Abstract
ObjectiveTo investigate whether dynamic cerebral autoregulation (CA) and neuroimaging characteristics are determinants of poststroke cognitive impairment (PSCI).MethodsEighty patients within 7 days of acute ischemic stroke and 35 age‐ and sex‐matched controls were enrolled. In the patients with stroke, brain magnetic resonance imaging and dynamic CA were obtained at baseline, and dynamic CA was followed up at 3 months and 1 year. Montreal Cognitive Assessment (MoCA) was performed at 3 months and 1 year. Patients with a MoCA score <23 at 1 year were defined as having PSCI, and those with a MoCA score that decreased by 2 points or more between the 3‐month and 1‐year assessments were defined as having progressive cognitive decline.ResultsIn total, 65 patients completed the study and 16 developed PSCI. The patients with PSCI exhibited poorer results for all cognitive domains than did those without PSCI. The patients with PSCI also had poorer CA (lower phase shift between cerebral blood flow and blood pressure waveforms in the very low frequency band) compared with that of the patients without PSCI and controls at baseline and 1 year. CA was not different between the patients without PSCI and controls. In the multivariate analysis, low education level, lobar microbleeds, and impaired CA (very low frequency phase shift [≤46°] within 7 days of stroke), were independently associated with PSCI. In addition, impaired CA was associated with progressive cognitive decline.InterpretationLow education level, lobar microbleeds, and impaired CA are involved in the pathogenesis of PSCI.
Highlights
Cerebral autoregulation (CA) is the mechanism that minimizes changes in cerebral blood flow (CBF) during blood pressure fluctuations
Patients with a Montreal Cognitive Assessment (MoCA) score
We followed up 65 patients with ischemic stroke for 1 year to investigate the risk factors of PSCI
Summary
Cerebral autoregulation (CA) is the mechanism that minimizes changes in cerebral blood flow (CBF) during blood pressure fluctuations. Hemodynamic Predictors of Poststroke Cognitive Impairment related network, whereas the mechanisms of late-onset PSCI are largely unclear. Because CA is impaired in patients with cerebrovascular or neurodegenerative diseases, impaired CA is likely to be a risk factor for late-onset PSCI. Some neuroimaging characteristics such as cerebral microbleeds or WMHs are known risk factors for cognitive impairment and are common in patients with stroke.[10]. We followed up the temporal change in cognitive function and dynamic CA for 1 year in patients with acute ischemic stroke to determine whether dynamic CA indices are associated with the occurrence of PSCI at 1 year. We investigated the association between patients’ dynamic CA and neuroimaging characteristics, including the presence of cerebral microbleeds and WMHs
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