Department of Radiology, The Second Affiliated Hospital of Soochow University, Suzhou, China.
SIEMENS Healthcare, China.
J Stroke Cerebrovasc Dis. 2021 Jan;30(1):105460. doi: 10.1016/j.jstrokecerebrovasdis.2020.105460. Epub 2020 Nov 20.
Two-thirds of stroke survivors suffer from cognitive impairment, and up to one-third of them progress to dementia. However, the underlying pathogenesis is complex and controversial. Recent evidence has found that cerebral small vessel disease (SVD) markers and the Alzheimer's disease (AD) neuroimaging marker medial temporal lobe atrophy (MTLA), alone or in combination, contribute to the pathogenesis of poststroke cognitive impairment (PSCI). In the present systematic review and meta-analysis, we synthesized proof for these neuroimaging risk factors among stroke patients.
PUBMED, MEDLINE, EMBASE and the Cochrane Library were searched for studies investigating imaging predictors of cognitive impairment or dementia following stroke. Meta-analysis was conducted to compute the odds ratios (ORs).
Thirteen studies were enrolled in the present study, and only ten of them, comprising 2713 stroke patients, were eligible for inclusion in the meta-analysis. MTLA was significantly correlated with PSCI (OR = 1.97, 95% CI: 1.48-2.62, I = 0.0%). In addition, white matter hyperintensities (WMH), as a neuroimaging marker of SVD, were associated with PSCI (OR = 1.17, 95% CI: 1.12-1.22, I = 0.0%). However, the presence of lacunar infarcts and enlarged perivascular spaces (EPVS) were not associated with the risk of PSCI.
The findings of the present study suggest that MTLA and WMH were associated with an increased risk of PSCI.
三分之二的中风幸存者患有认知障碍，其中多达三分之一进展为痴呆症。然而，其潜在发病机制复杂且存在争议。最近的证据发现，脑小血管疾病（SVD）标志物和阿尔茨海默病（AD）神经影像学标志物内侧颞叶萎缩（MTLA），单独或联合，有助于中风后认知障碍（PSCI）的发病机制。在本系统评价和荟萃分析中，我们综合了中风患者这些神经影像学危险因素的证据。
我们在 PUBMED、MEDLINE、EMBASE 和 Cochrane 图书馆中搜索了研究中风后认知障碍或痴呆的影像学预测因子的研究。进行荟萃分析以计算比值比（OR）。
本研究共纳入了 13 项研究，其中只有 10 项（包括 2713 例中风患者）符合纳入荟萃分析的标准。MTLA 与 PSCI 显著相关（OR=1.97，95%CI：1.48-2.62，I=0.0%）。此外，作为 SVD 神经影像学标志物的脑白质高信号（WMH）与 PSCI 相关（OR=1.17，95%CI：1.12-1.22，I=0.0%）。然而，腔隙性梗死和扩大的血管周围间隙（EPVS）的存在与 PSCI 的风险无关。
本研究的结果表明，MTLA 和 WMH 与 PSCI 的风险增加相关。
