Predicting post-stroke cognitive impairment using acute CT neuroimaging: A systematic review and meta-analysis

Abstract

Background: Identifying whether acute stroke patients are at risk of cognitive decline could improve prognostic discussions and management. Structural computed tomography (CT) neuroimaging is routine in acute stroke, and may, identify those at risk of post-stroke dementia (PSD) or post-stroke cognitive impairment (PSCI). Aim: To systematically review the literature to identify which stroke or pre-stroke features on brain CT scans, performed at the time of stroke, are associated with PSD or PSCI. Summary of review: We searched electronic databases to December 2020. We included studies reporting acute stroke brain CT, and later diagnosis of a cognitive syndrome. We created summary estimates of size of unadjusted association between CT features and cognition. Of 9536 citations, twenty-eight studies (41 papers) were eligible (N=7078, mean age 59.8-78.6 years). Cognitive outcomes were PSD (10 studies), PSCI (17 studies), and one study analysed both. Fifteen studies (N=2952) reported data suitable for meta-analyses. White matter lesions (WML) (6 studies, N=1054, OR=2.46, 95% CI=1.25-4.84), cerebral atrophy (4 studies, N=558, OR=2.80, 95% CI=1.21-6.51), and pre-existing stroke lesions (3 studies, N=352, OR=2.38, 95% CI=1.06-5.32) were associated with PSD. WML (4 studies, N=473, OR=3.46, 95% CI=2.17-5.52) were associated with PSCI. Other CT features were either not associated with cognitive outcome, or there were insufficient data. Conclusions: Cognitive impairment following stroke is of great concern to patients and carers. Features seen on visual assessment of acute stroke CT brain scans are strongly associated with cognitive outcomes. Clinicians should consider when and how this information should be discussed with stroke survivors.

Longitudinal Brain Changes After Stroke and the Association With Cognitive Decline

“…A selection of cortices and subcortical structures to be used in the analyses was made based on previous literature (14,(18)(19)(20)22).…”

“…Both cortical and subcortical atrophy have been shown to be associated with cognitive decline (14,18). The brain changes reported as providing the greatest risk of cognitive decline in cross-sectional and longitudinal studies lasting up to 3-12 months are global brain atrophy, medial temporal lobe (including hippocampal) atrophy, and WMH load (4,(19)(20)(21)(22). Since accelerated brain atrophy is demonstrated for a longer time period, potentially important changes in brain structure-function relationship over time may be overlooked due to relatively short follow-up times in previous studies.…”

Potential Biomarkers for Post-Stroke Cognitive Impairment: A Systematic Review and Meta-Analysis

“…However, stroke has been reported to increase the risk of cognitive impairment by at least five to eight times [ 26 ]. To diagnose PSCI, in fact, neuroimaging features of computed tomography (CT) or magnetic resonance imaging (MRI) such as functional MRI (fMRI) and diffusion tensor imaging (DTI) have been used [ 27 , 28 ] and cognitive assessments such as the Information Questionnaire on Cognitive Decline in the Elderly (IQCODE), the Mini-Mental State Examination (MMSE), and the National Institute of Neurological Disease and Stroke (NINDS) battery have been applied [ 29 ].…”

Longitudinal brain age prediction and cognitive function after stroke

“…This is a provisional file, not the final typeset article A selection of cortices and subcortical structures to be used in the analyses was made based on previous literature (Mijajlovic et al, 2017;Haque et al, 2019;Jokinen et al, 2020;Ball et al, 2021).…”

“…Cortical and subcortical atrophy has been shown to be associated with cognitive decline (Mijajlovic et al, 2017;Haque et al, 2019), with global atrophy, medial temporal lobe (including This is a provisional file, not the final typeset article hippocampal) atrophy, and WMH reported to be the most important factors in cross sectional and longitudinal studies lasting up to 3/6/12 months (Jokinen et al, 2020;Ball et al, 2021;. Although these associations have been found, potentially important changes over time may be overlooked due to methodological concerns, such as relatively short follow-up times.…”