Pre-stroke cognitive impairment is associated with vascular imaging pathology: a prospective observational study

Abstract

Background Chronic brain pathology and pre-stroke cognitive impairment (PCI) is predictive of post-stroke dementia. The aim of the current study was to measure pre-stroke neurodegenerative and vascular disease burden found on brain MRI and to assess the association between pre-stroke imaging pathology and PCI, whilst also looking for potential sex differences. Methods This prospective brain MRI cohort is part of the multicentre Norwegian cognitive impairment after stroke (Nor-COAST) study. Patients hospitalized with acute ischemic or hemorrhagic stroke were included from five participating stroke units. Visual rating scales were used to categorize baseline MRIs (N = 410) as vascular, neurodegenerative, mixed, or normal, based on the presence of pathological imaging findings. Pre-stroke cognition was assessed by interviews of patients or caregivers using the Global Deterioration Scale (GDS). Stroke severity was assessed with the National Institute of Health Stroke Scale (NIHSS). Univariate and multiple logistic regression analyses were performed to investigate the association between imaging markers, PCI, and sex. Results Patients’ (N = 410) mean (SD) age was 73.6 (±11) years; 182 (44%) participants were female, the mean (SD) NIHSS at admittance was 4.1 (±5). In 68% of the participants, at least one pathological imaging marker was found. Medial temporal lobe atrophy (MTA) was present in 30% of patients, white matter hyperintensities (WMH) in 38% of patients and lacunes in 35% of patients. PCI was found in 30% of the patients. PCI was associated with cerebrovascular pathology (OR 2.5; CI = 1.4 to 4.5, p = 0.001) and mixed pathology (OR 3.4; CI = 1.9 to 6.1, p = 0.001) but was not associated with neurodegeneration (OR 1.0; CI = 0.5 to 2.2; p = 0.973). Pathological MRI markers, including MTA and lacunes, were more prevalent among men, as was a history of clinical stroke prior to the index stroke. The OR of PCI for women was not significantly increased (OR 1.2; CI = 0.8 to 1.9; p = 0.3). Conclusions Pre-stroke chronic brain pathology is common in stroke patients, with a higher prevalence in men. Vascular pathology and mixed pathology are associated with PCI. There were no significant sex differences for the risk of PCI. Trial registration NCT02650531, date of registration: 08.01.2016.

Predicting the Emergence of Major Neurocognitive Disorder Within Three Months After a Stroke

“…It is generally found that women are at higher risk for post-stroke dementia, mainly due to a longer life-expectancy (Carcel et al, 2020). A study using the same data as the current study (Schellhorn et al, 2021) proposed that the absence of gender difference may come down to a counterbalancing effect happening in this cohort, as it was found that although the women were older, they were also more likely to have fewer lacunes, pathological MTA scores and fewer pathological imaging finding.…”

Longitudinal Brain Changes After Stroke and the Association With Cognitive Decline

“…About 30% of stroke survivors develop cognitive impairments after a first-ever stroke, with the incidence of dementia within the first year after a major stroke being almost 50 times higher than in the general population, and nearly 6 times higher after a minor one (1). Stroke and dementia both pose risks for each other and share many of the same neurodegenerative and cerebrovascular risk factors (2), with preexisting structural brain pathology being a frequent finding in stroke patients (3). Early onset (<3 months) of post-stroke dementia (PSD) has been found to be primarily associated with stroke lesion volume and white matter hyperintensity (WMH) load (4)(5)(6)(7).…”

Longitudinal brain age prediction and cognitive function after stroke

“…Aging is also associated with an overall vulnerability to both peripheral and central nervous system disease, likely partly due to an overall decreased maintenance and damage repair on cell level (Rattan, 2012) and the possible increased burden of multi-morbidity (Bektas et al, 2018). Around half of the participants in the current study suffered from pre-stroke hypertension, and a previous study on the same cohort has shown high levels of pre-stroke brain pathology (Schellhorn et al, 2021b). These diseases render the brain at risk and more vulnerable to the consequence of future events (Kelly et al, 2021).…”

“…Chronic inflammation will aggravate existing diseases but also factors associated with aging (Germolec et al, 2018) and cognitive decline (Darweesh et al, 2018; Gabin et al, 2018; Zheng & Xie, 2018). Pre-existing diseases (Cipolla et al, 2018) and brain pathology are common in stroke patients, in particular among those who develop cognitive impairment (Schellhorn et al, 2021b).…”

“…Several factors are associated with poorer outcomes after stroke, including old age, lower education, pre-stroke disability, left-sided stroke (Pendlebury, 2012; Pendlebury & Rothwell, 2009), diabetes mellitus, a history of stroke (Lo et al, 2019), larger stroke lesions and vascular factors, such as white matter hyperintensities (WMH) (Schellhorn et al, 2021a; Aamodt et al, 2021). Brain atrophy after stroke (Brodtmann et al, 2020; Levine et al, 2015) is also associated with cognitive decline (Mijajlovic et al, 2017; Haque et al, 2019), particularly if accompanied by hypertension (Sayed et al, 2020) or other vasculopathies (Schellhorn et al, 2021b), with global and medial temporal lobe atrophy and WMH load among the most predictive factors 12 months post-stroke (Jokinen et al, 2020; Casolla, 2019; Wang et al, 2021; Ball et al, 2021; Schellhorn et al, 2021a).…”