Abstract
Lacunar strokes are a common type of ischemic stroke. They are known to have long-term cognitive deficits, but the influencing factors are still largely unknown. We investigated if the location of the index lacunar stroke or regional WMH and their change at 1 year could predict the cognitive performance at 1 and 3 years post-stroke in lacunar stroke patients. We used lacunar lesion location and WMH-segmented data from 118 patients, mean age 64.9 who had a brain MRI scan soon after presenting with symptoms, of which 88 had a repeated scan 12 months later. Premorbid intelligence (National Adult Reading Test) and current intelligence [Addenbrooke's Cognitive Exam-Revised (ACE-R)] were measured at 1, 12, and 36 months after the stroke. ANCOVA analyses adjusting for baseline cognition/premorbid intelligence, vascular risk factors, age, sex and total baseline WMH volume found that the recent small subcortical infarcts (RSSI) in the internal/external capsule/lentiform nucleus and centrum semiovale did not predict cognitive scores at 12 and 36 months. However, RSSI location moderated voxel-based associations of WMH change from baseline to 1 year with cognitive scores at 1 and 3 years. WMH increase in the external capsule, intersection between the anterior limb of the internal and external capsules, and optical radiation, was associated with worsening of ACE-R scores 1 and 3 years post-stroke after accounting for the location of the index infarct, age and baseline cognition.
Highlights
Lacunar strokes make up 20–30% of all ischemic strokes [1]
Two studies reported no association between lacunar infarcts and subjective memory complaints [10, 11] while another reported an association with infarcts located in the basal ganglia [12], suggesting that lacunar infarct location is important in poststroke cognition
In our sample of patients who presented to the clinic with a mild stroke syndrome of type lacunar, the location of the acute lesion in the two locations with more incidence: internal/external capsule/lentiform nucleus and centrum semiovale, did not predict the general cognitive outcome at 1 or 3 years after
Summary
Lacunar strokes make up 20–30% of all ischemic strokes [1]. Despite smaller in size than most cortical strokes, they have been associated with long-term disability, physical [2], gait, and balance impairments [3], and progressive motor deficits, these defined as the deterioration of National Institutes of Health Stroke Scale (NIHSS) motor score ≥ 1 during the first 7 days after admission [4]. There is often a deterioration in cognitive function and memory [5], increased occurrence of depression [6], reduced spatial awareness [7, 8], and dementia. The general impact of infarct location on cognition has been studied in relation to stroke lesion volume [13], shape [14], white matter hyperintensity (WMH) volume [15], post-stroke depression and behavioral disorders [16]. A large multi-center study found that infarcts (i.e., cortical and subcortical) affecting the basal ganglia and internal capsule were associated with impairment of global cognition [17], in a sample of 878 patients with ischemic stroke. A study on 76 stroke patients reported a spatial pattern of acute ischemic lesion clusters associated with cognitive outcome at 1–3 months post-stroke being no longer associated with outcome at 1 year [15]
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