scholarly journals Carotid Atherosclerotic Calcification Characteristics Relate to Post-stroke Cognitive Impairment

2021 ◽  
Vol 13 ◽  
Author(s):  
Yingzhe Wang ◽  
Chanchan Li ◽  
Mengyuan Ding ◽  
Luyi Lin ◽  
Peixi Li ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Computer Tomography ◽  
Area Under Curve ◽  
Small Vessel Disease ◽  
Large Vessel ◽  
White Matter Hyperintensity ◽  
Post Stroke ◽  
Increased Risk ◽  
Computer Tomography Angiography ◽  
Carotid Calcification

Background: Together with cerebral small vessel disease (CSVD), large vessel atherosclerosis is considered to be an equally important risk factor in the progression of vascular cognitive impairment. This article aims to investigate whether carotid atherosclerotic calcification is associated with the increased risk of post-stroke cognitive impairment (PSCI).Methods: A total of 128 patients (mean age: 62.1 ± 12.2 years, 37 women) suffering from ischemic stroke underwent brain/neck computer tomography angiography examination. The presence and characteristic of carotid calcification (size, number and location) were analyzed on computer tomography angiography. White matter hyperintensity (WMH) was assessed using Fazekas scales. PSCI was diagnosed based on a battery of neuropsychological assessments implemented 6−12 months after stroke.Results: Among 128 patients, 26 developed post-stroke dementia and 96 had carotid calcification. Logistic regression found carotid calcification (odds ratio [OR] = 7.15, 95% confidence interval [CI]: 1.07–47.69) and carotid artery stenosis (OR = 6.42, 95% CI: 1.03–40.15) both significantly increased the risk for post-stroke dementia. Moreover, multiple, thick/mixed, and surface calcifications exhibited an increasing trend in PSCI (Ptrend = 0.004, 0.016, 0.045, respectively). The prediction model for post-stroke dementia including carotid calcification (area under curve = 0.67), WMH (area under curve = 0.67) and other covariates yielded an area under curve (AUC) of 0.90 (95% CI: 0.82–0.99).Conclusion: Our findings demonstrated that the quantity and location of carotid calcifications were independent indicators for PSCI. The significant role of large vessel atherosclerosis in PSCI should be concerned in future study.

Abstract P626: Periodontal Disease is Independently Associated With Cerebral Small Vessel Disease

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Forrest Lowe ◽  
Souvik Sen ◽  
Hamdi S Adam ◽  
Ryan Demmer ◽  
Bruce A Wasserman ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Periodontal Disease ◽  
Small Vessel Disease ◽  
Multinomial Logistic Regression ◽  
Cerebral Small Vessel Disease ◽  
Small Vessel ◽  
White Matter Hyperintensity ◽  
Periodontal Health ◽  
Vessel Disease ◽  
The Relationship

Background: Prior studies have shown the association between periodontal disease, lacunar strokes and cognitive impairment. Using the Atherosclerosis Risk in Communities (ARIC) cohort study we investigated the relationship between periodontal disease (PD) and the development of MRI verified small vessel disease. Methods: Using the ARIC database data we extracted data for 1143 (mean age 77 years, 76% white, 24% African-American and 45% male) participants assessed for PD (N=800) versus periodontal health (N=343). These participants were assessed for small vessel disease on 3T MRI as measured by the log of white matter hyperintensity volume (WMHV). WMHV were derived from a semiautomated segmentation of FLAIR images. Student t-test was then used to evaluate the relationship between small vessel disease as the log of WMHV in subjects with PD or periodontal health. Based on WMHV the patients were grouped into quartiles and the association of PD with WMHV were tested using the group in periodontal health and lowest quartile of WMHV as the reference groups. Multinomial logistic regression was used to compute crude and adjusted odds ratio (OR) for the higher quartiles of WMHV compared to the reference quartile. Results: There was a significant increase in the presence of small vessel disease measured as log WMHV in the PD cohort as compared to periodontal health cohort with p= 0.023 on Independent Sample t-est. Based on WMHV the subjects were grouped into quartiles 0-6.41, >6.41-11.56, >11.56-21.36 and >21.36 cu mm3). PD was associated with only the highest quartile of WMHV on univariate (crude OR 1.77, 95% CI 1.23-2.56) and multivariable (adjusted OR 1.61, 95% CI 1.06-2.44) analyses. The later was adjusted for age, race, gender, hypertension, diabetes and smoking. Conclusion: Based on this prospective cohort there is data to suggest that PD may be associated with cerebral small vessel disease. Maintaining proper dental health may decrease future risk for the associated lacunar strokes and vascular cognitive impairment.

scholarly journals Predictors of Lesion Cavitation After Recent Small Subcortical Stroke

2019 ◽  
Vol 11 (3) ◽  
pp. 402-411
Author(s):  
Thomas Gattringer ◽  
Maria Valdes Hernandez ◽  
Anna Heye ◽  
Paul A Armitage ◽  
Stephen Makin ◽  
...  
Keyword(s):  
Diffusion Tensor ◽  
Small Vessel Disease ◽  
Mean Diffusivity ◽  
Tissue Destruction ◽  
Post Stroke ◽  
Normal Appearing White Matter ◽  
Lower Baseline ◽  
Contrast Enhanced ◽  
Increased Risk ◽  
Morphologic Evolution

Abstract Morphologic evolution of recent small subcortical infarcts (RSSI) ranges from lesion disappearance to lacune formation and the reasons for this variability are still poorly understood. We hypothesized that diffusion tensor imaging (DTI) and blood-brain-barrier (BBB) abnormalities early on can predict tissue damage 1 year after an RSSI. We studied prospectively recruited patients with a symptomatic MRI-defined RSSI who underwent baseline and two pre-specified MRI examinations at 1–3-month and 1-year post-stroke. We defined the extent of long-term tissue destruction, termed cavitation index, as the ratio of the 1-year T1-weighted cavity volume to the baseline RSSI volume on FLAIR. We calculated fractional anisotropy and mean diffusivity (MD) of the RSSI and normal-appearing white matter, and BBB leakage in different tissues on dynamic contrast-enhanced MRI. Amongst 60 patients, at 1-year post-stroke, 44 patients showed some degree of RSSI cavitation on FLAIR, increasing to 50 on T2- and 56 on T1-weighted high-resolution scans, with a median cavitation index of 7% (range, 1–36%). Demographic, clinical, and cerebral small vessel disease features were not associated with the cavitation index. While lower baseline MD of the RSSI (rs = − 0.371; p = 0.004) and more contrast leakage into CSF (rs = 0.347; p = 0.007) were associated with the cavitation index in univariable analysis, only BBB leakage in CSF remained independently associated with cavitation (beta = 0.315, p = 0.046). Increased BBB leakage into CSF may indicate worse endothelial dysfunction and increased risk of tissue destruction post RSSI. Although cavitation was common, it only affected a small proportion of the original RSSI.

Abstract WP427: Cognitive Function of Ten-year Stroke Survivors Compared to Non-stroke Individuals: the Lund Stroke Register

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Hossein Delavaran ◽  
Ann-Cathrin Jönsson ◽  
Håkan Lövkvist ◽  
Susanne Iwarsson ◽  
Sölve Elmståhl ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Cognitive Assessment ◽  
Executive Dysfunction ◽  
Screening Methods ◽  
Stroke Survivors ◽  
Cognitive Screening ◽  
Severe Cognitive Impairment ◽  
Post Stroke ◽  
Increased Risk

Introduction: Post-stroke cognitive impairment (PSCI) has a considerable impact on patients and society. However, the characteristics and prevalence of long-term PSCI may be influenced by assessment methods and selection bias. We therefore used two cognitive screening methods to assess PSCI in ten-year stroke survivors, made comparisons with non-stroke individuals, and compared these screening methods. Methods: The Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) were administered and compared in a population-based consecutive sample of ten-year stroke survivors. In addition, age- and sex-matched non-stroke controls were assessed with the MMSE. Regression analyses adjusting for education compared the stroke survivors’ MMSE performance with the controls. Moderate/severe cognitive impairment, approximating to dementia, was defined using MMSE<24 and MoCA<20 as cut-offs. To detect those with mild cognitive impairment, alternative cut-offs of MMSE<27 and MoCA<25 were also used. Results: In total, 127 of 145 stroke survivors participated. The total MMSE-scores were similar for stroke survivors (median 27) and 354 controls (median 27; p =0.922); as well as proportions with MMSE<24 (23% vs. 17%; p =0.175) or MMSE<27 (47% vs. 49%; p =0.671). After adjustment for education, stroke survivors showed an increased risk for moderate/severe cognitive impairment defined by MMSE<24 (OR=1.82; p =0.036). Executive dysfunction was seen in 42% of the stroke survivors vs. 16% of the controls as evaluated by MMSE ( p <0.001). According to MoCA, moderate/severe cognitive impairment (MoCA<20) was observed in 28% of the stroke survivors; any degree of cognitive impairment (MoCA<25) was seen in 61%; and 45-61% displayed executive function deficits. Conclusions: PSCI including executive dysfunction is common among ten-year stroke survivors, who have an increased risk of moderate/severe cognitive impairment compared to non-stroke controls. The prevalence of long-term PSCI may have been previously underestimated, and MoCA may be more suitable for post-stroke cognitive assessment.

scholarly journals Increased risk of cognitive impairment and more severe brain lesions in hypertensive compared to non-hypertensive patients with cerebral small vessel disease

2018 ◽  
Vol 20 (9) ◽  
pp. 1260-1265 ◽  
Author(s):  
Aleksandra M. Pavlovic ◽  
Tatjana Pekmezovic ◽  
Jasna Zidverc Trajkovic ◽  
Gordana Tomic ◽  
Edita Cvitan ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Small Vessel Disease ◽  
Cerebral Small Vessel Disease ◽  
Brain Lesions ◽  
Small Vessel ◽  
Hypertensive Patients ◽  
Vessel Disease ◽  
Increased Risk

scholarly journals Prior intracerebral hemorrhage and white matter hyperintensity burden on recurrent stroke risk

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Jong-Ho Park ◽  
Sun U. Kwon ◽  
Hyuk Sung Kwon ◽  
Sung Hyuk Heo
Keyword(s):  
Ischemic Stroke ◽  
White Matter ◽  
Intracerebral Hemorrhage ◽  
Hemorrhagic Stroke ◽  
Small Vessel Disease ◽  
Recurrent Stroke ◽  
White Matter Hyperintensity ◽  
Major Adverse Cardiovascular Events ◽  
Stroke Incidence ◽  
Increased Risk

AbstractPrior intracerebral hemorrhage (ICH) is associated with increased risk of ischemic stroke. Since white matter hyperintensity (WMH) is associated with ischemic stroke and ICH, this study aimed to evaluate the relationship between ICH and the risk of recurrent stroke by WMH severity. From a prospective multicenter database comprising 1454 noncardioembolic stroke patients with cerebral small-vessel disease, patients were categorized by presence or absence of prior ICH and WMH severity: mild-moderate WMH (reference); advanced WMH; ICH with mild-moderate WMH; and ICH with advanced WMH. Among patients with ICH, the association with stroke outcomes by WMH burden was further assessed. The primary endpoint was ischemic stroke and hemorrhagic stroke. The secondary endpoint was major adverse cardiovascular events (MACE): stroke/coronary heart disease/vascular death. During the mean 1.9-year follow-up period, the ischemic stroke incidence rate per 100 person-years was 2.7, 4.0, 2.5, and 8.1 in increasing severity, and the rate of hemorrhagic stroke was 0.7, 1.3, 0.6, and 2.1, respectively. The risk of ischemic stroke was higher in ICH with advanced WMH (adjusted HR 2.62; 95% CI 1.22−5.60) than the reference group, while the risk of hemorrhagic stroke trended higher (3.75, 0.85–16.53). The risk of MACE showed a similar pattern in ICH with advanced WMH. Among ICH patients, compared with mild WMH, the risk of ischemic stroke trended to be higher in advanced WMH (HR 3.37; 95% CI 0.90‒12.61). Advanced WMH was independently associated with an increased risk of hemorrhagic stroke (HR 33.96; 95% CI 1.52−760.95). Given the fewer rate of hemorrhagic stroke, the risk of hemorrhagic stroke might not outweigh the benefits of antiplatelet therapy for secondary prevention.

scholarly journals Cognitive impairment in patients with atrial fibrillation

2020 ◽  
Vol 4 (9) ◽  
pp. 578-583
Author(s):  
E.V. Mityaeva ◽  
◽  
P.R. Kamchatnov ◽  
Keyword(s):  
Atrial Fibrillation ◽  
Alzheimer’S Disease ◽  
Cognitive Impairment ◽  
Tau Protein ◽  
Small Vessel Disease ◽  
Cardioembolic Stroke ◽  
Small Vessel ◽  
Vessel Disease ◽  
Increased Risk

Atrial fibrillation (AF) is an important medical and social problem due to its wide prevalence in the population and high risk of embolic complications leading to severe consequences. The article describes an association established between AF and an increased risk of cognitive impairment (CI). Cardioembolic stroke due to AF is a common cause of CI, however, there are other mechanisms for CI development. The article also examines the role of small vessel disease and asymptomatic cerebral infarction in the formation of CI in patients with AF. Adding that, it provides data on the AF role in the development of neurodegenerative process with the accumulation of amyloid and tau protein in the brain tissue. There is an increased risk of Alzheimer’s disease in patients with AF, although the causal relationship of these conditions requires clarification. Modern data concerning the role of neuroinflammation and genetic predisposition in the development of CI in AF were analyzed. The conclusion is made about the pathogenetic heterogeneity of higher cerebral functions disorders on the basis of the presented data on the CI pathogenetic mechanism in patients with AF and comorbid conditions. It was suggested that the optimal pathogenetic therapy can be chosen taking into account the known CI pathogenetic mechanisms. KEYWORDS: atrial fibrillation, cognitive impairment, dementia, Alzheimer’s disease, cardioembolic stroke, small vessel disease, neurodegeneration, amyloid, tau protein, pathogenesis. FOR CITATION: Mityaeva E.V., Kamchatnov P.R. Cognitive impairment in patients with atrial fibrillation. Russian Medical Inquiry. 2020;4(9):578–583. DOI: 10.32364/2587-6821-2020-4-9-578-583.

scholarly journals Plasma Phosphorylated-tau181 is a Predictor of Post-Stroke Cognitive Impairment: A Longitudinal Study

2021 ◽  
Author(s):  
Li-Kai Huang ◽  
Shu-Ping Chao ◽  
Chaur-Jong Hu ◽  
Yu-Chun Lo ◽  
Yi-Chen Hsieh
Keyword(s):  
Cognitive Impairment ◽  
Longitudinal Study ◽  
Small Vessel Disease ◽  
Cognitive Intervention ◽  
Cerebral Small Vessel Disease ◽  
Small Vessel ◽  
Blood Biomarkers ◽  
Post Stroke ◽  
Vessel Disease ◽  
Delayed Onset

Abstract IntroductionPost-stroke cognitive impairment (PSCI) cannot be neglected because it drastically influences the daily life of patients and their families. However, there are no studies exploring the association between preclinical blood biomarkers of neurodegeneration including plasma amyloid-β (Aβ), tau and brain-derived neurotrophic factor (BDNF) together with the risk of PSCI. The present longitudinal study was to investigate whether these blood biomarkers with imaging markers of cerebral small vessel disease can improve the prediction for PSCI. In addition, we also explored the association between blood biomarkers with the trajectories of PSCI.MethodsAdult patients with first ever acute ischemic stroke were recruited, and the cognitive and functional abilities of these patients were evaluated. Furthermore, blood biomarkers of neurodegeneration including plasma Aβ-40, Aβ-42, total tau, phosphorylated tau 181 (p-tau181), and BDNF levels and image markers of cerebral small vessel disease were measured. Each patient was followed up at 3 and 12 months at the outpatient department.ResultsOf 136 patients, 40 and 50 patients developed PSCI at 3 and 12 months after stroke, respectively. In functional trajectories, 27 patients did not have PSCI at 3 months but did at 12 months. By contrast, the PSCI status of 17 patients at 3 months was reversed at 12 months. Patients with high acute plasma p-tau181 had a significantly lower PSCI risk at 3 months (odds ratio [OR] = 0.62, 95% confidence interval [CI] = 0.40–0.94, p = 0.0243) and 12 months (OR = 0.69, 95% CI = 0.47–0.99, p = 0.0443) after adjustment for covariates and image biomarkers. Discrimination and reclassification statistics indicated that the p-tau181 level can improve discrimination ability for PSCI at 3 and 12 months, respectively. Additionally, the plasma p-tau181 level was the highest in subjects without PSCI followed by those with delayed-onset PSCI and early-onset PSCI with reversal, whereas the lowest plasma p-tau181 level was found among those with persistent PSCI, showing a significant trend test (p = 0.0081).ConclusionsPlasma p-tau181 is a potential biomarker for predicting early- and delayed-onset PSCI. Future studies should incorporate plasma p-tau181 as indicator for timely cognitive intervention in the follow-up of patients with stroke.

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