Strategic Infarct and Cognitive Impairment: A Narrative Review

Abstract

The location of single strategic infarcts and the cognitive impairment after a stroke reect the neuroanatomy of the brain's cognitive functions. Poststroke dementia or post-stroke cognitive impairment (PSD/PSCI) is a form of cognitive disturbance caused by cerebrovascular disease that can manifest at different times after a stroke, including during the acute phase of stroke, during the recovery phase (while motor stroke symptoms improve), or months and years later. The onset of cognitive impairment depends on the location of infarct. Infarct in certain locations have cognitive impairment as a sole presentation from the outset. Infarcts in the left frontotemporal lobes, right parietal lobe, and left thalamus are notably correlated with cognitive impairment following a stroke. In the former, patients present with complains of motor difculties as the main complain. In addition to these locations, vascular lesions in the thalamo-perforating area of the PCAmay cause dementia and other forms of severe memory loss. Abaseline (pre-morbid) and early post-stroke (early post-morbid) cognitive status should be evaluated and a protocol for the same is needed in regular clinical and ICU care facilities. MoCA assessment is commonly used for cognitive assessment. Its role in strategic infarcts is undermined as it leaves out the evaluation of symptoms corresponding to common strategic infarct locations such as the medial temporal lobe and thalami. There is a need for dedicated neuropsychological assessment score based on education level, and native-language for PSCI.