From the Department of Experimental Psychology (G.H., N.D.), University of Oxford, United Kingdom; Queensland Brain Institute (M.J.M.), University of Queensland, Australia; Nuffield Department of Clinical Neurosciences (E.C., S.T.P., N.D.), University of Oxford; and NIHR Oxford Biomedical Research Centre and Departments of General (Internal) Medicine and Geratology (S.T.P.), John Radcliffe Hospital, Oxford, United Kingdom.
Neurology. 2023 Oct 24;101(17):e1687-e1696. doi: 10.1212/WNL.0000000000207756. Epub 2023 Sep 1.
Poststroke cognitive impairment (PSCI) is associated with neuroimaging markers, including cortical atrophy and white matter lesions (WMLs), on clinically acquired CT neuroimaging. The objective was to investigate the association between cortical atrophy/WMLs and PSCI in specific cognitive domains in the acute/subacute and chronic stages after stroke, to provide clarity on the relationship between these neuroimaging markers and the temporal evolution of PSCI.
We visually assessed cortical atrophy using the Global Cortical Atrophy (GCA) scale and WMLs using the Fazekas scale. Oxford Cognitive Screen or Birmingham Cognitive Screen assessed PSCI at 2 time points (acute/subacute and chronic) in 6 domains (language, memory, number processing, executive function, attention, and praxis). We binarized domain-specific performance as impaired/unimpaired using normative cutoffs. Multivariable linear and logistic regression analyses evaluated associations between GCA/Fazekas scores with acute/subacute and chronic global and domain-specific PSCI, and ANCOVAs examined whether these scores were significantly different in patients with recovered vs persistent PSCI. Age, sex, education, NIHSS, lesion volume, and recurrent stroke were covariates in these analyses.
Among 411 stroke patients (Mdn/IQR age = 76.16/66.84-83.47; 193 female; 346 ischemic stroke; 107 recurrent stroke), GCA and Fazekas scores were not associated with global cognitive impairment in the acute/subacute stage after stroke, but GCA score was associated with chronic global PSCI ( = 0.01, < 0.001, 95% CI 0.00-0.01). In domain-specific analyses, GCA score was associated with chronic impairment in the memory ( = 0.06, < 0.001, 95% CI 0.03-0.10) and attention ( = 0.05, = 0.003, 95% CI 0.02-0.09) domains, and in patients with persistent PSCI, these domains showed significantly higher GCA scores than patients who had recovered (memory: (1, 157) = 6.63, = 0.01, = 0.04; attention: (1, 268) = 10.66, = 0.001, 0.04).
This study highlights the potential effect of cortical atrophy on the cognitive recovery process after stroke and demonstrates the prognostic utility of CT neuroimaging for poststroke cognitive outcomes. Clinical neuroimaging could help identify patients at long-term risk of PSCI during acute hospitalization.
卒中后认知障碍（PSCI）与临床获得的 CT 神经影像学上的神经影像学标志物相关，包括皮质萎缩和白质病变（WMLs）。本研究旨在探讨皮质萎缩/WMLs 与卒中后急性期/亚急性期和慢性期特定认知领域 PSCI 之间的关系，以阐明这些神经影像学标志物与 PSCI 的时间演变之间的关系。
我们使用全球皮质萎缩（GCA）量表评估皮质萎缩，使用 Fazekas 量表评估 WMLs。在 6 个领域（语言、记忆、数字处理、执行功能、注意力和操作），使用牛津认知筛查或伯明翰认知筛查在 2 个时间点（急性期/亚急性期和慢性期）评估 PSCI。我们使用标准截断值将特定领域的表现分为受损/未受损。多变量线性和逻辑回归分析评估了 GCA/Fazekas 评分与急性/亚急性期和慢性整体及特定领域 PSCI 之间的关系，ANCOVA 检验了在认知障碍恢复和持续患者中这些评分是否存在显著差异。这些分析中的协变量包括年龄、性别、教育、NIHSS、病灶体积和复发性卒中。
在 411 名卒中患者中（中位数/四分位距年龄=76.16/66.84-83.47；193 名女性；346 名缺血性卒中；107 名复发性卒中），GCA 和 Fazekas 评分与卒中后急性期的整体认知障碍无关，但 GCA 评分与慢性整体 PSCI 相关（ = 0.01， ＜0.001，95%CI 0.00-0.01）。在特定领域分析中，GCA 评分与慢性记忆（ = 0.06， ＜0.001，95%CI 0.03-0.10）和注意力（ = 0.05， = 0.003，95%CI 0.02-0.09）领域的障碍有关，在持续性 PSCI 患者中，这些领域的 GCA 评分明显高于认知障碍恢复的患者（记忆：（1，157）=6.63， = 0.01， = 0.04；注意力：（1，268）=10.66， = 0.001， 0.04）。
本研究强调了皮质萎缩对卒中后认知恢复过程的潜在影响，并证明了 CT 神经影像学对卒中后认知结局的预后价值。临床神经影像学可以帮助在急性住院期间识别长期存在 PSCI 风险的患者。
