Stroke Location Is an Independent Predictor of Cognitive Outcome

Abstract

Background and Purpose-On top of functional outcome, accurate prediction of cognitive outcome for stroke patients is an unmet need with major implications for clinical management. We investigated whether stroke location may contribute independent prognostic value to multifactorial predictive models of functional and cognitive outcomes. Methods-Four hundred twenty-eight consecutive patients with ischemic stroke were prospectively assessed with magnetic resonance imaging at 24 to 72 hours and at 3 months for functional outcome using the modified Rankin Scale and cognitive outcome using the Montreal Cognitive Assessment (MoCA). Statistical maps of functional and cognitive eloquent regions were derived from the first 215 patients (development sample) using voxel-based lesion-symptom mapping. We used multivariate logistic regression models to study the influence of stroke location (number of eloquent voxels from voxel-based lesion-symptom mapping maps), age, initial National Institutes of Health Stroke Scale and stroke volume on modified Rankin Scale and MoCA. The second part of our cohort was used as an independent replication sample. Results-In univariate analyses, stroke location, age, initial National Institutes of Health Stroke Scale, and stroke volume were all predictive of poor modified Rankin Scale and MoCA. In multivariable analyses, stroke location remained the strongest independent predictor of MoCA and significantly improved the prediction compared with using only age, initial National Institutes of Health Stroke Scale, and stroke volume (area under the curve increased from 0.697-0.771; difference=0.073; 95% confidence interval, 0.008-0.155). In contrast, stroke location did not persist as independent predictor of modified Rankin Scale that was mainly driven by initial National Institutes of Health Stroke Scale (area under the curve going from 0.840 to 0.835). Similar results were obtained in the replication sample. Conclusions-Stroke location is an independent predictor of cognitive outcome (MoCA) at 3 months post stroke.

Brain connectivity measures improve modeling of functional outcome after acute ischemic stroke

“…Our results align with findings in the literature. Munsch et al 27 identified stroke location as an independent determinant of cognitive outcome as measured at 3 months post-stroke. Similar results were demonstrated by Wu et al 28 , highlighting the importance of joint modelling of DWI volume and topography for stroke outcomes, while our approach also takes network topology into account.…”

“…Targeted attacks on their connections can have a significant impact on global network efficiency 8 and have been shown to lead to functional deficits in disorders like Alzheimer's disease 26 . Importantly, stroke location has been identified as an independent determinant of cognitive outcome 27,28 , in addition to widely accepted clinical factors, such as age 29 and stroke lesion size 30,31 . Furthermore, a strong coupling between brain hubs, especially those lying in the cerebral cortex, and regional blood flow has been unveiled during rest as well as in response to task demands 32 .…”

Boundary and vulnerability estimation of the internal borderzone using ischemic stroke lesion mapping

“…However, to date, lesion volumes have shown only moderate correlation with long-term clinical outcome measures 2 . Recent studies 5,7,28,29 demonstrated that models taking into account accurate lesion topography (in addition to lesion volume) improve stroke prediction outcome and identify patients likely to benefit most aggressive reperfusion intervention and personalized rehabilitation therapies. Indeed, when deciding whether to perform reperfusion therapy, it is important to confirm whether the lenticulostriate arteries are involved in the ischemia 16,30,31 .…”

Post-stroke cognitive impairment (results of a 5-year follow-up)

“…Ведущую роль в генезе КН играет не объем инфаркта или кровоизлияния, а поражение стратегических для когни-тивных функций областей головного мозга [12,13]. Постин-сультные КН бывают вызваны не только очаговым сосуди-стым поражением головного мозга, но и наличием сопутст-вующих сосудистых и дегенеративных либо других пораже-ний, которые могут усилиться (декомпенсироваться) после развития инсульта [1,2,14].…”