Abstract
Background and objectiveAs reported, both minor stroke and white matter hyperintensities (WMHs) are associated with an increased risk of cognitive impairment and dementia. The underlying factors for dynamic changes in WMH volume and cognitive performances in patients with minor stroke remain poorly understood. A 2-year longitudinal study was designed to investigate the factors associated with the changes in white matter hyperintensity (WMH) volume on brain MRI and cognitive decline in patients with minor stroke.MethodsA group of eligible patients with minor ischemic stroke was recruited in a row. At the initial and 2-year follow-up visits, all the participants underwent routine examinations, multimodal MRI, and cognitive assessment. Using a lesion prediction algorithm tool, we were able to automate the measurement of the change in WMH volume. During the 2-year follow-up, cognitive function was evaluated using Telephone Interview for Cognitive Status-Modified (TICS-m). Participants’ demographic, clinical, and therapeutic data were collected and statistically analyzed. Regression analyses were used to test the relationships between risk factors and changes in WMH volume and cognitive decline.ResultsFinally, we followed up with 225/261 participants for 2 years, with a mean age of 65.67 ± 10.73 years (65.6% men). WMH volume was observed to be increased in 113 patients, decreased in 74 patients, and remained stable in 58 patients. Patients with WMH progression were more often had a history of hypertension (p = 0.006) and a higher CSVD burden both at baseline and follow-up visit (p < 0.05). Longitudinally, the proportion of patients taking antihypertension medications on a regular basis in the regression group was higher than in the stable group (p = 0.01). When compared to the stable group, the presence of lacunes (OR 9.931, 95% CI 1.597–61.77, p = 0.014) was a stronger predictor of progression in WMH volume. 87 subjects (38.6%) displayed incident cognitive impairment. The progression of WMH volume was a significant risk factor for cognitive decline (p < 0.001).ConclusionsThe longitudinal change of WMH is dynamic. The regressive WMH volume was associated with the use of antihypertensive medications on a regular basis. The presence of lacunes at the initial visit of the study was a stronger predictor of WMH progression. The progression of WMH volume could be useful in predicting cognitive decline in patients with minor stroke.
Highlights
Minor stroke is proposed to define as National Institutes of Health Stroke Scale ≤ 3 with normal level of consciousness and favorable short- and medium-term outcomes [1]
The main findings of the study were as follows: (1) among the 225 participants who completed followup, 113 patients (50.2%) progressed, 74 patients (32.8%) regressed, and 58 patients (25.8%) remained stable in White matter hyperintensities (WMHs) volume over a 2-year period; (2) WMH regression was associated with regular use of antihypertension medications; presence of lacunes at baseline was a strong predictor of WMH progression; (3) 87 subjects (38.6%) displayed incident cognitive impairment; and (4) subjects with WMH volume progression performed significantly worse on the cognitive impairment
The longitudinal change in WMH volume has mostly been reported as progression [23, 24], whereas several studies have reported a decrease in participants with ischemic stroke over time [12, 16]
Summary
Minor stroke is proposed to define as National Institutes of Health Stroke Scale ≤ 3 with normal level of consciousness and favorable short- and medium-term outcomes [1]. The underlying factors for dynamic changes in WMH volume and cognitive performances in patients with minor stroke remain poorly understood. A 2-year longitudinal study was designed to investigate the factors associated with the changes in white matter hyperintensity (WMH) volume on brain MRI and cognitive decline in patients with minor stroke. Regression analyses were used to test the relationships between risk factors and changes in WMH volume and cognitive decline. When compared to the stable group, the presence of lacunes (OR 9.931, 95% CI 1.597–61.77, p = 0.014) was a stronger predictor of progression in WMH volume. The progression of WMH volume was a significant risk factor for cognitive decline (p < 0.001). The progression of WMH volume could be useful in predicting cognitive decline in patients with minor stroke
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