Structural Integrity of the Contralesional Hemisphere Predicts Cognitive Impairment in Ischemic Stroke at Three Months

Dacosta-Aguayo, Rosalía; Graña, Manuel; Fernández‐Andújar, Marina; López‐Cancio, Elena; Cáceres, Cynthia; Bargalló, Núria; Barrios, Maite; Clemente, Imma C.; Torán-Monserrat, Pere; Sas, Maite Alzamora; Dávalos, Antoni; Auer, Tibor; Mataró, María

doi:10.1371/journal.pone.0086119

Cited by 56 publications

(56 citation statements)

References 75 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…38 Similarly, in a cohort of patients with right hemispheric ischemic stroke, with the use of Tract Based Spatial Statistics, FA values in the specific regions of the contralateral hemisphere correlated with performance on neuropsychological testing. 33 Our data now offer new evidence to demonstrate the utility of global measures of WM integrity in this population.…”

Section: Resultsmentioning

confidence: 61%

“…7,27,[29][30][31] Thus, it seems intuitive that WM integrity would influence poststroke recovery. 3,4,[32][33][34][35] The exact mechanisms by which prestroke WM integrity might influence poststroke functional recovery are yet to be determined; however, data that underscore the role of structural connectivity in functional performance in general populations point in the direction of potential underlying pathology. 7,21 Therefore, more severe total pre-AIS burden of WM disease (including overt WMH and microstructural injury in NAWM) may signify a degree of subclinical baseline cognitive and functional decline that predisposes these individuals for less favorable recovery after AIS.…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Integrity of normal-appearing white matter and functional outcomes after acute ischemic stroke

Etherton

Cougo

et al. 2017

Neurology

View full text Add to dashboard Cite

Objective: To characterize the effect of white matter microstructural integrity on cerebral tissue and long-term functional outcomes after acute ischemic stroke (AIS).Methods: Consecutive AIS patients with brain MRI acquired within 48 hours of symptom onset and 90-day modified Rankin Scale (mRS) score were included. Acute infarct volume on diffusion-weighted imaging (DWIv) and white matter hyperintensity volume (WMHv) on T2 fluidattenuated inversion recovery MRI were measured. Median fractional anisotropy (FA), mean diffusivity, radial diffusivity, and axial diffusivity values were calculated within normal-appearing white matter (NAWM) in the hemisphere contralateral to the acute lesion. Regression models were used to assess the association between diffusivity metrics and acute cerebral tissue and longterm functional outcomes in AIS. Level of significance was set at p , 0.05 for all analyses.Results: Among 305 AIS patients with DWIv and mRS score, mean age was 64.4 6 15.9 years, and 183 participants (60%) were male. Median NIH Stroke Scale (NIHSS) score was 3 (interquartile range [IQR] 1-8), and median normalized WMHv was 6.19 cm 3 (IQR 3.0-12.6 cm 3 ). Admission stroke severity (b 5 0.16, p , 0.0001) and small vessel stroke subtype (b 5 21.53, p , 0.0001), but not diffusivity metrics, were independently associated with DWIv. However, median FA in contralesional NAWM was independently associated with mRS score (b 5 29.74, p 5 0.02), along with age, female sex, NIHSS score, and DWIv.Conclusions: FA decrease in NAWM contralateral to the acute infarct is associated with worse mRS category at 90 days after stroke. These data suggest that white matter integrity may contribute to functional recovery after stroke. Neurology ® 2017;88:1701-1708 GLOSSARY AD 5 axial diffusivity; AIS 5 acute ischemic stroke; DTI 5 diffusion tensor imaging; DWIv 5 diffusion-weighted imaging volume; FA 5 fractional anisotropy; FLAIR 5 fluid-attenuated inversion recovery; IQR 5 interquartile range; MD 5 mean diffusivity; MNI 5 Montreal Neurological Institute; mRS 5 modified Rankin Scale; nDWIv 5 normalized diffusion-weighted imaging volume; NAWM 5 normal-appearing white matter; NIHSS 5 NIH Stroke Scale; nWMHv 5 normalized white matter hyperintensity volume; RD 5 radial diffusivity; TOAST 5 Trial of Org 10172 in Acute Stroke Treatment; tPA 5 tissue plasminogen activator; WM 5 white matter; WMH 5 white matter hyperintensity; WMHv 5 white matter hyperintensity volume.The role of white matter hyperintensity (WMH), or leukoaraiosis, in outcomes after acute ischemic stroke (AIS) is increasingly recognized through its link to larger acute infarct lesions, 1 likelihood of infarct expansion, 2 and association with worse functional poststroke outcomes. [3][4][5] However, a growing body of evidence suggests that macrostructural white matter (WM) disease burden, quantified as WMH on T2-weighted fluid-attenuated inversion recovery (FLAIR) MRI, may not adequately reflect the total extent of WM injury and that microstructural injury to normal-appear...

show abstract

Section: Resultsmentioning

confidence: 61%

Section: Resultsmentioning

confidence: 99%

Integrity of normal-appearing white matter and functional outcomes after acute ischemic stroke

Etherton

Cougo

et al. 2017

Neurology

View full text Add to dashboard Cite

show abstract

“…TBSS can reduce the effects of local misregistrations by projecting all FA voxels onto the nearest location on a "skeleton" approximating WM tract center [9] [12] [13]. So TBSS has become a kind of popular software to study DTI, and has been used in some studies of various diseases, such as stroke [14], Parkinson [15], epilepsy [16], multiple sclerosis [17], traumatic brain injury [18], schizophrenia [19] and so on. Also some studies of cognitive disorders used TBSS, included mild cognitive impairment (MCI) and AD [9] [20].…”

Section: Introductionmentioning

confidence: 99%

White Matter Changes in Alzheimer’s Disease Revealed by Diffusion Tensor Imaging with TBSS

Chen¹,

Wang²,

Yao³

et al. 2015

WJNS

View full text Add to dashboard Cite

Alzheimer's disease (AD) is a progressive, neurodegenerative disorder characterized by impairments in multiple cognitive domains and it is hard to diagnose in early stage because it's not easy to recognize and develop slowly. In this study, we try to evaluate the difference of white matter between AD and health volunteers using diffusion tensor imaging (DTI) and try to provide some evidence for diagnose AD in early stage. Twelve elderly Chinese patients with AD and twelve healthy volunteers were recruited and underwent DTI. The raw diffusion data were dealt with the toolkit of FSL image post-processing. Fractional anisotrogy (FA) data were then carried out by using tract-based spatial statistics (TBSS). The result showed that the FA of cingulum, hippocampus, corticospinal tract, and inferior fronto-occipital fasciculus significantly reduced in AD patients than that of volunteers. This indicated that the integrity of white matter tracts in these regions with AD was disturbed. On the other hand, the FA of other encephalic regions had no discrepancy compared with that of healthy volunteers. FA values were found reduced significantly in AD patients, especially in the posterior of the brain. These findings may provide image methods to diagnose patients with early stage of AD.

show abstract

“…11,12 Besides remote structural changes in the ipsilesional hemisphere, a few small neuroimaging studies (6-16 patients) in older patients with stroke (≥60 years) found loss of white matter integrity as remote as the contralesional hemisphere, 13 and this was associated with motor impairment ≤6 months after stroke 14,15 and poorer cognitive recovery 3 months after right middle cerebral artery stroke. 16 It is unknown whether lower microstructural integrity in areas remote from the initial stroke, including as remote as the contralesional hemisphere, is related to long-term (ie, years) cognitive dysfunction after stroke. In addition, the presence of preexisting (subclinical) cerebral small vessel disease, such as diffuse white-matter hyperintensities or subclinical infarcts, may also contribute to the poststroke spectrum of cognitive impairment 6 …”

mentioning

confidence: 99%

Remote Lower White Matter Integrity Increases the Risk of Long-Term Cognitive Impairment After Ischemic Stroke in Young Adults

Schaapsmeerders

Tuladhar

Arntz

et al. 2016

Stroke

View full text Add to dashboard Cite

; however, this has never been investigated in young patients with stroke. A better understanding of Background and Purpose-Poststroke cognitive impairment occurs frequently in young patients with ischemic stroke (18 through 50 years of age). Accumulating data suggest that stroke is associated with lower white matter integrity remote from the stroke impact area, which might explain why some patients have good long-term cognitive outcome and others do not. Given the life expectancy of decades in young patients, we therefore investigated remote white matter in relation to long-term cognitive function. Methods-We included all consecutive first-ever ischemic stroke patients, left/right hemisphere, without recurrent stroke or transient ischemic attack during follow-up, aged 18 through 50 years, admitted to our university medical center between 1980 and 2010. One hundred seventeen patients underwent magnetic resonance imaging scanning including a T1-weighted scan, a diffusion tensor imaging scan, and completed a neuropsychological assessment. Patients were compared with a matched stroke-free control group (age, sex, and education matched). Cognitive impairment was defined as >1.5 SD below the mean cognitive index score of controls and no cognitive impairment as ≤1 SD. Tract-Based Spatial Statistics was used to assess the white matter integrity (fractional anisotropy and mean diffusivity). Results-About 11 years after ischemic stroke, lower remote white matter integrity was associated with a worse long-term cognitive performance. A lower remote white matter integrity, even in the contralesional hemisphere, was observed in cognitively impaired patients (n=25) compared with cognitively unimpaired patients (n=71). Conclusions-These findings indicate that although stroke has an acute onset, it might have long lasting effects on remote white matter integrity and thereby increases the risk of long-term cognitive impairment. (Stroke. 2016;47:2517-2525.

show abstract

Structural Integrity of the Contralesional Hemisphere Predicts Cognitive Impairment in Ischemic Stroke at Three Months

Cited by 56 publications

References 75 publications

Integrity of normal-appearing white matter and functional outcomes after acute ischemic stroke

Integrity of normal-appearing white matter and functional outcomes after acute ischemic stroke

White Matter Changes in Alzheimer’s Disease Revealed by Diffusion Tensor Imaging with TBSS

Remote Lower White Matter Integrity Increases the Risk of Long-Term Cognitive Impairment After Ischemic Stroke in Young Adults

Contact Info

Product

Resources

About