Vascular and Neurodegenerative Markers for the Prediction of Post-Stroke Cognitive Impairment: Results from the TABASCO Study

Molad, Jeremy; Hallevi, Hen; Korczyn, Amos D.; Kliper, Efrat; Auriel, Eitan; Bornstein, Natan M.; Assayag, Einor Ben

doi:10.3233/jad-190339

Cited by 37 publications

(34 citation statements)

References 32 publications

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“…In line with previous literature, stroke lesion volumes were found to be higher in the major NCD group, with a mean volume of 16.7 vs. 5.8 ml in the normal/mild NCD group. Due to its potential to destroy or compromise tissue vital for cognitive function, stroke lesion volume, as well as WMH load, has been found to be an important independent predictor of post-stroke cognitive deficits (Pendlebury, 2012;Puy et al, 2018;Georgakis et al, 2019), at least for volumes larger than 5 ml (Molad et al, 2019).…”

Section: Discussionmentioning

confidence: 99%

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

Aamodt

Schellhorn

Stage

et al. 2021

Front. Aging Neurosci.

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Background: Neurocognitive disorder (NCD) is common after stroke, with major NCD appearing in about 10% of survivors of a first-ever stroke. We aimed to classify clinical- and imaging factors related to rapid development of major NCD 3 months after a stroke, so as to examine the optimal composition of factors for predicting rapid development of the disorder. We hypothesized that the prediction would mainly be driven by neurodegenerative as opposed to vascular brain changes.Methods: Stroke survivors from five Norwegian hospitals were included from the “Norwegian COgnitive Impairment After STroke” (Nor-COAST) study. A support vector machine (SVM) classifier was trained to distinguish between patients who developed major NCD 3 months after the stroke and those who did not. Potential predictor factors were based on previous literature and included both vascular and neurodegenerative factors from clinical and structural magnetic resonance imaging findings. Cortical thickness was obtained via FreeSurfer segmentations, and volumes of white matter hyperintensities (WMH) and stroke lesions were semi-automatically gathered using FSL BIANCA and ITK-SNAP, respectively. The predictive value of the classifier was measured, compared between classifier models and cross-validated.Results: Findings from 227 stroke survivors [age = 71.7 (11.3), males = (56.4%), stroke severity NIHSS = 3.8 (4.8)] were included. The best predictive accuracy (AUC = 0.876) was achieved by an SVM classifier with 19 features. The model with the fewest number of features that achieved statistically comparable accuracy (AUC = 0.850) was the 8-feature model. These features ranked by their weighting were; stroke lesion volume, WMH volume, left occipital and temporal cortical thickness, right cingulate cortical thickness, stroke severity (NIHSS), antiplatelet medication intake, and education.Conclusion: The rapid (<3 months) development of major NCD after stroke is possible to predict with an 87.6% accuracy and seems dependent on both neurodegenerative and vascular factors, as well as aspects of the stroke itself. In contrast to previous literature, we also found that vascular changes are more important than neurodegenerative ones. Although possible to predict with relatively high accuracy, our findings indicate that the development of rapid onset post-stroke NCD may be more complex than earlier suggested.

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Section: Discussionmentioning

confidence: 99%

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

Aamodt

Schellhorn

Stage

et al. 2021

Front. Aging Neurosci.

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“…As has been the case for TBI and stroke, knowledge of individual genotypes may improve the prediction of differing clinical outcomes of COVID-19 patients. [283][284][285][286] Although individual, nongenetic susceptibility may influence the occurrence or severity of brain injury caused by SARS-Cov-2, variation in susceptibility to SARS-Cov-2 may also be attributable to individual differences in genetic susceptibility factors in infected individuals. Susceptible persons may have impaired innate abilities to fight viruses attributable to suboptimal interferon responses 287 or inability to mount adequate cell-mediated immune responses.…”

Section: Genotypingmentioning

confidence: 99%

Blood Biomarkers for Detection of Brain Injury in COVID-19 Patients

DeKosky

Kochanek

Valadka

et al. 2021

Journal of Neurotrauma

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The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus attacks multiple organs of coronavirus disease 2019 (COVID-19) patients, including the brain. There are worldwide descriptions of neurological deficits in COVID-19 patients. Central nervous system (CNS) symptoms can be present early in the course of the disease. As many as 55% of hospitalized COVID-19 patients have been reported to have neurological disturbances three months after infection by SARS-CoV-2. The mutability of the SARS-COV-2 virus and its potential to directly affect the CNS highlight the urgency of developing technology to diagnose, manage, and treat brain injury in COVID-19 patients. The pathobiology of CNS infection by SARS-CoV-2 and the associated neurological sequelae of this infection remain poorly understood. In this review, we outline the rationale for the use of blood biomarkers (BBs) for diagnosis of brain injury in COVID-19 patients, the research needed to incorporate their use into clinical practice, and the improvements in patient management and outcomes that can result. BBs of brain injury could potentially provide tools for detection of brain injury in COVID-19

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“…The pathophysiologic process by which WMH develops includes endothelial dysfunction, disturbance of the microcirculation, and blood-brain barrier breakdown at the level of cerebral arterioles, capillaries, and venules [2, 3]. In acute ischemic stroke, WMH burden has been shown to predict functional and cognitive impairment after the stroke [4-6]. Large vessel occlusion (LVO) strokes are distinct from other forms of ischemic stroke as mechanical thrombectomy, a highly effective therapy in this disease category, is not available to other stroke subtypes [7].…”

Section: Introductionmentioning

confidence: 99%

Effects of White Matter Hyperintensities on 90-Day Functional Outcome after Large Vessel and Non-Large Vessel Stroke

et al. 2020

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Introduction: White matter hyperintensity (WMH) burden is a critically important cerebrovascular phenotype related to the diagnosis and prognosis of acute ischemic stroke. The effect of WMH burden on functional outcome in large vessel occlusion (LVO) stroke has only been sparsely assessed, and direct LVO and non-LVO comparisons are currently lacking. Material and Methods: We reviewed acute ischemic stroke patients admitted between 2009 and 2017 at a large healthcare system in the USA. Patients with LVO were identified and clinical characteristics, including 90-day functional outcomes, were assessed. Clinical brain MRIs obtained at the time of the stroke underwent quantification of WMH using a fully automated algorithm. The pipeline incorporated automated brain extraction, intensity normalization, and WMH segmentation. Results: A total of 1,601 acute ischemic strokes with documented 90-day mRS were identified, including 353 (22%) with LVO. Among those strokes, WMH volume was available in 1,285 (80.3%) who had a brain MRI suitable for WMH quantification. Increasing WMH volume from 0 to 4 mL, age, female gender, a number of stroke risk factors, presence of LVO, and higher NIHSS at presentation all decreased the odds for a favorable outcome. Increasing WMH above 4 mL, however, was not associated with decreasing odds of favorable outcome. While WMH volume was associated with functional outcome in non-LVO stroke (p = 0.0009), this association between WMH and functional status was not statistically significant in the complete case multivariable model of LVO stroke (p = 0.0637). Conclusion: The burden of WMH has effects on 90-day functional outcome after LVO and non-LVO strokes. Particularly, increases from no measurable WMH to 4 mL of WMH correlate strongly with the outcome. Whether this relationship of increasing WMH to worse outcome is more pronounced in non-LVO than LVO strokes deserves additional investigation.

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Vascular and Neurodegenerative Markers for the Prediction of Post-Stroke Cognitive Impairment: Results from the TABASCO Study

Cited by 37 publications

References 32 publications

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

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

Blood Biomarkers for Detection of Brain Injury in COVID-19 Patients

Effects of White Matter Hyperintensities on 90-Day Functional Outcome after Large Vessel and Non-Large Vessel Stroke

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