Abstract
Objective: Cerebral small vessel disease (SVD) is associated with increased mortality, disability and cognitive decline, depression in stroke survivors. This study examined the association between SVD burden, defined by a combination of SVD markers, and health-related quality of life (HRQoL) in acute ischemic stroke.Methods: Patients admitted with acute ischemic stroke of any etiology were prospectively screened between January 2010 to December 2014 and enrolled in the study if they met study entry criteria. HRQoL was evaluated with the 12-item Stroke Specific Quality of Life (SSQoL) at 3 months after the onset of acute ischemic stroke. SVD was ascertained by the presence of any of the SVD markers including lacune, white matter hyperintensities (WMH), cerebral microbleeds (CMB) and enlarged perivascular spaces (EPVS) in the basal ganglia or their combinations on brain magnetic resonance imaging (MRI). The presence of each individual marker scored 1 point and was summed up to generate an ordinal “SVD score” (0–4) capturing total SVD burden. Linear regression was used to determine the associations between SVD burden and HRQoL.Results: Of the743 acute ischemic stroke patients that formed he study sample (mean age: 66.3 ± 10.6 years; 41.7% women), 49.3%, 22.5%, 16.0%, 9.2% and 3.1% had SVD scores of 0, 1, 2, 3 and 4, respectively. After adjusting for demographic, clinical and imaging variables, the SVD score was independently associated with lower overall score of SSQoL (B = −1.39, SE = 0.56, p = 0.01), and its domains of mobility (B = −0.41, SE = 0.10, p < 0.001) and vision (B = −0.12, SE = 0.06, p = 0.03). Acute infract volume (B = −1.44, SE = 0.54, p = 0.01), functional independence (B = 5.69, SE = 0.34, p < 0.001) and anxious (B = −1.13, SE = 0.23, p < 0.001) and depressive symptoms (B = −3.41, SE = 0.22, p < 0.001) were also the significant predictors of the overall score of SSQoL.Conclusion: The brain’s SVD burden predicts lower HRQoL, predominantly in domains of mobility and vision at 3 months after acute ischemic stroke. The evaluation of SVD burden could facilitate developing individual treatment strategies.
Highlights
Cerebral small vessel disease (SVD) is a condition of clinical, neuroimaging and neuropathological presentations that causes the damage to the brain’s small perforating vessels (Wardlaw et al, 2013a)
Patients with first-ever or recurrent acute ischemic stroke of any etiology admitted to the Stroke Unit of Prince of Wales Hospital between January 2010 and December 2014 were consecutively screened for the following study entry criteria: having magnetic resonance imaging (MRI) scans on admission, Cantonese speakers and of Chinese ethnicity, having sufficient language, auditory and visual abilities to allow the assessments, having no history of neurological diseases, alcoholism, dementia or severe comorbid medical diseases and no recurrence of the index stroke before the 3-month follow up
The age did not differ between the included and excluded patients (66.3 ± 10.6 vs. 67.0 ± 13.1; p = 0.200), but the excluded patients were more likely to be female (61.3% vs. 38.7%; p = 0.043) and had more severe stroke indicated by higher National Institutes of Health Stroke Scale (NIHSS) scores on the index admission (3 (1–6) vs. 3 (1–5); p < 0.001)
Summary
Cerebral small vessel disease (SVD) is a condition of clinical, neuroimaging and neuropathological presentations that causes the damage to the brain’s small perforating vessels (Wardlaw et al, 2013a). The markers of SVD on magnetic resonance imaging (MRI) are white matter hyperintensities (WMH), lacunes, cerebral microbleeds (CMB) and enlarged perivascular spaces (EPVS; Wardlaw et al, 2013a) As these markers are closely associated with increased mortality (Song et al, 2017), poor physical function (Arauz et al, 2003; Charidimou et al, 2016; Sato et al, 2016; Senda et al, 2016; Yang et al, 2016; Helenius et al, 2017), stroke recurrence (Arauz et al, 2003; Lau et al, 2017), cognitive decline (Huijts et al, 2013; Uiterwijk et al, 2016) and depression (Zhang et al, 2016) after stroke, SVD is thought to be a poor prognostic marker of stroke (Kim and Lee, 2015). To the best of our knowledge, the association between SVD burden and poststroke HRQoL has never been investigated, which gave the impetus to examine this relationship at 3 months after the index acute ischemic stroke in a large cohort of systematically screened and assessed patients
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