Valdés Hernández Maria Del C, Grimsley-Moore Tara, Chappell Francesca M, Thrippleton Michael J, Armitage Paul A, Sakka Eleni, Makin Stephen, Wardlaw Joanna M
Centre for Clinical Brain Sciences, UK Dementia Research Institute at the University of Edinburgh, Edinburgh, United Kingdom.
College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, United Kingdom.
Front Neurol. 2021 Mar 1;12:634460. doi: 10.3389/fneur.2021.634460. eCollection 2021.
Lacunar strokes are a common type of ischemic stroke. They are known to have long-term cognitive deficits, but the influencing factors are still largely unknown. We investigated if the location of the index lacunar stroke or regional WMH and their change at 1 year could predict the cognitive performance at 1 and 3 years post-stroke in lacunar stroke patients. We used lacunar lesion location and WMH-segmented data from 118 patients, mean age 64.9 who had a brain MRI scan soon after presenting with symptoms, of which 88 had a repeated scan 12 months later. Premorbid intelligence (National Adult Reading Test) and current intelligence [Addenbrooke's Cognitive Exam-Revised (ACE-R)] were measured at 1, 12, and 36 months after the stroke. ANCOVA analyses adjusting for baseline cognition/premorbid intelligence, vascular risk factors, age, sex and total baseline WMH volume found that the recent small subcortical infarcts (RSSI) in the internal/external capsule/lentiform nucleus and centrum semiovale did not predict cognitive scores at 12 and 36 months. However, RSSI location moderated voxel-based associations of WMH change from baseline to 1 year with cognitive scores at 1 and 3 years. WMH increase in the external capsule, intersection between the anterior limb of the internal and external capsules, and optical radiation, was associated with worsening of ACE-R scores 1 and 3 years post-stroke after accounting for the location of the index infarct, age and baseline cognition.
腔隙性卒中是缺血性卒中的一种常见类型。已知其会导致长期认知缺陷，但影响因素仍大多不明。我们研究了首发腔隙性卒中的部位或局部脑白质高信号（WMH）及其1年时的变化是否能预测腔隙性卒中患者卒中后1年和3年的认知表现。我们使用了118例患者的腔隙性病变部位和WMH分割数据，这些患者平均年龄64.9岁，在出现症状后不久进行了脑部MRI扫描，其中88例在12个月后进行了重复扫描。在卒中后1个月、12个月和36个月测量病前智力（国家成人阅读测试）和当前智力[Addenbrooke认知检查修订版（ACE-R）]。在对基线认知/病前智力、血管危险因素、年龄、性别和总基线WMH体积进行调整的协方差分析中发现，内囊/外囊/豆状核和半卵圆中心的近期小皮质下梗死（RSSI）不能预测12个月和36个月时的认知评分。然而，RSSI部位调节了从基线到1年的WMH变化与1年和3年时认知评分的基于体素的关联。在考虑了首发梗死部位、年龄和基线认知后，外囊、内囊前肢与外囊交界处以及视辐射处的WMH增加与卒中后1年和3年ACE-R评分恶化相关。
