de Kort, F. A.S. et al. (2023) White matter hyperintensity volume and poststroke cognition: an individual patient data pooled analysis of 9 ischemic stroke cohort studies. Stroke, 54(12), pp. 3021-3029. (doi: 10.1161/STROKEAHA.123.044297) (PMID:37901947) (PMCID:PMC10664782)
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Abstract
Background: White matter hyperintensities (WMH) are associated with cognitive dysfunction after ischemic stroke. Yet, uncertainty remains about affected domains, the role of other preexisting brain injury, and infarct types in the relation between WMH burden and poststroke cognition. We aimed to disentangle these factors in a large sample of patients with ischemic stroke from different cohorts. Methods: We pooled and harmonized individual patient data (n=1568) from 9 cohorts, through the Meta VCI Map consortium (www.metavcimap.org). Included cohorts comprised patients with available magnetic resonance imaging and multidomain cognitive assessment <15 months poststroke. In this individual patient data meta-analysis, linear mixed models were used to determine the association between WMH volume and domain-specific cognitive functioning (Z scores; attention and executive functioning, processing speed, language and verbal memory) for the total sample and stratified by infarct type. Preexisting brain injury was accounted for in the multivariable models and all analyses were corrected for the study site as a random effect. Results: In the total sample (67 years [SD, 11.5], 40% female), we found a dose-dependent inverse relationship between WMH volume and poststroke cognitive functioning across all 4 cognitive domains (coefficients ranging from −0.09 [SE, 0.04, P=0.01] for verbal memory to −0.19 [SE, 0.03, P<0.001] for attention and executive functioning). This relation was independent of acute infarct volume and the presence of lacunes and old infarcts. In stratified analyses, the relation between WMH volume and domain-specific functioning was also largely independent of infarct type. Conclusions: In patients with ischemic stroke, increasing WMH volume is independently associated with worse cognitive functioning across all major domains, regardless of old ischemic lesions and infarct type.
| Item Type: | Articles |
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| Additional Information: | The Meta VCI Map consortium is supported by Vici Grant 918.16.616 from ZonMW to Dr G.J. Biessels Harmonization analyses for this study were supported by a Rudolf Magnus Young Talent Fellowship from the University Medical Center Utrecht Brain Center to Dr J. Matthijs Biesbroek. Dr J.M. Wardlaw reports grants from the Row Fogo Charitable Trust, the Wellcome Trust, and the UK Dementia Research Institute which receives its funding from the UK Medical Research Council, Alzheimer’s Society and Alzheimer’s Research UK, during the conduct of the study; and grants from Fondation Leducq, EU Horizon 2020 (SVDs@ target project, grant agreement number 666881), the British Heart Foundation, and the UK Stroke Association, outside the submitted work. Dr O.K.L. Hamilton is supported by the Medical Research Council [MC_UU_00022/2] and the Scottish Chief Scientist Office [SPHSU17]. Dr Aben reports grants from ZonMW. Dr C.P.L.H. Chen reports grants from the National Medical Research Council (NMRC) of Singapore and the National University of Singapore. Dr S. Köhler received governmental funding from the Netherlands Society of Science (NWO) and ZonMW. The CASPER study (Cognition and Affect After Stroke: A Prospective Evaluation of Risk) was supported by Maastricht University, Health Foundation Limburg, and Stichting Adriana van Rinsum-Ponsen. The PROCRAS cohort (Prediction of Cognitive Recovery After Stroke) was funded via ZonMW as part of the TopZorg project in 2015 (grant number 842003011). The CODECS cohort ([Cognitive Deficits in Cerebellar Stroke]; ongoing) is supported by a grant from Stichting Coolsingel (grant number 514). The DEDEMAS cohort (Determinants of Dementia After Stroke) was funded by the Vascular Dementia Research Foundation. |
| Keywords: | Ischemic stroke, white matter hyperintensities, domain-specific cognitive functioning. |
| Status: | Published |
| Refereed: | Yes |
| Glasgow Author(s) Enlighten ID: | Hamilton, Dr Olivia |
| Authors: | de Kort, F. A.S., Coenen, M., Weaver, N. A., Kuijf, H. J., Aben, H. P., Bae, H.-J., Bordet, R., Cammà, G., Chen, C. P.L.H., Dewenter, A., Duering, M., Fang, R., van der Giessen, R. S., Hamilton, O. K.L., Hilal, S., Huenges Wajer, I. M.C., Kan, C. N., Kim, J., Kim, B. J., Köhler, S., de Kort, P. L.M., Koudstaal, P. J., Lim, J.-S., Lopes, R., Mok, V. C.T., Staals, J., Venketasubramanian, N., Verhagen, C. M., Verhey, F. R.J., Wardlaw, J. M., Xu, X., Yu, K.-H., Biesbroek, J. M., and Biessels, G. J. |
| College/School: | College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > MRC/CSO SPHSU |
| Journal Name: | Stroke |
| Publisher: | American Heart Association |
| ISSN: | 0039-2499 |
| ISSN (Online): | 1524-4628 |
| Published Online: | 30 October 2023 |
| Copyright Holders: | Copyright © 2023 The Authors |
| First Published: | First published in Stroke 54(12):3021-3029 |
| Publisher Policy: | Reproduced under a Creative Commons license |
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