Department of Neurology, Medical University of Graz, Graz, Austria.
Research Unit for Neuronal Plasticity and Repair, Medical University of Graz, Graz, Austria.
Eur J Neurol. 2021 Feb;28(2):401-410. doi: 10.1111/ene.14593. Epub 2020 Nov 12.
Cognitive impairment is a common sequel of recent small subcortical infarction (RSSI) and might be negatively affected by preexisting cerebral small vessel disease (SVD). We investigated whether the course of cognitive function in patients with RSSI is influenced by the severity of white matter hyperintensities (WMH), an important imaging feature of SVD.
Patients with magnetic resonance imaging (MRI)-proven single RSSI were tested neuropsychologically concerning global cognition, processing speed, attention, and set-shifting. Deep and periventricular WMH severity was assessed using the Fazekas scale, and total WMH lesion volume was calculated from T1-weighted MRI images. We compared baseline function and course of cognition 15 months after the acute event in patients with absent, mild, and moderate-to-severe WMH.
The study cohort comprised 82 RSSI patients (mean age: 61 ± 10 years, 23% female). At baseline, 40% had cognitive impairment (1.5 standard deviations below standardized mean), and deficits persisted in one-third of the sample after 15 months. After age correction, there were no significant differences in set-shifting between WMH groups at baseline. However, although patients without WMH (deep: p < 0.001, periventricular: p = 0.067) or only mild WMH (deep: p = 0.098, periventricular: p = 0.001) improved in set-shifting after 15 months, there was no improvement in patients with moderate-to-severe WMH (deep: p = 0.980, periventricular: p = 0.816). Baseline total WMH volume (p = 0.002) was the only significant predictor for attention 15 months poststroke.
This longitudinal study demonstrates that preexisting moderate-to-severe WMH negatively affect the restoration of cognitive function after RSSI, suggesting limited functional reserve in patients with preexisting SVD.
认知障碍是近期皮质下小梗死（RSSI）的常见后遗症，可能受到脑小血管病（SVD）的预先存在的影响。我们研究了 RSSI 患者的认知功能是否受到脑白质高信号（WMH）严重程度的影响，WMH 是 SVD 的重要影像学特征。
通过磁共振成像（MRI）证实的单 RSSI 患者接受神经心理学测试，评估总体认知、处理速度、注意力和转换能力。使用 Fazekas 量表评估深部和脑室周围 WMH 的严重程度，并从 T1 加权 MRI 图像计算总 WMH 病变体积。我们比较了无、轻度和中重度 WMH 患者在急性事件后 15 个月时的基线功能和认知过程。
研究队列包括 82 例 RSSI 患者（平均年龄：61±10 岁，23%为女性）。基线时，40%的患者有认知障碍（低于标准化平均值 1.5 个标准差），1/3 的患者在 15 个月后仍存在缺陷。在年龄校正后，WMH 组之间在基线时的转换能力上没有显著差异。然而，尽管无 WMH（深部：p<0.001，脑室周围：p=0.067）或仅轻度 WMH（深部：p=0.098，脑室周围：p=0.001）的患者在 15 个月后在转换能力上有所改善，但中重度 WMH 患者没有改善（深部：p=0.980，脑室周围：p=0.816）。基线总 WMH 体积（p=0.002）是脑卒中后 15 个月注意力的唯一显著预测因素。
这项纵向研究表明，预先存在的中重度 WMH 会对 RSSI 后认知功能的恢复产生负面影响，表明预先存在 SVD 的患者的功能储备有限。
