White matter hyperintensities as a predictor of neuropsychological deficits post-stroke

Abstract

Objectives: Cerebral white matter hyperintensities (WMHs) on magnetic resonance imaging (MRI) are a recognised risk factor for post-stroke dementia. Their specific relations to cognitive impairment are still not well known. The purpose of this study was to explore how the severity and location of WMHs predict neuropsychological test performance in the context of other brain lesions in elderly stroke patients. Methods: In the Helsinki Stroke Aging Memory Study, 323 patients, aged from 55 to 85 years, completed a detailed neuropsychological test battery and MRI 3 months after an ischaemic stroke. The demographic and MRI predictors of cognition were studied with sequential linear regression analyses. Results: After age, education and total infarct volume were controlled for, the overall degree of WMHs predicted poor performance in tests of mental speed, executive functions, memory, and visuospatial functions, but not in those of short term memory storage or verbal conceptualisation. However, the contribution of separate white matter regions was relatively low. Only the lesions along the bodies of lateral ventricles were independently associated with speed and executive measures. Additionally, general cortical atrophy clearly predicted a wide range of cognitive deficits while infarct volume had less relevance. Further analyses revealed that executive functions act as a strong mediator between the relationship of WMHs to memory and visuospatial functions. Conclusions: The degree of WMHs is independently related to post-stroke cognitive decline. The most affected cognitive domains seem to be executive functions and speed of mental processing, which may lead to secondary deficits of memory and visuospatial functions.

Hidden Dysfunctioning in Subacute Stroke

“…36,37 Although leukoaraiosis was associated with CDF and correlated with cognitive tests in this study, it was not a predictor, presumably because of the low frequency of leukoaraiosis. Again, this could be explained by the low age and high MMSE of our patients.…”

Network measures predict neuropsychological outcome after brain injury

“…Extent of poststroke recovery varies with many patient-related factors (e.g., age at stroke onset, sex, handedness, socioeconomic status) and various stroke-and lesion-related factors (e.g., initial stroke severity, lesion size, stroke subtype, lesion location), but these factors have very limited predictive power for outcome (19)(20)(21)(22)(23)(24). Even good predictors, including initial stroke severity and lesion volume, leave most of the variability in outcome unexplained (25)(26)(27)(28).…”

Patterns of neuropsychological impairment in MCI patients with small subcortical infarcts or hippocampal atrophy

“…This line of research followed from the observations that, according to some authors, there are differences between the neuropsychological patterns of DAT patients and those of patients with VD resulting from small-vessel disease. The former consistently show a predominance of episodic memory disorders (Gainotti et al, 1989(Gainotti et al, , 2001Graham et al, 2004;Ingles et al, 2007;Looi & Sachdev, 1999;Matsuda et al, 1998;Mendez &Ashla-Mendez, 1991), whereas the latter appear to show a prevalence of executive dysfunction (Desmond, 2004;Jokinen et al, 2005;Kertesz & Clydesdale, 1994;Kramer et al, 2002;Looi & Sachdev, 1999;Padovani et al, 1995). Furthermore, psychomotor retardation, considered to be a prominent consequence of stroke (Ballard et al, 2003;Rasquin et al, 2004) is also found in small-vessel subcortical dementia (Gainotti et al, 2001), in vascular cognitive impairment (Desmond, 2004) and in association with recognized risk factors for vascular dementia, such as white matter hyperintensities (Jokinen et al, 2005).…”

“…The former consistently show a predominance of episodic memory disorders (Gainotti et al, 1989(Gainotti et al, , 2001Graham et al, 2004;Ingles et al, 2007;Looi & Sachdev, 1999;Matsuda et al, 1998;Mendez &Ashla-Mendez, 1991), whereas the latter appear to show a prevalence of executive dysfunction (Desmond, 2004;Jokinen et al, 2005;Kertesz & Clydesdale, 1994;Kramer et al, 2002;Looi & Sachdev, 1999;Padovani et al, 1995). Furthermore, psychomotor retardation, considered to be a prominent consequence of stroke (Ballard et al, 2003;Rasquin et al, 2004) is also found in small-vessel subcortical dementia (Gainotti et al, 2001), in vascular cognitive impairment (Desmond, 2004) and in association with recognized risk factors for vascular dementia, such as white matter hyperintensities (Jokinen et al, 2005). A further difference between DAT and VD could include phonological and semantic fluency, because some authors (e.g., Canning et al, 2004;Jones et al, 2006), but not others (e.g., Bentham et al, 1997;Crossley et al, 1997) have found a greater semantic fluency impairment in DAT patients and a greater phonological fluency impairment in VD patients.…”