Abstract
Purpose: Impairment of cortical cholinergic pathways (CCP) is an important risk factor for chronic vascular cognitive impairment. However, this phenomenon has rarely been studied in post-stroke cognitive impairment (PSCI). We investigated the relationship between PSCI and CCP lesions assessed by structural magnetic resonance imaging (MRI).Patients and methods: We prospectively enrolled 103 patients within 7 days of ischemic stroke onset. CCP was measured by the cholinergic pathways hyperintensities scale (CHIPS), which semiquantitatively grades MR lesions strategically located on the CCP identified in human brains. We also measured other MRI parameters, including the location and volumes of acute infarcts, cerebral microbleeds, medial temporal lobe atrophy, and white matter lesions. Neuropsychological assessments were performed using the 60-min modified vascular dementia battery (VDB) at 3 months after the index stroke, and PSCI was defined according to VDB as well as ADL.Results: Of all 103 patients, 69 men (67.0%) and 34 women (33.0%) with a mean age of 57.22 ± 12.95 years, 55 patients (53.4%) were judged to have PSCI at 3 months, including 43 (41.7%) patients with PSCI-no dementia and 12 (11.7%) patients with poststroke dementia. According to the VBD assessment, the most commonly impaired cognitive domain was visuomotor speed (27.2%) followed by verbal memory (25.2%). Univariate analysis showed that patients with PSCI were older; had higher informant questionnaire on cognitive decline in the elderly (IQCODE) scores; had more frequent previous stroke history and atrial fibrillation; and had higher CHIPS scores, more severe white matter lesions, and medial temporal lobe atrophy. PSCI patients also had higher depression scores at 3 months. In the multivariate regression analysis, age, IQCODE score, CHIPS score, and Hamilton depression rating scale score were independent predictors of PSCI. Ordinal regression analysis for risk factors of poor functional outcomes revealed that IQCODE scores and cognitive function status were related to mRS score at 3 months after stroke.Conclusion: In patients with early subacute ischemic stroke, the severity of lesions involving the CCP may be associated with cognitive impairment at 3 months.Clinical Trial Registration: Chinese Clinical Trial Registry, identifier: ChiCTR1800014982.
Highlights
Poststroke cognitive impairment (PSCI), which includes PSCI-no dementia (PSCI-ND) and poststroke dementia (PSD), is one of the most common outcomes of acute ischemic stroke, occurring in ≥80% of survivors [1, 2]
The inclusion criteria for the study were [1] age >18 years, [2] first or recurrent early subacute ischemic stroke occurring within 7 days before admission [18], and [3] that a complete brain magnetic resonance imaging (MRI) examination had been performed
Compared with the excluded patients, the study population was younger (57.22 ± 12.95 years vs. 65.74 ± 13.51 years; P < 0.001) and had lower National Institutes of Health stroke scale (NIHSS) scores and IQCODE scores (2 [1–4] vs. 4 [2–8.5], P = 0.003; [48–49] vs. [48–53.75], P < 0.001, respectively); there was no significant difference in sex (69 men [67.0%] vs. 117 women [66.5%]; P = 0.930), respectively
Summary
Poststroke cognitive impairment (PSCI), which includes PSCI-no dementia (PSCI-ND) and poststroke dementia (PSD), is one of the most common outcomes of acute ischemic stroke, occurring in ≥80% of survivors [1, 2] It has a negative effect on functional outcomes [1, 3] and predicts the recurrence of vascular events [4]. There are two types of ACh receptors: muscarinic acetylcholine receptors (mAChRs) and nicotinic acetylcholine receptors (nAChRs), located in the presynaptic and postsynaptic membranes in the brain, playing important roles in regulating the release of glutamate, γ-aminobutyric acid, dopamine, norepinephrine, and other neurotransmitters related to cognitive function [9, 10]. The CCP is one of the major cholinergic structural connections in the brain It includes the diagonal band of Broca, the medial septal nuclei, and the nucleus basalis of Meynert (nbM) and projecting fibers from these cells [12]. Damage to cholinergic fibers and a decrease in cholinergic neurotransmitters may be involved in cognitive impairment
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