Abstract
Executive dysfunction affects 40% of stroke patients, but is poorly predicted by characteristics of the stroke itself. Stroke typically occurs on a background of cerebrovascular burden, which impacts cognition and brain network structural integrity. We used structural equation modelling to investigate whether measures of white matter microstructural integrity (fractional anisotropy and mean diffusivity) and cerebrovascular risk factors better explain executive dysfunction than markers of stroke severity.126 stroke patients (mean age 68.4 years) were scanned three months post-stroke and compared to 40 age- and sex-matched control participants on neuropsychological measures of executive function. Executive function was below what would be expected for age and education level in stroke patients as measured by the organizational components of the Rey Complex Figure Test, F(3,155) = 17, R2 = 0.25, p < 0.001 (group significant predictor at p < 0.001) and the Trail-Making Test (B), F(3,157) = 3.70, R2 = 0.07, p < 0.01 (group significant predictor at p < 0.001). A multivariate structural equation model illustrated the complex relationship between executive function, white matter integrity, stroke characteristics and cerebrovascular risk (root mean square error of approximation = 0.02).Pearson’s correlations confirmed a stronger relationship between executive dysfunction and white matter integrity (r = − 0.74, p < 0.001), than executive dysfunction and stroke severity (r = 0.22, p < 0.01). The relationship between executive function and white matter integrity is mediated by cerebrovascular burden. White matter microstructural degeneration of the superior longitudinal fasciculus in the executive control network better explains executive dysfunction than markers of stroke severity. Executive dysfunction and incident stroke can be both considered manifestations of cerebrovascular risk factors.
Highlights
Executive dysfunction affects 40% of stroke patients, but is poorly predicted by characteristics of the stroke itself
Using the accepted Oxfordshire Community Stroke Project[37] classification, 1% (2) of the strokes were classified as total anterior circulation infarcts (TACI), 52% (70) were partial anterior circulation infarcts (PACI), 14% (19) were lacunar infarcts (LACI), and 33% (44) were posterior circulation infarcts (POCI)
We demonstrate executive function below what would be expected for age and education level in a cohort of ischemic stroke patients three months after stroke
Summary
Executive dysfunction affects 40% of stroke patients, but is poorly predicted by characteristics of the stroke itself. Stroke typically occurs on a background of cerebrovascular burden, which impacts cognition and brain network structural integrity. We used structural equation modelling to investigate whether measures of white matter microstructural integrity (fractional anisotropy and mean diffusivity) and cerebrovascular risk factors better explain executive dysfunction than markers of stroke severity. White matter microstructural degeneration of the superior longitudinal fasciculus in the executive control network better explains executive dysfunction than markers of stroke severity. Executive dysfunction is a major component of vascular and post-stroke cognitive impairment, occurring in around 40% of patients after ischemic stroke, and predicting quality of life, even when controlling for age, depression and stroke s everity[1,2]. Stroke occurs on a background of aging and cerebrovascular risk (CVR) factors, which predominantly impact executive function[12,13]. The canonical frontoparietal brain networks subserve higher cognitive functions related to attention and executive function[23,24]
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