Silent brain infarctions and cognition decline: systematic review and meta-analysis

Azeem, Feeha; Durrani, Romella; Zerna, Charlotte; Smith, Eric E.

doi:10.1007/s00415-019-09534-3

Cited by 40 publications

(34 citation statements)

References 44 publications

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“…43 A meta-analysis of 30 studies (with/without ACS) reported that most showed a significant association between cortical/lacunar SCI and impaired tests of executive function and processing speed. 44 The same systematic review found no association between SCI at baseline and the incident risk of developing minor cognitive impairment in the future (HR 0.83, 95% CI 0.4 e 1.72), but SCI was associated with a significantly higher risk of dementia (HR 1.27, 95% CI 1.06 e 1.51). 44 However, in a second meta-analysis (nine studies; 10 772 patients with/without ACS), SCI was initially associated with a significantly increased risk of dementia (HR 1.29, 95% CI 1.02 e 1.6%), but after correcting for repeat NP testing, statistical significance disappeared.…”

Section: Cortical and Lacunar Silent Cerebral Infarctions Combinedmentioning

confidence: 96%

“…44 The same systematic review found no association between SCI at baseline and the incident risk of developing minor cognitive impairment in the future (HR 0.83, 95% CI 0.4 e 1.72), but SCI was associated with a significantly higher risk of dementia (HR 1.27, 95% CI 1.06 e 1.51). 44 However, in a second meta-analysis (nine studies; 10 772 patients with/without ACS), SCI was initially associated with a significantly increased risk of dementia (HR 1.29, 95% CI 1.02 e 1.6%), but after correcting for repeat NP testing, statistical significance disappeared. 45 These two meta-analyses actually showed very similar findings in dementia patients, being only separated by the lower 95% CI being slightly above 1 in one meta-analysis 44 and slightly below 1 in the other.…”

Section: Cortical and Lacunar Silent Cerebral Infarctions Combinedmentioning

confidence: 96%

“…44 However, in a second meta-analysis (nine studies; 10 772 patients with/without ACS), SCI was initially associated with a significantly increased risk of dementia (HR 1.29, 95% CI 1.02 e 1.6%), but after correcting for repeat NP testing, statistical significance disappeared. 45 These two meta-analyses actually showed very similar findings in dementia patients, being only separated by the lower 95% CI being slightly above 1 in one meta-analysis 44 and slightly below 1 in the other. 45 It is well recognised that the "retest" phenomenon biases interpretation of cognitive impairment studies and this may explain why the second meta-analysis found no evidence of a significant link between SCI and dementia, after correcting for retesting.…”

Section: Cortical and Lacunar Silent Cerebral Infarctions Combinedmentioning

confidence: 97%

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Editor's Choice – Asymptomatic Carotid Stenosis and Cognitive Impairment: A Systematic Review

Paraskevas¹,

Faggioli

Ancetti

et al. 2021

European Journal of Vascular and Endovascular Surgery

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Study heterogeneity confounded data interpretation, largely because there is no standardisation regarding cognitive testing. However, 94% of studies reported an association between asymptomatic carotid stenosis (ACS) and one or more tests of cognitive impairment. The review found no clear evidence that ACS caused cognitive impairment via silent cortical infarction (few studies addressed this question), or by involvement in the pathophysiology of lacunar infarction or white matter hyperintensities. There was, however, better evidence suggesting that patients with severe ACS and impaired cerebral vascular reserve were more likely to have cognitive impairment and to suffer further cognitive decline with time.Objective: The aim was to evaluate the relationship between asymptomatic carotid stenosis (ACS) of any severity and cognitive impairment and to determine whether there is evidence supporting an aetiological role for ACS in the pathophysiology of cognitive impairment. Data sources: PubMed/Medline, Embase, Scopus, and the Cochrane library. Review methods: This was a systematic review (35 cross sectional or longitudinal studies) Results: Study heterogeneity confounded data interpretation, largely because of no standardisation regarding cognitive testing. In the 30 cross sectional and six longitudinal studies (one included both), 33/35 (94%) reported an association between any degree of ACS and one or more tests of impaired cognitive function (20 reported one to three tests with poorer cognition; 11 reported four to six tests with poorer cognition, while three studies reported seven or more tests with poorer cognition). There was no evidence that ACS caused cognitive impairment via silent cortical infarction, or via involvement in the pathophysiology of lacunar infarction or white matter hyperintensities. However, nine of 10 studies evaluating cerebral vascular reserve (CVR) reported that ACS patients with impaired CVR were significantly more likely to have cognitive impairment and that impaired CVR was associated with worsening cognition over time. Patients with severe ACS but normal CVR had cognitive scores similar to controls. Conclusion: Notwithstanding significant heterogeneity within the constituent studies, which compromised overall interpretation, 94% of studies reported an association between ACS and one or more tests of cognitive impairment. However, "significant association" does not automatically imply an aetiological relationship. At present, there is no clear evidence that ACS causes cognitive impairment via silent cortical infarction (but very few studies have addressed this question) and no evidence of ACS involvement in the pathophysiology of white matter hyperintensities or lacunar infarction. There is, however, better evidence that patients with severe ACS and impaired CVR are more likely to have cognitive impairment and to suffer further cognitive decline with time.

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Section: Cortical and Lacunar Silent Cerebral Infarctions Combinedmentioning

confidence: 96%

Section: Cortical and Lacunar Silent Cerebral Infarctions Combinedmentioning

confidence: 96%

Section: Cortical and Lacunar Silent Cerebral Infarctions Combinedmentioning

confidence: 97%

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Editor's Choice – Asymptomatic Carotid Stenosis and Cognitive Impairment: A Systematic Review

Paraskevas¹,

Faggioli

Ancetti

et al. 2021

European Journal of Vascular and Endovascular Surgery

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“…148 Furthermore, MRI features of cerebral small vessel disease, ie, white matter hyperintensities, lacunes, microbleeds, perivascular spaces, and cerebral atrophy were additively associated with dementia and cognitive decline. [149][150][151] Therefore, it seems likely to expect that COVID-19-related cardiovascular and F I G U R E 1 Consortium participants. Colored countries in the map represent those with at least one academic institution participating in the Consortium for Chronic Neuropsychiatric Sequelae of SARS-CoV-2 cerebrovascular disease will also contribute to a higher long-term risk of cognitive decline and dementia in recovered individuals.…”

Section: Implications For Neuropsychiatric Disordersmentioning

confidence: 99%

The chronic neuropsychiatric sequelae of COVID‐19: The need for a prospective study of viral impact on brain functioning

Erausquin

Snyder

Carrillo

et al. 2021

Alzheimer's & Dementia

170

154

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Introduction:The increasing evidence of SARS-CoV-2 impact on the central nervous system (CNS) raises key questions on its impact for risk of later life cognitive decline, Alzheimer's disease (AD), and other dementia.Methods: The Alzheimer's Association and representatives from more than 30 countries-with technical guidance from the World Health Organization-have formed an international consortium to study the short-and long-term consequences of SARS-CoV-2 on the CNS-including the underlying biology that may contribute to AD and other dementias. This consortium will link teams from around the world covering more than 22 million COVID-19 cases to enroll two groups of individuals including people with disease, to be evaluated for follow-up evaluations at 6, 9, and 18 months, and people who are already enrolled in existing international research studies to add additional measures and markers of their underlying biology. Conclusions:The increasing evidence and understanding of SARS-CoV-2's impact on the CNS raises key questions on the impact for risk of later life cognitive decline, AD, and other dementia. This program of studies aims to better understand the long-term consequences that may impact the brain, cognition, and functioning-including the underlying biology that may contribute to AD and other dementias.

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“…In addition to strokes, transient ischemic attacks (TIA), defined as a brief episode of neurological dysfunction caused by ischemia in the brain, often are accompanied by impaired consciousness or neuropsychological symptoms impairing driving safety. Silent brain infarction (SBI), meaning the absence of clinically obvious symptoms only diagnosed by MRI, which is linked to a two-fold increased risk of future stroke [55] often leading to a cognitive decline and dementia, might have an impact on driving fitness [56].…”

Section: Strokementioning

confidence: 99%

Age-Related Diseases and Driving Safety

Falkenstein¹,

Karthaus

Brüne-Cohrs

2020

Geriatrics

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Due to demographic changes, the number of older drivers is steadily increasing. Mobility is highly relevant for leading an independent life in the elderly. It largely depends on car driving, which is a complex task requiring a multitude of cognitive and motor skills vulnerable to age- related functional deterioration. The almost inevitable effects of senescence may be potentiated by age-related diseases, such as stroke or diabetes mellitus. Respective pharmacological treatment may cause side effects, additionally affecting driving safety. The present article reviews the impact of age-related diseases and drug treatment of these conditions on driving fitness in elderly drivers. In essence, we focus on diseases of the visual and auditory systems, diseases of the central nervous system (i.e., stroke, depression, dementia and mild cognitive disorder, and Parkinson’s disease), sleep disorders, as well as cardiovascular diseases, diabetes mellitus, musculoskeletal disorders, and frailty. We will outline the role of functional tests and the assessment of driving behavior (by a driving simulator or in real traffic), as well as the clinical interview including questions about frequency of (near) accidents, etc. in the evaluation of driving fitness of the elderly. We also address the impact of polypharmacy on driving fitness and end up with recommendations for physicians caring for older patients.

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Silent brain infarctions and cognition decline: systematic review and meta-analysis

Cited by 40 publications

References 44 publications

Editor's Choice – Asymptomatic Carotid Stenosis and Cognitive Impairment: A Systematic Review

Editor's Choice – Asymptomatic Carotid Stenosis and Cognitive Impairment: A Systematic Review

The chronic neuropsychiatric sequelae of COVID‐19: The need for a prospective study of viral impact on brain functioning

Age-Related Diseases and Driving Safety

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