From the Departments of Neurology (P.S., A.M.T., R.M.A., S.F., N.A.M.M., H.C.S., E.J.v.D., F.-E.d.L.) and Medical Psychology (R.P.C.K.), Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands; Department of Clinical Neurosciences, University of Cambridge, United Kingdom (L.C.A.R.-J.); and Department of Neurology, Medisch Spectrum Twente, Enschede, The Netherlands (L.D.A.D.).
Stroke. 2016 Oct;47(10):2517-25. doi: 10.1161/STROKEAHA.116.014356. Epub 2016 Sep 13.
Poststroke cognitive impairment occurs frequently in young patients with ischemic stroke (18 through 50 years of age). Accumulating data suggest that stroke is associated with lower white matter integrity remote from the stroke impact area, which might explain why some patients have good long-term cognitive outcome and others do not. Given the life expectancy of decades in young patients, we therefore investigated remote white matter in relation to long-term cognitive function.
We included all consecutive first-ever ischemic stroke patients, left/right hemisphere, without recurrent stroke or transient ischemic attack during follow-up, aged 18 through 50 years, admitted to our university medical center between 1980 and 2010. One hundred seventeen patients underwent magnetic resonance imaging scanning including a T1-weighted scan, a diffusion tensor imaging scan, and completed a neuropsychological assessment. Patients were compared with a matched stroke-free control group (age, sex, and education matched). Cognitive impairment was defined as >1.5 SD below the mean cognitive index score of controls and no cognitive impairment as ≤1 SD. Tract-Based Spatial Statistics was used to assess the white matter integrity (fractional anisotropy and mean diffusivity).
About 11 years after ischemic stroke, lower remote white matter integrity was associated with a worse long-term cognitive performance. A lower remote white matter integrity, even in the contralesional hemisphere, was observed in cognitively impaired patients (n=25) compared with cognitively unimpaired patients (n=71).
These findings indicate that although stroke has an acute onset, it might have long lasting effects on remote white matter integrity and thereby increases the risk of long-term cognitive impairment.
卒中后认知障碍在年轻缺血性卒中患者（18 至 50 岁）中较为常见。越来越多的数据表明，卒中与远离卒中影响区域的白质完整性降低有关，这可能解释了为什么有些患者长期认知预后良好，而有些患者则不然。鉴于年轻患者有几十年的预期寿命，我们因此研究了与长期认知功能相关的远隔白质。
我们纳入了所有连续的首次缺血性卒中患者，无论左侧或右侧半球，在随访期间无再发卒中或短暂性脑缺血发作，年龄 18 至 50 岁，1980 年至 2010 年期间入住我们大学医学中心。117 例患者接受了磁共振成像扫描，包括 T1 加权扫描、弥散张量成像扫描，并完成了神经心理学评估。患者与匹配的无卒中对照组（年龄、性别和教育匹配）进行比较。认知障碍定义为 >1.5 个标准差低于对照组的平均认知指数得分，无认知障碍定义为 ≤1 个标准差。基于束的空间统计学用于评估白质完整性（各向异性分数和平均弥散系数）。
在缺血性卒中发生约 11 年后，远隔白质完整性降低与长期认知表现较差相关。与认知无障碍患者（n=71）相比，认知障碍患者（n=25）的远隔白质完整性更低，甚至在对侧半球也是如此。
这些发现表明，尽管卒中发病急骤，但它可能对白质完整性产生长期持久的影响，从而增加长期认知障碍的风险。
