Cerebral small vessel disease, medial temporal lobe atrophy and cognitive status in patients with ischaemic stroke and transient ischaemic attack

Arba, F., Quinn, T. , Hankey, G.J., Ali, M. , Lees, K. R. and Inzitari, D. (2017) Cerebral small vessel disease, medial temporal lobe atrophy and cognitive status in patients with ischaemic stroke and transient ischaemic attack. European Journal of Neurology, 24(2), pp. 276-282. (doi: 10.1111/ene.13191) (PMID:27862654)

Abstract

BACKGROUND AND PURPOSE: Small vessel disease (SVD) and Alzheimer's disease (AD) are two common causes of cognitive impairment and dementia, traditionally considered as distinct processes. The relationship between radiological features suggestive of AD and SVD was explored, and the association of each of these features with cognitive status at 1 year was investigated in patients with stroke or transient ischaemic attack. METHODS: Anonymized data were accessed from the Virtual International Stroke Trials Archive (VISTA). Medial temporal lobe atrophy (MTA; a marker of AD) and markers of SVD were rated using validated ordinal visual scales. Cognitive status was evaluated with the Mini Mental State Examination (MMSE) 1 year after the index stroke. Logistic regression models were used to investigate independent associations between (i) baseline SVD features and MTA and (ii) all baseline neuroimaging features and cognitive status 1 year post-stroke. RESULTS: In all, 234 patients were included, mean (±SD) age 65.7 ± 13.1 years, 145 (62%) male. Moderate to severe MTA was present in 104 (44%) patients. SVD features were independently associated with MTA (P < 0.001). After adjusting for age, sex, disability after stroke, hypertension and diabetes mellitus, MTA was the only radiological feature independently associated with cognitive impairment, defined using thresholds of MMSE ≤ 26 (odds ratio 1.94; 95% confidence interval 1.28-2.94) and MMSE ≤ 23 (odds ratio 2.31; 95% confidence interval 1.48-3.62). CONCLUSION: In patients with ischaemic cerebrovascular disease, SVD features are associated with MTA, which is a common finding in stroke survivors. SVD and AD type neurodegeneration coexist, but the AD marker MTA, rather than SVD markers, is associated with post-stroke cognitive impairment.

• Item Type: Articles
• Additional Information: This study was partly supported by Tenovus Scotland.Dr Quinn is supported by a joint Stroke Association/Chief Scientist Office Senior Clinical Lectureship.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Lees, Professor Kennedy and Ali, Dr Myzoon and Arba, Dr Francesco and Quinn, Professor Terry
• Authors: Arba, F., Quinn, T., Hankey, G.J., Ali, M., Lees, K. R., and Inzitari, D.
• College/School: College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
• Journal Name: European Journal of Neurology
• Journal Abbr.: Eur J Neurology
• Publisher: Wiley
• ISSN: 1351-5101
• ISSN (Online): 1468-1331
• Published Online: 14 November 2016
• Copyright Holders: Copyright © 2016 EAN
• First Published: First published in European Journal of Neurology 24(2): 276-282
• Publisher Policy: Reproduced in accordance with the publisher copyright policy