Abstract
Dynamic cerebral autoregulation (dCA) is impaired following stroke. However, the relationship between dCA, brain atrophy, and functional outcomes following stroke remains unclear. In this study, we aimed to determine whether impairment of dCA is associated with atrophy in specific regions or globally, thereby affecting daily functions in stroke patients.We performed a retrospective analysis of 33 subjects with chronic infarctions in the middle cerebral artery territory, and 109 age-matched non-stroke subjects. dCA was assessed via the phase relationship between arterial blood pressure and cerebral blood flow velocity. Brain tissue volumes were quantified from MRI. Functional status was assessed by gait speed, instrumental activities of daily living (IADL), modified Rankin Scale, and NIH Stroke Score.Compared to the non-stroke group, stroke subjects showed degraded dCA bilaterally, and showed gray matter atrophy in the frontal, parietal and temporal lobes ipsilateral to infarct. In stroke subjects, better dCA was associated with less temporal lobe gray matter atrophy on the infracted side ( = 0.029), faster gait speed ( = 0.018) and lower IADL score (0.002). Our results indicate that better dynamic cerebral perfusion regulation is associated with less atrophy and better long-term functional status in older adults with chronic ischemic infarctions.
Highlights
Cerebral autoregulation (CA) modulates cerebral blood flow in order to meet regional perfusion demands despite variations in arterial blood pressure (BP) associated with daily activities [1]
If post-stroke Dynamic CA (dCA) directly impacts gray matter (GM) atrophy and functional status, interventions aimed at improving dCA function may provide an additional modality for clinicians to mitigate long-term functional deficits in stroke patients
Demographic characteristics, mean BP, middle cerebral artery (MCA) and Internal carotid arteries (ICA) diameters on the non-stroke side, mean blood flow velocity (BFV) and CO2 vasoreactivity and laboratory results were similar between the stroke and non-stroke groups (Table 1)
Summary
Cerebral autoregulation (CA) modulates cerebral blood flow in order to meet regional perfusion demands despite variations in arterial blood pressure (BP) associated with daily activities [1]. Autoregulation is affected by age-related cerebro-microvascular diseases such as hypertension [3] and diabetes [4], and is damaged by ischemic stroke both acutely [5,6,7,8] and chronically [3]. Both impaired dCA [5,9], assessed in the acute stroke period, and stroke-associated gray matter (GM) atrophy [10,11] are associated with deficits in functional outcomes. If post-stroke dCA directly impacts GM atrophy and functional status, interventions aimed at improving dCA function may provide an additional modality for clinicians to mitigate long-term functional deficits in stroke patients
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