Longitudinal Brain Atrophy Rates in Transient Ischemic Attack and Minor Ischemic Stroke Patients and Cognitive Profiles.

Muhammad Munir,Alzheimer's Disease Neuroimaging Initiative ,Richard Frayne,Eric E Smith,Christopher D D'Esterre,Arooj Aftab,Tolulope T Sajobi,Jake Ursenbach,Meng Wang,Meaghan Reid,Sana Tariq,Giovanna Zamboni,Philip A Barber,Ludovica Griffanti,Shelagh B Coutts,Rani Gupta Sah,Amith Sitaram

doi:10.3389/fneur.2019.00018

Abstract

Introduction: Patients with transient ischemic attack (TIA) and minor stroke demonstrate cognitive impairment, and a four-fold risk of late-life dementia.Aim: To study the extent to which the rates of brain volume loss in TIA patients differ from healthy controls and how they are correlated with cognitive impairment.Methods: TIA or minor stroke patients were tested with a neuropsychological battery and underwent T1 weighted volumetric magnetic resonance imaging scans at fixed intervals over a 3 years period. Linear mixed effects regression models were used to compare brain atrophy rates between groups, and to determine the relationship between atrophy rates and cognitive function in TIA and minor stroke patients.Results: Whole brain atrophy rates were calculated for the TIA and minor stroke patients; n = 38 between 24 h and 18 months, and n = 68 participants between 18 and 36 months, and were compared to healthy controls. TIA and minor stroke patients demonstrated a significantly higher whole brain atrophy rate than healthy controls over a 3 years interval (p = 0.043). Diabetes (p = 0.012) independently predicted higher atrophy rate across groups. There was a relationship between higher rates of brain atrophy and processing speed (composite P = 0.047 and digit symbol coding P = 0.02), but there was no relationship with brain atrophy rates and memory or executive composite scores or individual cognitive tests for language (Boston naming, memory recall, verbal fluency or Trails A or B score).Conclusion: TIA and minor stroke patients experience a significantly higher rate of whole brain atrophy. In this cohort of TIA and minor stroke patients changes in brain volume over time precede cognitive decline.

Highlights

Patients with transient ischemic attack (TIA) and minor stroke demonstrate cognitive impairment, and a four-fold risk of late-life dementia
Patients were recruited from the Extended-CATCH (CT and magnetic resonance imaging (MRI) in the Triage of Transient ischemic attack (TIA) and minor Cerebrovascular events to identify High risk patients) study [12] at the Foothills Medical Center or Calgary Stroke Prevention Clinic from March 2009 to December 2012, while healthy controls were drawn from the Alzheimer’s Disease Neuroimaging Initiative (ADNI) study
A total of 90 patients were recruited to the Extended-CATCH study and those patients with 2 consecutive MRI scans by March 2014 were included into the study

Summary

Introduction

Patients with transient ischemic attack (TIA) and minor stroke demonstrate cognitive impairment, and a four-fold risk of late-life dementia. Transient ischemic attack (TIA) and minor stroke, traditionally considered as risk factors for major ischemic stroke, are common medical emergency (incidence 0.37–1.1 per 1,000) associated with a four-fold increase risk of cognitive decline and dementia [1,2,3]. Mechanisms linking TIA and minor stroke with cognitive decline are poorly understood. Pathological studies link late life cognitive impairment and brain atrophy to two dominant disease entities, Alzheimer’s disease (AD) and small vessel disease [5, 6]. Fifty per cent of late-life cognitive impairment is attributed to vascular and lifestyle-related risk factors in midlife. Studies identifying early incipient disease stroke and TIA cohorts vary considerably in clinical selection criteria, cognitive measures and methods for measuring changes in brain structure over time [9,10,11]

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