Abstract
Post-stroke dementia is common but has heterogenous mechanisms that are not fully understood, particularly in patients with atrial fibrillation (AF)-related ischaemic stroke or TIA. We investigated the relationship between MRI small-vessel disease markers (including a composite cerebral amyloid angiopathy, CAA, score) and cognitive trajectory over 12 months. We included patients from the CROMIS-2 AF study without pre-existing cognitive impairment and with Montreal Cognitive Assessment (MoCA) data. Cognitive impairment was defined as MoCA < 26. We defined “reverters” as patients with an “acute” MoCA (immediately after the index event) score < 26, who then improved by ≥ 2 points at 12 months. In our cohort (n = 114), 12-month MoCA improved overall relative to acute performance (mean difference 1.69 points, 95% CI 1.03–2.36, p < 0.00001). 12-month cognitive impairment was associated with increasing CAA score (per-point increase, adjusted OR 4.09, 95% CI 1.36–12.33, p = 0.012). Of those with abnormal acute MoCA score (n = 66), 59.1% (n = 39) were “reverters”. Non-reversion was associated with centrum semi-ovale perivascular spaces (per-grade increase, unadjusted OR 1.83, 95% CI 1.06–3.15, p = 0.03), cerebral microbleeds (unadjusted OR 10.86, 95% CI 1.22–96.34, p = 0.03), and (negatively) with multiple ischaemic lesions at baseline (unadjusted OR 0.11, 95% CI 0.02–0.90, p = 0.04), as well as composite small-vessel disease (per-point increase, unadjusted OR 2.91, 95% CI 1.23–6.88, p = 0.015) and CAA (per-point increase, unadjusted OR 6.71, 95% CI 2.10–21.50, p = 0.001) scores. In AF-related acute ischaemic stroke or TIA, cerebral small-vessel disease is associated both with cognitive performance at 12 months and failure to improve over this period.
Highlights
Materials and methodsPost-stroke dementia is common [30] but has heterogenous mechanisms that are not fully understood
Post-stroke dementia is associated with factors relating to brain resilience and the index stroke lesion, whereas delayed-onset post-stroke dementia is more associated with cerebral small-vessel diseases [23]
Montreal Cognitive Assessment (MoCA)-defined cognitive impairment at 12 months is common, observed in approximately half of our cohort, and associated with factors relating to brain resilience and stroke severity, as well as increases in a composite cerebral amyloid angiopathy (CAA) score
Summary
Materials and methodsPost-stroke dementia is common [30] but has heterogenous mechanisms that are not fully understood. Post-stroke dementia (within 6 months) is associated with factors relating to brain resilience and the index stroke lesion, whereas delayed-onset post-stroke dementia is more associated with cerebral small-vessel diseases [23]. This appears to be the case for both ischaemic and haemorrhagic stroke; dementia after ischaemic intracerebral events (stroke or transient ischaemic attacks, TIA) is associated with white-matter hyperintensities, lacunes and cortical atrophy [1, 24], and markers of cerebral amyloid angiopathy (CAA) are associated with dementia after intracerebral haemorrhage [25]. The Montreal Cognitive Assessment (MoCA) appears to be a sensitive cognitive screen for identifying these changes [34], and there has been recent interest in identifying the characteristics of so-called “reverters”, who demonstrate improvements in their cognitive performance over time [27, 34, 38, 43]
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