Vascular Cognitive Impairment After Mild Stroke: Connectomic Insights, Neuroimaging, and Knowledge Translation

Abstract

Contemporary stroke assessment protocols have a limited ability to detect vascular cognitive impairment (VCI), especially among those with subtle deficits. This lesser-involved categorization, termed mild stroke (MiS), can manifest compromised processing speed that negatively impacts cognition. From a neurorehabilitation perspective, research spanning neuroimaging, neuroinformatics, and cognitive neuroscience supports that processing speed is a valuable proxy for complex neurocognitive operations, insofar as inefficient neural network computation significantly affects daily task performance. This impact is particularly evident when high cognitive loads compromise network efficiency by challenging task speed, complexity, and duration. Screening for VCI using processing speed metrics can be more sensitive and specific. Further, they can inform rehabilitation approaches that enhance patient recovery, clarify the construct of MiS, support clinician-researcher symbiosis, and further clarify the occupational therapy role in targeting functional cognition. To this end, we review relationships between insult-derived connectome alterations and VCI, and discuss novel clinical approaches for identifying disruptions of neural networks and white matter connectivity. Furthermore, we will frame knowledge translation efforts to leverage insights from cutting-edge structural and functional connectomics research. Lastly, we highlight how occupational therapists can provide expertise as knowledge brokers acting within their established scope of practice to drive substantive clinical innovation.

Lower glomerular filtration rate after mild stroke induces cognitive impairment by causing endothelial dysfunction

“…At present, about two-thirds of patients with AIS only experience less neurological dysfunction during the acute phase 19 . Previous studies have shown that patients with MIS have a high incidence rate of PSCI 20 . Similarly, our study excluded patients with cognitive impairment prior to enrollment and found that the incidence of PSCI was also more than 50%.…”

Cognitive impairment in diffuse axonal injury patients with favorable outcome

“…“Neurocognition” is defined as a collection of interrelated domains such as executive function (EF), language and perceptual motor function, calculation, complex attention, memory, and visuoperception ( George et al, 2018 ; Holguin et al, 2022 ; RaukolaLindblom et al, 2022 ). Found that the Finnish KAT test is a valuable tool to detect cognitive-linguistic deficits by comparing the cognitive function of 48 adults with moderate to severe DAI and 27 healthy controls.…”

“…The Hopkins Language Learning Test (HVLT), Trail Making Test (TMT), and Rey–Osterrieth Complex Figure test were used to assess neuropsychological results in 25 DAI patients at 6 and 12 months post-traumatic, revealed that patients’ episodic verbal memory, attention, and executive function were improved at 6 and 12 months after the trauma ( Macruz et al, 2022 ). All of the above test methods could only evaluate certain domains of Neurocognition, and the Montreal Cognitive Assessment (MoCA) ( Nasreddine et al, 2005 ) was considered to be a more appropriate scale to comprehensively assess cognitive function after traumatic brain injury, subarachnoid hemorrhage, stroke and Alzheimer’s disease ( Cornea et al, 2022 ; Holguin et al, 2022 ; Wang et al, 2022 ). MoCA and resting-state perfusion magnetic resonance imaging were performed in 40 patients with acute mild TBI and 40 healthy controls within 14 days following injury to elucidate the relationship between cerebral blood flow connectivity differences and cognitive outcomes in the acute phase after mild TBI ( Duan et al, 2022 ).…”