Modified cerebral small vessel disease score is associated with vascular cognitive impairment after lacunar stroke

Zhi, Nan; Zhang, Lei; Wang, Yao; Bai, Shuwei; Geng, Junping; Yu, Ling; Cao, Wenwei; Zhuang, Lei; Zhou, Yan; Guan, Yangtai

doi:10.18632/aging.202438

Cited by 17 publications

(18 citation statements)

References 48 publications

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“…Several studies have previously reported that CSVD marker numbers or total load of CSVD impacts multiple cognitive domains and increases the risk of dementia and cognitive decline. [31][32][33][34] Most of these studies were in older or specific populations (eg, stroke, hypertension people et al). Before adjustment, we did find 3 image markers and 4 marker group associated with NCT-A (DST) variables, after age adjustment, only 4 marker group remained statistically significant.…”

Section: Discussionmentioning

confidence: 99%

Prevalence and Consequences of Cerebral Small Vessel Diseases: A Cross-Sectional Study Based on Community People Plotted Against 5-Year Age Strata

Qin

Guo

et al. 2022

NDT

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To study the variation tendency of cerebral small vessel disease (CSVD) imaging markers and total burden with aging and to research the relationship between aging, CSVD markers and cognitive function. Methods: Participants in local urban communities were recruited for neuropsychological and magnetic resonance imaging assessments. Montreal Cognitive Assessment (MoCA), Mini-mental State Examination (MMSE), Number Connection Test A (NCT-A) and Digital Symbol Test (DST) were adopted as neuropsychological scale. Age was stratified at 5-year intervals, and the variation tendency of imaging markers and variables of neuropsychological scales in different age groups was studied. We further studied the relationship between aging, image markers and neuropsychological scales by multi-linear regression. Results: Finally, a total of 401 stroke-free participants (age, 54.83±7.74y; 45.9% were male) were included in the present analysis. With the increase of age, the incidence of imaging markers of CSVD were increased with aging except cerebral microbleeds. The performance results of NCT-A and DST were significant difference in 6 age groups (P < 0.001). In addition, linear decline of the neuropsychological function reflected by NCT-A and DST variables was observed. Linear regression found that age was an independent factor affecting the neuropsychological function reflected by NCT-A and DST variables, and the standard correction coefficients among different age groups increased gradually with age. In addition, brain atrophy is an independent factor affecting neuropsychological variables (odds ratio: −2.929, 95% CI: [−5.094 to −0.765]). There was no correlation between the number of neuroimaging markers and neuropsychological variables after full adjustment. Conclusion: There are many CVSD markers even in younger people, the incidence rate and CVSD marker numbers increase with age. Aging and CSVD may eventually affect cognitive function through brain atrophy.

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Section: Discussionmentioning

confidence: 99%

Prevalence and Consequences of Cerebral Small Vessel Diseases: A Cross-Sectional Study Based on Community People Plotted Against 5-Year Age Strata

Qin

Guo

et al. 2022

NDT

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“…Nevertheless, another study suggested that the total burden score was negatively associated with cognitive impairment in patients suffering from both hypertension and lacunar stroke [ 37 ]. Zhi et al also reported that both the total and modified CSVD scores were not correlated with cognitive function in patients with acute lacunar stroke [ 38 ].…”

Section: Discussionmentioning

confidence: 99%

Heterogeneity of White Matter Hyperintensity and Cognitive Impairment in Patients with Acute Lacunar Stroke

Zhou

Chen

et al. 2022

Brain Sciences

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Background: The severity of white matter hyperintensity (WMH) in patients with acute lacunar stroke (ALS) may be not completely parallel to cognitive impairment. Controversies persist about the effects of WMH on cognitive dysfunction. It is vital to explore whether the association may be affected by certain factors and whether a subsequent subgroup analysis is necessary. The aim of this study was to evaluate the relationship between WMH and cognitive impairment in acute lacunar stroke patients and the possible causal factors. Methods: We continuously enrolled patients with ALS who were hospitalized at the First Affiliated Hospital of Soochow University between October 2017 and June 2022. The cognitive function of all patients was assessed by using the Montreal Cognitive Assessment (MoCA) scale 14 ± 2 days after the onset of AIS, and the results were adjusted to the education level. The MoCA scale was reevaluated at the 6-month (day 182 ± 7) follow-up by outpatient visit or video. Demographic and clinical data were collected. The manifestations of chronic cerebral small-vessel disease (CSVD), including the total Fazekas score and total CSVD burden score, were assessed with an MRI scan. A mismatch refers to an inconsistency between the severity of WMH and cognitive dysfunction. A Type 1 mismatch refers to cognitive impairment with mild WMH (total Fazekas score = 0–1), and a Type 2 mismatch refers to severe WMH (total Fazekas score = 5–6) in patients with normal cognitive function. Results: Among 213 enrolled ALS patients, 66 patients (31.0%) had cognitive dysfunction, and 40 patients (18.8%) had mismatches. Twenty-seven cases (12.7%) were Type 1 mismatched, and seventeen cases (8.0%) were Type 2 mismatched. Age, gender, fibrinogen and cerebral infarction history were independent risk factors for cognitive impairment in ALS patients. Imaging features, including moderate to severe WMH, deep WMH and the total CSVD burden score, were also independently associated with cognitive impairment. The patients in the mismatched group were older, had more severe deep WMH and had a higher occurrence of depression (p < 0.05). The NIHSS score, depression and microbleeds were significantly different between the Type 1 mismatched group and the matched group (p = 0.018, p = 0.012 and p = 0.047). Patients in the Type 2 mismatched group were male (p = 0.04), had a lower level of fibrinogen (p = 0.005), a lower incidence of CMBs (p = 0.003), a lower total CSVD burden score (p = 0.017), more severe paraventricular WMH (p = 0.035) and milder deep WMH (p = 0.026). Conclusions: Our study examined a homogeneous study cohort of recruited patients with symptomatic ALS. We found heterogeneity between WMH and cognitive function in ALS patients. Despite a similar WMH severity, some baseline clinical features and other conventional CSVD imaging characteristics may account for this heterogeneity phenomenon. Our findings provide data for the early diagnosis and prevention of cognitive impairment in ALS patients and suggest that the severity of WMH is not completely parallel to cognitive impairment. The white matter microstructural injury and remote WMH effects may account for the mismatch phenomenon. More attention should be paid to understanding the underlying mechanisms and finding new imaging markers.

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“… 27 Finally, SVD may impair the cognitive function of patients, lead to post-stroke depression and delay active rehabilitation. 28 …”

Section: Discussionmentioning

confidence: 99%

Influence of Pre-Existing Cerebral Small Vessel Disease on the Outcome of Acute Cardioembolic Stroke: A Retrospective Study

Su¹,

Guo²,

Chen³

et al. 2022

NDT

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Purpose This study was to explore the role of pre-existing small vessel disease (SVD) on the 3-month outcomes of acute cardioembolic stroke (CES) patients. Patients and Methods Data of 189 consecutive acute CES patients at a single center were retrospectively enrolled. SVD imaging markers of lacunes, white matter hyperintensities (WMH) and enlarged perivascular spaces (EPVS) were evaluated and their total burden score (0–3 points) was calculated. Patients were divided into the good functional outcome group (modified Rankin scale, mRS ≤ 2) and the poor functional outcome group (mRS ≥ 3) at 3 months after stroke onset. The effect of each single SVD marker and its total burden score on the outcome was identified using binary logistic regression. Results Overall, 100 (52.9%), 52 (27.1%), 28 (14.8%) and 9 (4.8%) patients had 0, 1, 2 and 3 SVD imaging markers. Patients with a total SVD burden score of 2 and 3 were significantly older and had higher baseline National Institutes of Health Stroke Scale (NIHSS) score than those with a score of 0 and 1 (P<0.01). Forty-seven (24.9%) patients had a poor outcome. Patients in the poor outcome group had significantly higher baseline NIHSS score, increased incidence of stroke associated pneumonia, and heavier burden of lacunes, WMH and EPVS, and thus had elevated total SVD burden score than those in good outcome group (P<0.05). After adjusting for potential confounders, the WMH (odds ratio [OR] = 2.6777, 95% confidence interval [CI] = 1.052–6.812, P = 0.039) and the total SVD burden score (OR = 1.717, 95% CI = 1.072–2.749, P = 0.024) were, respectively, independent risk factors for a poor outcome. Conclusion The pre-existing SVD may be associated with the 3-month prognosis of CES.

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Modified cerebral small vessel disease score is associated with vascular cognitive impairment after lacunar stroke

Cited by 17 publications

References 48 publications

Prevalence and Consequences of Cerebral Small Vessel Diseases: A Cross-Sectional Study Based on Community People Plotted Against 5-Year Age Strata

Prevalence and Consequences of Cerebral Small Vessel Diseases: A Cross-Sectional Study Based on Community People Plotted Against 5-Year Age Strata

Heterogeneity of White Matter Hyperintensity and Cognitive Impairment in Patients with Acute Lacunar Stroke

Influence of Pre-Existing Cerebral Small Vessel Disease on the Outcome of Acute Cardioembolic Stroke: A Retrospective Study

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