Abstract
Background and purposeStroke is a major cause of cognitive impairment and dementia in adults, however the role of the ischemic lesions themselves, on top of other risk factors known in the elderly, remains controversial. This study used structural equation modeling to determine the respective impact of the new ischemic lesions' volume, preexisting white matter lesions and white matter integrity on post stroke cognitive state.MethodsConsecutive first ever mild to moderate stroke or transient ischemic attack patients recruited into the ongoing prospective TABASCO study underwent magnetic resonance imaging scans within seven days of stroke onset and were cognitively assessed one year after the event using a computerized neuropsychological battery. The volumes of both ischemic lesions and preexisting white matter lesions and the integrity of the normal appearing white matter tissue were measured and their contribution to cognitive state was assessed using structural equation modeling path analysis taking into account demographic parameters. Two models were hypothesized, differing by the role of ischemic lesions' volume.ResultsStructural equation modeling analysis of 142 patients confirmed the predominant role of white matter lesion volume (standardized path coefficient β = −0.231) and normal appearing white matter integrity (β = −0.176) on the global cognitive score, while ischemic lesions' volume showed no such effect (β = 0.038). The model excluding the ischemic lesion presented better fit to the data (comparative fit index 0.9 versus 0.092).ConclusionsMild to moderate stroke patients with preexisting white matter lesions are more vulnerable to cognitive impairment regardless of their new ischemic lesions. Thus, these patients can serve as a target group for studies on cognitive rehabilitation and neuro-protective therapies which may, in turn, slow their cognitive deterioration.
Highlights
Background and purposeStroke is a major cause of cognitive impairment and dementia in adults, the role of the ischemic lesions themselves, on top of other risk factors known in the elderly, remains controversial
Tissue parameters Based on the Diffusion weighted imaging (DWI) data, acute ischemic lesions were detected in 92 out of 142 patients by a senior neuro-radiologist
In the 8 remaining patients the infarcts were not detected by the automatic method due to their small size and low contrast differences on fluid-attenuated inversion recovery (FLAIR) images
Summary
Stroke is a major cause of cognitive impairment and dementia in adults, the role of the ischemic lesions themselves, on top of other risk factors known in the elderly, remains controversial. This study used structural equation modeling to determine the respective impact of the new ischemic lesions’ volume, preexisting white matter lesions and white matter integrity on post stroke cognitive state. Cognitive impairment or dementia affects approximately 30% of stroke patients [1,2,3,4,5,6], but the role of the ischemic lesions’ volume (ILV) on top of other risk factors known in the elderly, remains open to debate. The effect of WML load on cognitive function was shown regardless of the cognitive domain assessed [20]
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