中风后神经认知障碍的临床可及性神经影像学预测因素：一项前瞻性观察研究。
Clinically accessible neuroimaging predictors of post-stroke neurocognitive disorder: a prospective observational study.
作者信息
Schellhorn Till, Aamodt Eva Birgitte, Lydersen Stian, Aam Stina, Wyller Torgeir Bruun, Saltvedt Ingvild, Beyer Mona Kristiansen
机构信息
Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway.
Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
出版信息
BMC Neurol. 2021 Feb 25;21(1):89. doi: 10.1186/s12883-021-02117-8.
BACKGROUND
Neurocognitive disorder (NCD) is common in stroke survivors. We aimed to identify clinically accessible imaging markers of stroke and chronic pathology that are associated with early post-stroke NCD.
METHODS
We included 231 stroke survivors from the "Norwegian Cognitive Impairment after Stroke (Nor-COAST)" study who underwent a standardized cognitive assessment 3 months after the stroke. Any NCD (mild cognitive impairment and dementia) and major NCD (dementia) were diagnosed according to "Diagnostic and Statistical Manual of Mental Disorders (DSM-5)" criteria. Clinically accessible imaging findings were analyzed on study-specific brain MRIs in the early phase after stroke. Stroke lesion volumes were semi automatically quantified and strategic stroke locations were determined by an atlas based coregistration. White matter hyperintensities (WMH) and medial temporal lobe atrophy (MTA) were visually scored. Logistic regression was used to identify neuroimaging findings associated with major NCD and any NCD.
RESULTS
Mean age was 71.8 years (SD 11.1), 101 (43.7%) were females, mean time from stroke to imaging was 8 (SD 16) days. At 3 months 63 (27.3%) had mild NCD and 65 (28.1%) had major NCD. Any NCD was significantly associated with WMH pathology (odds ratio (OR) = 2.73 [1.56 to 4.77], p = 0.001), MTA pathology (OR = 1.95 [1.12 to 3.41], p = 0.019), and left hemispheric stroke (OR = 1.8 [1.05 to 3.09], p = 0.032). Major NCD was significantly associated with WMH pathology (OR = 2.54 [1.33 to 4.84], p = 0.005) and stroke lesion volume (OR (per ml) =1.04 [1.01 to 1.06], p = 0.001).
CONCLUSION
WMH pathology, MTA pathology and left hemispheric stroke were associated with the development of any NCD. Stroke lesion volume and WMH pathology were associated with the development of major NCD 3 months after stroke. These imaging findings may be used in the routine clinical setting to identify patients at risk for early post-stroke NCD.
TRIAL REGISTRATION
ClinicalTrials.gov, NCT02650531 , Registered 8 January 2016 - Retrospectively registered.
背景
神经认知障碍（NCD）在中风幸存者中很常见。我们旨在确定与中风后早期NCD相关的、临床上可获取的中风及慢性病理影像学标志物。
方法
我们纳入了来自“挪威中风后认知障碍（Nor-COAST）”研究的231名中风幸存者，他们在中风后3个月接受了标准化认知评估。根据《精神疾病诊断与统计手册（DSM-5）》标准诊断任何NCD（轻度认知障碍和痴呆）和重度NCD（痴呆）。在中风后的早期阶段，对研究特定的脑部MRI上可获取的临床影像学发现进行分析。中风病灶体积通过半自动定量，战略中风位置通过基于图谱的配准确定。对白质高信号（WMH）和内侧颞叶萎缩（MTA）进行视觉评分。使用逻辑回归来确定与重度NCD和任何NCD相关的神经影像学发现。
结果
平均年龄为71.8岁（标准差11.1），101名（43.7%）为女性，从中风到成像的平均时间为8天（标准差16）。在3个月时，63名（27.3%）有轻度NCD，65名（28.1%）有重度NCD。任何NCD与WMH病理显著相关（优势比（OR）=2.73[1.56至4.77]，p=0.001）、MTA病理（OR=1.95[1.12至3.41]，p=0.019）和左半球中风（OR=1.8[1.05至3.09]，p=0.032）。重度NCD与WMH病理（OR=2.54[1.33至4.84]，p=0.005）和中风病灶体积（OR（每毫升）=1.04[1.01至1.06]，p=0.001）显著相关。
结论
WMH病理、MTA病理和左半球中风与任何NCD的发生相关。中风病灶体积和WMH病理与中风后3个月重度NCD的发生相关。这些影像学发现可用于常规临床环境中识别中风后早期NCD风险患者。
试验注册
ClinicalTrials.gov，NCT02650531，2016年1月8日注册 - 回顾性注册。
Zotero 插件