Cognitive reserve moderates long-term cognitive and functional outcome in cerebral small vessel disease

ObjectiveTo determine whether CT-based cerebral small vessel disease (SVD) biomarkers are associated with 6-month functional outcome after intracerebral hemorrhage (ICH) and whether these biomarkers improve the performance of the preexisting ICH prediction score.MethodsWe included 864 patients with acute ICH from a multicenter, hospital-based prospective cohort study. We evaluated CT-based SVD biomarkers (white matter hypodensities [WMH], lacunes, brain atrophy, and a composite SVD burden score) and their associations with poor 6-month functional outcome (modified Rankin Scale score >2). The area under the receiver operating characteristic curve (AUROC) and Hosmer-Lemeshow test were used to assess discrimination and calibration of the ICH score with and without SVD biomarkers.ResultsIn multivariable models (adjusted for ICH score components), WMH presence (odds ratio [OR] 1.52, 95% confidence interval [CI] 1.12–2.06), cortical atrophy presence (OR 1.80, 95% CI 1.19–2.73), deep atrophy presence (OR 1.66, 95% CI 1.17–2.34), and severe atrophy (either deep or cortical) (OR 1.94, 95% CI 1.36–2.74) were independently associated with poor functional outcome. For the revised ICH score, the AUROC was 0.71 (95% CI 0.68–0.74). Adding SVD markers did not significantly improve ICH score discrimination; for the best model (adding severe atrophy), the AUROC was 0.73 (95% CI 0.69–0.76). These results were confirmed when lobar and nonlobar ICH were considered separately.ConclusionsThe ICH score has acceptable discrimination for predicting 6-month functional outcome after ICH. CT biomarkers of SVD are associated with functional outcome, but adding them does not significantly improve ICH score discrimination.Trial Registration InformationClinicalTrials.gov Identifier: NCT02513316.

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Synergistic associations of cognitive and motor impairments with functional outcome in covert cerebral small vessel disease

European Journal of Neurology ◽

10.1111/ene.15108 ◽

2021 ◽

Author(s):

Hanna Jokinen ◽

Hanna M. Laakso ◽

Matti Ahlström ◽

Anne Arola ◽

Juha Lempiäinen ◽

...

Keyword(s):

Functional Outcome ◽

Small Vessel Disease ◽

Cerebral Small Vessel Disease ◽

Small Vessel ◽

Motor Impairments ◽

Vessel Disease

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Long-Term Premorbid Blood Pressure and Cerebral Small Vessel Disease Burden on Imaging in Transient Ischemic Attack and Ischemic Stroke

Stroke ◽

10.1161/strokeaha.118.021578 ◽

2018 ◽

Vol 49 (9) ◽

pp. 2053-2060 ◽

Cited By ~ 8

Author(s):

Kui Kai Lau ◽

Linxin Li ◽

Michela Simoni ◽

Ziyah Mehta ◽

Wilhelm Küker ◽

...

Keyword(s):

Blood Pressure ◽

Ischemic Stroke ◽

Transient Ischemic Attack ◽

Disease Burden ◽

Small Vessel Disease ◽

Cerebral Small Vessel Disease ◽

Small Vessel ◽

Vessel Disease ◽

Ischemic Attack

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Association of Neuroimaging Markers of Cerebral Small Vessel Disease With Short-Term Outcomes in Patients With Minor Cerebrovascular Events

10.21203/rs.3.rs-57506/v1 ◽

2020 ◽

Author(s):

Xuemei Chen ◽

Lin Wang ◽

Junying Jiang ◽

Yuanyuan Gao ◽

Rui Zhang ◽

...

Keyword(s):

Functional Outcome ◽

Small Vessel Disease ◽

Cerebral Small Vessel Disease ◽

Small Vessel ◽

Stroke Recurrence ◽

Short Term ◽

Poor Functional Outcome ◽

Term Outcome ◽

Vessel Disease ◽

Cerebrovascular Events

Abstract Objective: As one of the Magnetic resonance imaging (MRI) makers of cerebral small vessel disease (SVD), increasing evidences have showed that white matter hyperintensity (WMH) can predict the short-term outcome of acute ischemic stroke (AIS). It is unclear that whether neuroimaging markers of SVD are also associated with short-term outcomes of minor cerebrovascular events. In the present study, We investigate neuroimaging markers of SVD in order to explore their roles in prediction of short-term outcome in patients with minor cerebrovascular events. Methods: Consecutive first-ever stroke patients(n=546)from the Affiliated Jiangning Hospital of Nanjing Medical University were enrolled. A total of 388 patients were enrolled according to minor cerebrovascular events definition and exclusion criteria. MRI scans were performed within seven days of stroke onset, and then neuroimaging markers of SVD including WMH, lacunes, cerebral microbleeds (CMB), and perivascular spaces (PVS) , SVD burden scores were assessed. We completed baseline characteristics and evaluated the relationships of short-term outcomes to SVD neuroimaging markers and SVD scores. The 90-day modified Rankin Scale (mRS) was thought as primary outcome and was dichotomized as good functional outcome (mRS 0-1) and poor outcome (mRS 2-6). Secondary outcomes were stroke progression and stroke recurrence. Results: Higher age, National Institutes of Health Stroke Scale (NIHSS) upon admission, lipoprotein-associated phospholipase A2 (LP-PLA2) and lacunes, Fazekas score were correlated with poor functional outcome (P<0.05), But after adjusting for confounding variables, among the neuroimaging markers of cerebral small vessel disease, only Fazekas score (OR, 1.343; 95% confidence interval, 1.020-1.770; P=0.036) was found to be associated with poor outcome at 90 days. Higher Fazekas and SVD scores were not associated with stroke progression or stroke recurrence. Conclusion: WMH can predict the poor functional outcome of minor cerebrovascular events. Adding other neuroimaging markers of SVD and total SVD burden score, however, does not improve the prediction,which indicated WMH can as neuroimaging markers for guiding the treatment of minor cerebrovascular events.

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Abstract TP39: Long-term Imaging Outcomes in Cerebral Small Vessel Disease

Stroke ◽

10.1161/str.48.suppl_1.tp39 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Yan Chen ◽

Renyuan Liu ◽

Wu Xu ◽

Yuanyuan Gao ◽

Xin Xu ◽

...

Keyword(s):

White Matter ◽

White Matter Hyperintensities ◽

Small Vessel Disease ◽

Cerebral Small Vessel Disease ◽

Small Vessel ◽

Lacunar Stroke ◽

Vessel Disease ◽

Drum Tower Hospital ◽

The Relationship

Background: About 90% Older people above the age of 65 years present white matter hyperintensities (WMH) of varying severity when undergoing MRI. However, white matter hyperintensities is one of the characteristic in imaging for cerebral small vessel disease (CSVD). The relationship between WMH volume and lacunar stroke is unknown. Patients and Methods: A total of 8475 patients with hypertension and WMH on MRI, which were from Nanjing Drum Tower hospital imaging register center from 2011 to 2015, were studied retrospectively. Age between 60 and 85 years without dementia or parkinsonism. The patients were scanned MRI including DWI, T1W, T2W, FLAIR in 1 time each year, acute lacunar stroke is as an endpoint. Patients with Intracranial atherosclerosis in larger arteries were excluded. Areas of supratentorial WMH were semi-automated segmented on FLAIR sequences using MRIcron software. DWI identificates acute lacunar infarct. Results: Of 8475 patients, 599 got acute lacunar stroke and accound for 7.07%. A percentage of 82.5 acute lacunar infarctions were located beside periventricular WMH and merge into white matter disease abnormalities. In compared with patients that were spared from any vascular incidents, higher periventricular WMH volumes were found among the 599 patients in baseline FLAIR images (p=0.012). Furthermore, by annual MRI scan, about 612 patients were found with increased volumes of periventricular WMH, and 86.5% of the patients ended up with acute lacunar stroke. While in patients with stable WMH volumes, only 0.89% of them ended up with vascular incidents. Logistic regression analysis demonstrated that only periventricular WMH volumes were associated with incidence of acute lacunar stroke (p=0.001), while no association of aging (p=0.275) and hypertension (p=0.146) were found. Conclusion: This study indicates that periventricular WMH volumes on FLAIR are independent predictors for acute lacunar stroke and suggest that therapies aimed at reducing progression of white matter hyperintensities via regulating hyperintensities and end-arteriole damage may protect against acute lacunar stroke in clinic.

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Cerebral Small Vessel Disease Load Predicts Functional Outcome and Stroke Recurrence After Intracerebral Hemorrhage: A Median Follow-Up of 5 Years

Frontiers in Aging Neuroscience ◽

10.3389/fnagi.2021.628271 ◽

2021 ◽

Vol 13 ◽

Author(s):

Mangmang Xu ◽

Baojin Li ◽

Di Zhong ◽

Yajun Cheng ◽

Qian Wu ◽

...

Keyword(s):

Regression Analysis ◽

Intracerebral Hemorrhage ◽

Functional Outcome ◽

Small Vessel Disease ◽

Cerebral Small Vessel Disease ◽

Stroke Recurrence ◽

Poor Functional Outcome ◽

Vessel Disease

Background: Uncertainty exists over the long-term prognostic significance of cerebral small vessel disease (CSVD) in primary intracerebral hemorrhage (ICH).Methods: We performed a longitudinal analysis of CSVD and clinical outcomes in consecutive patients with primary ICH who had MRI. Baseline CSVD load (including white matter hyperintensities [WMH], cerebral microbleeds [CMBs], lacunes, and enlarged perivascular spaces [EPVS]) was evaluated. The cumulative CSVD score was calculated by combining the presence of each CSVD marker (range 0–4). We followed participants for poor functional outcome [modified Rankin scale [mRS] ≥ 4], stroke recurrence, and time-varying survival during a median follow-up of 4.9 [interquartile range [IQR] 3.1–6.0] years. Parsimonious and fuller multivariable logistic regression analysis and Cox-regression analysis were performed to estimate the association of CSVD markers, individually and collectively, with each outcome.Results: A total of 153 patients were included in the analyses. CMBs ≥ 10 [adjusted OR [adOR] 3.252, 95% CI 1.181–8.956, p = 0.023] and periventricular WMH (PWMH) (adOR 2.053, 95% CI 1.220–3.456, p = 0.007) were significantly associated with poor functional outcome. PWMH (adOR 2.908, 95% CI 1.230–6.878, p = 0.015) and lobar CMB severity (adOR 1.811, 95% CI 1.039–3.157, p = 0.036) were associated with stroke recurrence. The cumulative CSVD score was associated with poor functional outcome (adOR 1.460, 95% CI 1.017–2.096) and stroke recurrence (adOR 2.258, 95% CI 1.080–4.723). Death occurred in 36.1% (13/36) of patients with CMBs ≥ 10 compared with 18.8% (22/117) in those with CMB < 10 (adjusted HR 2.669, 95% CI 1.248–5.707, p = 0.011). In addition, the cumulative CSVD score ≥ 2 was associated with a decreased survival rate (adjusted HR 3.140, 95% CI 1.066–9.250, p = 0.038).Conclusions: Severe PWMH, CMB, or cumulative CSVD burden exert important influences on the long-term outcome of ICH.

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