Ölmestig Joakim, Sørensen Viktor Frederik Idin, Grimsgaard Ingrid, Fagerlund Birgitte, Kruuse Christina
Neurovascular Research Unit, Department of Neurology, Copenhagen University Hospital - Herlev and Gentofte, Borgmester Ib Juuls Vej 1, 2730 Herlev, Denmark.
Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen N, Denmark.
Cereb Circ Cogn Behav. 2025 Jun 10;9:100387. doi: 10.1016/j.cccb.2025.100387. eCollection 2025.
Cognitive impairment, depression, and fatigue are often neglected symptoms post-stroke. This study aimed to identify how white matter hyperintensity (WMH), a marker for cerebral small vessel disease (CSVD), is associated with post-stroke cognitive impairment, fatigue, and depression.
This prospective cohort study included participants admitted with stroke or transient ischemic attack. Participants were classified into two groups based on WMH on magnetic resonance imaging (MRI) using the Fazekas scale (0-1: no CSVD, 2-3: CSVD). Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA), Symbol Digit Modalities Test (SDMT), and Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) in the acute stroke phase (≤14 days) and three months post-stroke. Fatigue and depression were evaluated with the Fatigue Severity Scale (FSS) and the Beck Depression Inventory-II (BDI-II).
Two hundred and fifty-six participants were included with MRI. A high Fazekas score was associated with lower baseline SDMT (-4.17 ± 1.48, = 0.005, = 0.019), three-months SDMT (-3.56 ± 1.66, = 0.034, = 0.103), and higher baseline FSS (0.78 ± 0.26, = 0.003, = 0.011) independently of age. There was no association between the Fazekas score and MoCA or BDI-II.
These findings highlight the association between WMH, lower processing speed on the SDMT test in the acute stroke phase, and higher fatigue post-stroke. We propose that the WMH burden should be considered in all patients admitted with stroke or transient ischemic attack to identify those at increased risk of post-stroke cognitive impairment and fatigue.
认知障碍、抑郁和疲劳是中风后常被忽视的症状。本研究旨在确定脑小血管疾病（CSVD）的标志物——白质高信号（WMH）与中风后认知障碍、疲劳和抑郁之间的关联。
这项前瞻性队列研究纳入了因中风或短暂性脑缺血发作入院的参与者。根据磁共振成像（MRI）上使用Fazekas量表的WMH情况将参与者分为两组（0 - 1：无CSVD，2 - 3：CSVD）。在急性中风阶段（≤14天）和中风后三个月，使用蒙特利尔认知评估量表（MoCA）、符号数字模态测验（SDMT）和老年人认知下降知情者问卷（IQCODE）评估认知功能。使用疲劳严重程度量表（FSS）和贝克抑郁量表第二版（BDI-II）评估疲劳和抑郁。
纳入了256名进行MRI检查的参与者。Fazekas高分与较低的基线SDMT（-4.17±1.48，P = 0.005，r = 0.019）、三个月后的SDMT（-3.56±1.66，P = 0.034，r = 0.103）以及较高的基线FSS（0.78±0.26，P = 0.003，r = 0.011）独立相关，与年龄无关。Fazekas评分与MoCA或BDI-II之间无关联。
这些发现突出了WMH、急性中风阶段SDMT测试中较低的处理速度以及中风后较高的疲劳之间的关联。我们建议，对于所有因中风或短暂性脑缺血发作入院的患者，都应考虑WMH负担，以识别那些中风后认知障碍和疲劳风险增加的患者。
