known to have long-term cognitive deficits, but the influencing factors are still largely unknown. We investigated if the location of the index lacunar stroke or regional WMH and their change at 1 year could predict the cognitive performance at 1 and 3 years post-stroke in lacunar stroke patients. We used lacunar lesion location and WMH-segmented data from 118 patients, mean age 64.9 who had a brain MRI scan soon after presenting with symptoms, of which 88 had a repeated scan 12 months later. Premorbid intelligence (National Adult Reading Test) and current intelligence [Addenbrooke's Cognitive Exam-Revised (ACE-R)] were measured at 1, 12, and 36 months after the stroke. ANCOVA analyses adjusting for baseline cognition/premorbid intelligence, vascular risk factors, age, sex and total baseline WMH volume found that the recent small subcortical infarcts (RSSI) in the internal/external capsule/lentiform nucleus and centrum semiovale did not predict cognitive scores at 12 and 36 months. However, RSSI location moderated voxel-based associations of WMH change from baseline to 1 year with cognitive scores at 1 and 3 years. WMH increase in the external capsule, intersection between the anterior limb of the internal and external capsules, and optical radiation, was associated with worsening of ACE-R scores 1 and 3 years post-stroke after accounting for the location of the index infarct, age and baseline cognition.

Changes in White Matter Microstructure Over 3 Years in People With and Without Stroke

“…Finally, poststroke cognition assessed at 1 or 3 years is known to be influenced by white matter microstructure. 17,18 Our findings confirm multidomain impairments, with the most robust associations in visuospatial, processing speed, language, and verbal recognition memory functions. Note that impaired visuospatial processing, language, and processing speed have been specifically identified as predictive of long-term poststroke outcomes (assessed 7 years poststroke).…”

“…16 Lesions were automatically characterized as a mixture of white matter–like signal, other tissues, and fluid. 17 A population template was produced using FOD images from 25 participants (including all 3 time points for each), resulting in 231077 fixels in the analysis mask. Individual tracts of interest in both hemispheres (see eAppendix 1, links.lww.com/WNL/C642, for the list of tract names and acronyms) were delineated using the Automated TractSeg tool applying the default pipeline with 10,000 streamlines.…”

Impact of Small Vessel Disease Progression on Long-term Cognitive and Functional Changes After Stroke

“…This analysis builds on the recent finding in the same population that cognitive impairment after lacunar stroke is more related to background SVD than to index lesion location. 35 Notwithstanding that, considering the range of all subtypes of stroke, lesion location does appear to pay a role in post stroke cognitive impairment. 36 These findings add clarity to the time-course of vascular cognitive impairment and the impact of WMH progression in the first year after stroke, both increases and decreases, suggesting that clinical evidence of SVDrelated cognitive or mRS change becomes progressively apparent in the chronic rather than subacute phase post-stroke (Figure 3).…”

Prediction of white matter hyperintensities evolution one-year post-stroke from a single-point brain MRI and stroke lesions information

“…Data pre-processing for incorporation of probabilistic maps of WMH change Given the influence of stroke lesion location in WMH change and evolution patterns when the stroke lesions are located at the centrum semiovale or the lentiform nucleus 20 , we only used probability maps of WMH change based on stroke lesions incident at centrum semiovale or lentiform nucleus, publicly available 1 .…”