Highlights
- •Thalamic infarction is associated with cognitive deterioration in patients with minor ischemic stroke at 12 months.
- •Stroke etiology is not correlated with worse cognitive performance in patients with minor ischemic stroke at 12 months.
- •Thalamus may be a critical structure in preserving cognition after stroke.
Abstract
Background and purpose
Post stroke cognitive impairment is closely related to the quality of life. We aimed
to evaluate the association between infarct location and cognitive change over time
after acute ischemic stroke (AIS).
Methods
Patients were selected from the Impairment of Cognition and Sleep after AIS or transient
ischemic attack in Chinese patients (ICONS) study. Infarct location was assessed by
brain magnetic resonance imaging. Cognition was screened at two weeks and 12 months
by the Montreal Cognitive Assessment (MoCA). The primary outcome was the cognitive
change at 12 months compared to two weeks. We tested the associations with cognitive
change using logistic regression analysis.
Results
A total of 865 patients were enrolled. The mean age of the study participants was
59.67 ± 10.92 years, and the median National Institutes of Health Stroke Scale was
3 (1–5). In a fully adjusted model, thalamic infarction was significantly associated
with cognitive decline after 12 months following an AIS (odds ratio [OR] 4.873, 95%
confidence interval [CI] 1.634–14.534; p = 0.005), independent of stroke etiology
(p > 0.05).
Conclusions
Thalamic infarction increased the risk of worse cognitive performance, as screened
by MoCA in relatively young patients with minor ischemic stroke at 12 months, suggesting
the thalamus may be a critical structure in preserving cognition after stroke.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of the Neurological SciencesAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Global, regional, and national burden of stroke, 1990-2016: a systematic analysis for the global burden of disease study 2016.Lancet Neurol. 2019; 18: 439-458
- Vascular contributions to cognitive impairment and dementia: a statement for healthcare professionals from the american heart association/american stroke association.Stroke. 2011; 42: 2672-2713
- Cognitive impairment after stroke: clinical determinants and its associations with long-term stroke outcomes.J. Am. Geriatr. Soc. 2010; 50: 700-706
- Preventing dementia by preventing stroke: the Berlin manifesto.Alzheimers Dement. 2019; 15: 961-984
- Post-stroke cognitive impairment as an independent predictor of ischemic stroke recurrence: PICASSO sub-study.J. Neurol. 2020; 267: 688-693
- Post-stroke cognitive impairment: epidemiology, mechanisms and management.Ann. Transl. Med. 2014; 2: 80
- The occurrence and longitudinal changes of cognitive impairment after acute ischemic stroke.Neuropsychiatr. Dis. Treat. 2020; 16: 807-814
- Natural history of cognitive impairment after stroke and factors associated with its recovery.Clin. Rehabil. 2003; 17: 158-166
- Progression of cognitive decline before and after incident stroke.Neurology. 2019; 93: e20-e28
- Emerging role of white matter lesions in cerebrovascular disease.Eur. J. Neurosci. 2021; 1
- White matter hyperintensity volume predicts persistent cognitive impairment in transient ischemic attack and minor stroke.Int. J. Stroke. 2017; 12: 264-272
- Gray matter atrophy in patients with ischemic stroke with cognitive impairment.Stroke. 2008; 39: 785-793
- Biological and imaging predictors of cognitive impairment after stroke: a systematic review.J. Neurol. 2019; 266: 2593-2604
- Risk factors for poststroke cognitive decline: the REGARDS study (reasons for geographic and racial differences in stroke).Stroke. 2018; 49: 987-994
- Stroke location is an independent predictor of cognitive outcome.Stroke. 2016; 47: 66-73
- Strategic infarct location for post-stroke cognitive impairment: a multivariate lesion-symptom mapping study.J. Cereb. Blood Flow Metab. 2018; 38: 1299-1311
- Strategic infarct locations for post-stroke cognitive impairment: a pooled analysis of individual patient data from 12 acute ischaemic stroke cohorts.Lancet Neurol. 2021; 20: 448-459
- Impairment of cognition and sleep after acute ischaemic stroke or transient ischaemic attack in Chinese patients: design, rationale and baseline patient characteristics of a nationwide multicentre prospective registry.Stroke Vasc. Neurol. 2021; 6: 139-144
- The third China National Stroke Registry (CNSR-III) for patients with acute ischaemic stroke or transient ischaemic attack: design, rationale and baseline patient characteristics.Stroke Vasc. Neurol. 2019; 4: 158-164
- Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of org 10172 in acute stroke treatment.Stroke. 1993; 24: 35-41
- Neuroimaging standards for research into small vessel disease and its contribution to ageing and neurodegeneration.Lancet Neurol. 2013; 12: 822-838
- MR signal abnormalities at 1.5 T in Alzheimer’s dementia and normal aging.AJR Am. J. Roentgenol. 1987; 149: 351-356
- Enlarged perivascular spaces on MRI are a feature of cerebral small vessel disease.Stroke. 2010; 41: 450-454
- Inter-and intraobserver reproducibility of cerebral atrophy assessment on MRI scans with hemispheric infarcts.Eur. Neurol. 1996; 36: 268-272
- Cognitive and mood assessment tools for use in stroke.Stroke. 2018; 49: 483-490
- Decline in changing Montreal cognitive assessment (MoCA) scores is associated with post-stroke cognitive decline determined by a formal neuropsychological evaluation.PLoS One. 2017; 12e0173291
- Changes in Montreal cognitive assessment scores over time.Assessment. 2017; 24: 772-777
- Serial Montreal cognitive assessments demonstrate reversible cognitive impairment in patients with acute transient ischemic attack and minor stroke.Stroke. 2014; 45: 1709-1715
- Strategic infarcts of the thalamus in vascular dementia.J. Neurol. Sci. 2002; 203-204: 91-97
Article info
Publication history
Published online: May 10, 2022
Accepted:
May 5,
2022
Received in revised form:
May 4,
2022
Received:
November 1,
2021
Identification
Copyright
© 2022 Elsevier B.V. All rights reserved.
