Ball, E. L., Sutherland, R., Squires, C., Mead, G. E., Religa, D., Lundström, E., Cheyne, J., Wardlaw, J. M., Quinn, T. J. and Shenkin, S. D. (2022) Predicting post-stroke cognitive impairment using acute CT neuroimaging: a systematic review and meta-analysis. International Journal of Stroke, 17(6), pp. 618-627. (doi: 10.1177/17474930211045836) (PMID:34569865) (PMCID:PMC9260488)
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Abstract
Background: Identifying whether acute stroke patients are at risk of cognitive decline could improve prognostic discussions and management. Structural computed tomography neuroimaging is routine in acute stroke, and may identify those at risk of post-stroke dementia or post-stroke cognitive impairment (PSCI). Aim: To systematically review the literature to identify which stroke or pre-stroke features on brain computed tomography scans, performed at the time of stroke, are associated with post-stroke dementia or PSCI. Summary of review: We searched electronic databases to December 2020. We included studies reporting acute stroke brain computed tomography, and later diagnosis of a cognitive syndrome. We created summary estimates of size of unadjusted association between computed tomography features and cognition. Of 9536 citations, 28 studies (41 papers) were eligible (N = 7078, mean age 59.8–78.6 years). Cognitive outcomes were post-stroke dementia (10 studies), PSCI (17 studies), and one study analyzed both. Fifteen studies (N = 2952) reported data suitable for meta-analyses. White matter lesions (WML) (six studies, N = 1054, OR = 2.46, 95% CI = 1.25–4.84), cerebral atrophy (four studies, N = 558, OR = 2.80, 95% CI = 1.21–6.51), and pre-existing stroke lesions (three studies, N = 352, OR = 2.38, 95% CI = 1.06–5.32) were associated with post-stroke dementia. WML (four studies, N = 473, OR = 3.46, 95% CI = 2.17–5.52) were associated with PSCI. Other computed tomography features were either not associated with cognitive outcome, or there were insufficient data. Conclusions: Cognitive impairment following stroke is of great concern to patients and carers. Features seen on visual assessment of acute stroke computed tomography brain scans are strongly associated with cognitive outcomes. Clinicians should consider when and how this information should be discussed with stroke survivors.
| Item Type: | Articles |
|---|---|
| Status: | Published |
| Refereed: | Yes |
| Glasgow Author(s) Enlighten ID: | Mead, Dr Gillian and Quinn, Professor Terry and Ball, Emily and Cheyne, Mr Joshua |
| Authors: | Ball, E. L., Sutherland, R., Squires, C., Mead, G. E., Religa, D., Lundström, E., Cheyne, J., Wardlaw, J. M., Quinn, T. J., and Shenkin, S. D. |
| College/School: | College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health |
| Journal Name: | International Journal of Stroke |
| Publisher: | SAGE Publications |
| ISSN: | 1747-4930 |
| ISSN (Online): | 1747-4949 |
| Published Online: | 27 September 2021 |
| Copyright Holders: | Copyright © 2021 World Stroke Organization |
| First Published: | First published in International Journal of Stroke 17(6): 618-627 |
| Publisher Policy: | Reproduced under a Creative Commons License |
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