Predictors of post-stroke cognitive impairment using acute structural MRI neuroimaging: a systematic review and meta-analysis

Ball, E. L. et al. (2022) Predictors of post-stroke cognitive impairment using acute structural MRI neuroimaging: a systematic review and meta-analysis. International Journal of Stroke, (doi: 10.1177/17474930221120349) (PMID:35924821) (Early Online Publication)

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Abstract

Background: Stroke survivors are at an increased risk of developing post-stroke cognitive impairment and post-stroke dementia; those at risk could be identified by brain imaging routinely performed at stroke onset. Aim: This systematic review aimed to identify features which are associated with post-stroke cognitive impairment (including dementia), on magnetic resonance imaging (MRI) performed at stroke diagnosis. Summary of review: We searched the literature from inception to January 2022 and identified 10,284 records. We included studies that performed MRI at the time of stroke (0-30 days after a stroke) and assessed cognitive outcome at least three months after stroke. We synthesised findings from 26 papers, comprising 27 stroke-populations (N=13,114, average age range=40-80 years, 19-62% female). When data were available, we pooled unadjusted (ORu) and adjusted (ORa) odds ratios. We found associations between cognitive outcomes and presence of cerebral atrophy (3 studies, N=453, ORu=2.48, 95%CI=1.15-4.62), presence of microbleeds (2 studies, N=9151, ORa=1.36, 95%CI=1.08-1.70), and increasing severity of white matter hyperintensities (3 studies, N=704, ORa=1.26, 95%CI=1.06-1.49). Increasing cerebral small vessel disease score was associated with cognitive outcome following unadjusted analysis only (2 studies, N=499, ORu=1.34, 95%CI=1.12-1.61; 3 studies, N=950, ORa=1.23, 95%CI=0.96-1.57). Associations remained after controlling for pre-stroke cognitive impairment. We did not find associations between other stroke features and cognitive outcome, or there were insufficient data. Conclusions: Acute stroke MRI features may enable healthcare professionals to identify patients at risk of post-stroke cognitive problems. However, there is still substantial uncertainty about the prognostic utility of acute MRI for this.

Item Type:Articles
Status:Early Online Publication
Refereed:Yes
Glasgow Author(s) Enlighten ID:Quinn, Professor Terry
Authors: Ball, E. L., Shah, M., Ross, E., Sutherland, R., Squires, C., Mead, G. E., Wardlaw, J., Quinn, T. J., Religa, D., Lundström, E., Cheyne, 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:04 August 2022

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