Abstract
Mild stroke is a known risk factor for dementia. The relationship between cerebral white matter (WM) integrity and cognitive impairment (CI) in mild stroke patients with basal ganglia region infarcts is unknown. Total of 33 stroke patients and 19 age-matched controls underwent diffusion tensor imaging scans and a formal neuropsychological test battery. CI was defined as having a performance score 1.5 SD below the established norm. We compared the differences in Z-scores and Fraction Anisotropy (FA) values among controls, stroke with no CI (NCI) and stroke with CI groups. Multiple linear regressions were performed between FA values in affected regions and neuropsychological tests in stroke patients. The majority of stroke patients were in their 50s (56.90 ± 9.23 years). CI patients exhibited a significantly decreased Z score in visual delayed memory and remarkably decreased FA values in the right external capsule and right fornix (FWE-corrected) compared with NCI patients and controls. In stroke patients, the FA value in the right fornix was positively correlated with delayed visual memory. Mild stroke with basal ganglia region infarcts may be related to widespread abnormality of WM integrity. The lower WM integrity in the right fornix may be a marker of impaired delayed visual memory.
Highlights
A fundamental building block of performing cognitive tasks of various complexity[6,7,8]
There were no significant differences in age, sex, education, the scores of National Institute of Health stroke scale (NIHSS) at admission, mRS, Hamilton Depression Rating Score (HAMD), basal ADL, IQCODE, the prevalence of risk factors, family history and affected circulation system among the three groups
The median NIHSS score in stroke patients was 1.00 point [interquartile range (IQR): 2.00 points], and most strokes were classified as small artery occlusion (SAO) (n = 29, 87.88%), with four patients having large atherothrombotic infarction (LAA) (12.12%) strokes
Summary
A fundamental building block of performing cognitive tasks of various complexity[6,7,8]. Recent study showed that an ischemic lesion after right middle cerebral artery stroke could affect remote white matter integrity, which was associated with poorer cognitive recovery[12,13] It is unknown whether patients with acute basal ganglia region infarcts experienced abnormality of white matter integrity in remote areas, and whether this was related to cognitive dysfunction. A few small neuroimaging studies in older patients with stroke found that ischemic lesions could cause loss of white matter integrity in the ipsilesional and contralesional hemispheres[22,23,24] and this was associated with poor cognitive function after stroke[13] It is unknown whether lower microstructural integrity in focal regions or areas remote from stroke with basal ganglia region infarcts, including as remote as the contralesional hemisphere, was related to cognitive dysfunction after stroke. We hypothesized that cognitive impairment after stroke with basal ganglia region infarcts would show a lower white matter structural integrity remote from the initial stroke and that white matter integrity might predict cognitive impairment after stroke
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