Utility of white matter disease and atrophy on routinely acquired brain imaging for prediction of long-term delirium risk: population-based cohort study

Pendlebury, Sarah T.; Thomson, Ross; Welch, Sarah; Küker, Wilhelm; Rothwell, Peter M.; Study, O V

doi:10.1093/ageing/afab200

Cited by 14 publications

(10 citation statements)

References 45 publications

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“…Future studies should further assess the prognostic utility of CT-derived neuroimaging measures for predicting clinical, cognitive, and functional outcomes in acutely unwell patient populations, such as patients with stroke and delirium. 37,38 Once the prognostic utility of clinical CT scans has been established more firmly, data from acute CT neuroimaging could be incorporated into clinical risk prediction algorithms for post-stroke outcome, particularly should automated quantitative assessment methods become widely clinically available for CT. Such algorithms would facilitate identification of individual patients at risk of poor cognitive and functional outcomes post-stroke.…”

Section: Resultsmentioning

confidence: 99%

Post-stroke executive function in relation to white matter damage on clinically acquired CT brain imaging

Hobden

2021

Preprint

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BACKGROUNDThere is a high prevalence of executive function impairments among stroke survivors. However, the underlying aetiology remains unclear. In particular, we address whether focal, stroke-specific white matter damage or diffuse comorbid white matter damage (leukoaraiosis) is more associated with executive function impairments.METHODSThis project is a retrospective analysis of data collected within the Oxford Cognitive Screening programme. Patients were recruited in the acute stage of stroke if they had a confirmed diagnosis of stroke, were at least 18 years of age, were able to remain alert for 20 minutes, and were able to provide informed consent. Patients in the present analysis completed follow up neuropsychological assessment at six-months with the Oxford Cognitive Screen-Plus to assess executive function. Stroke lesions were manually delineated on acute clinical brain scans allowing us to quantify focal stroke-specific white matter damage using the HCP-842 tractography atlas. Leukoaraiosis was visually rated on clinical scans using the Age-Related White Matter Changes scale.RESULTSThis study included data from 90 stroke patients (mean age = 73.76 years; 47.78% female). Multiple linear regression analyses showed that the presence of leukoaraiosis predicted poorer executive functioning six-months after stroke (B = −0.33, p = .031, 95% CI [-0.64 - 0.03]). However, post-stroke executive functioning was not predicted by stroke-specific damage to white matter tracts.CONCLUSIONSOverall, these results provide novel insight into the neural substrates underlying post-stroke executive dysfunction and highlight the prognostic utility of using routine clinical CT scans to assess leukoaraiosis.

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Section: Resultsmentioning

confidence: 99%

Post-stroke executive function in relation to white matter damage on clinically acquired CT brain imaging

Hobden

2021

Preprint

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“…This finding is important given that CT is commonly acquired in clinical practice and is often the only imaging modality available in underserved and under-resourced global regions (Frija et al, 2021). Future studies should assess the prognostic utility of CT-derived imaging measures for predicting other clinical, cognitive, and functional outcomes post stroke (Pendlebury et al, 2022).…”

Section: Discussionmentioning

confidence: 99%

Poststroke Executive Function in Relation to White Matter Damage on Clinically Acquired CT Brain Imaging

Hobden,

Moore,

Mair

et al. 2023

Cognitive and Behavioral Neurology

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Background: Executive function (EF) impairments are prevalent post stroke and are associated with white matter (WM) damage on MRI. However, less is known about the relationship between poststroke EF and WM damage on CT imaging. Objective: To investigate the relationship between poststroke EF and WM damage associated with stroke lesions and WM hypointensities (WMHs) on clinically acquired CT imaging. Method: This study analyzed data from the Oxford Cognitive Screening Program, which recruited individuals aged ≥18 years with a confirmed stroke from an acute stroke unit. The individuals completed a follow-up assessment 6 months post stroke. We included individuals with a CT scan showing a visible stroke who completed follow-up EF assessment using the Oxford Cognitive Screen–Plus rule-finding task. We manually delineated stroke lesions and quantified then dichotomized WM damage caused by the stroke using the HCP-842 atlas. We visually rated then dichotomized WMHs using the Age-Related White Matter Changes Scale. Results: Among 87 stroke survivors (Mage = 73.60 ± 11.75; 41 female; 61 ischemic stroke), multivariable linear regression showed that stroke damage to the medial lemniscus (B = –8.86, P < 0.001) and the presence of WMHs (B = –5.42, P = 0.005) were associated with poorer EF 6 months post stroke after adjusting for covariates including age and education. Conclusion: Poorer EF was associated with WM damage caused by stroke lesions and WMHs on CT. These results confirm the importance of WM integrity for EF post stroke and demonstrate the prognostic utility of CT-derived imaging markers for poststroke cognitive outcomes.

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“…Incorporating CS-PVS into delirium prediction algorithms might have potential clinical utility in aiding delirium risk stratification, and this needs to be confirmed by future studies. Although a few studies have investigated brain CSVD markers (e.g., WMH and cerebral microbleeds) in relation to delirium (Omiya et al, 2015;Nitchingham et al, 2018;Lachmann et al, 2019;Clancy et al, 2021;Pendlebury et al, 2022), no previous study has yet explored the link between MRI-visible PVS and delirium. PVS is frequently seen in the aging brain (Bown et al, 2022) and has been proposed as a key contributor to cognitive decline and dementia in older adults (Debette et al, 2019;Paradise et al, 2021).…”

Section: Discussionmentioning

confidence: 99%

“…The advancement of neuroimaging particularly magnetic resonance imaging (MRI) provides a unique chance to study the neural substrates of delirium, and certain abnormalities on brain MRI have been reported to be associated with delirium ( Nitchingham et al, 2018 ; Kalvas and Monroe, 2019 ). Several studies have indicated that white matter hyperintensities, markers of cerebral small vessel disease (CSVD), can predict the occurrence of delirium ( Omiya et al, 2015 ; Nitchingham et al, 2018 ; Clancy et al, 2021 ; Pendlebury et al, 2022 ). Nevertheless, for other CSVD markers, especially MRI-visible perivascular spaces (PVS), this is still unknown.…”

Section: Introductionmentioning

confidence: 99%

Perivascular spaces visible on magnetic resonance imaging predict subsequent delirium in older patients

Song

Zhao

Yue

2022

Front. Aging Neurosci.

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BackgroundIt remains unknown whether perivascular spaces (PVS) are associated with delirium in older hospitalized patients. We aimed to determine the association between magnetic resonance imaging (MRI)-visible PVS and the risk of delirium in a cohort of older patients.MethodsWe consecutively recruited older patients (≥70 years) admitted to the Geriatric Department of West China Hospital between March 2016 and July 2017, and their imaging data within one year before admission were reviewed retrospectively. PVS was rated on axial T2-weighted images in the basal ganglia (BG) and centrum semiovale (CS) using the validated semiquantitative 4-point ordinal scale. Delirium was screened within 24 h of admission and three times daily thereafter, using the confusion assessment method. Binary logistic regression analyses were performed to investigate the associations between PVS and delirium.ResultsAmong 114 included patients (mean age 84.3 years, 72.8% male), delirium occurred in 20 (17.5%). In patients with MRI examined within 6 months before admission, CS-PVS was found to be associated with delirium (odds ratio [OR] 3.88, 95% confidence interval [CI] 1.07-14.06, unadjusted; and OR 4.24, 95% CI 1.11-16.28, adjusted for age). The associations were enhanced and remained significant even after full adjustment of covariates (OR 7.16, 95% CI 1.16-44.32, adjusted for age, cognitive impairment, smoking, and Charlson Comorbidity Index). Similarly, the relationships between high CS-PVS and delirium were also strengthened after sequentially adjusting all variables of interest, with OR 4.17 (95% CI 1.04-16.73) in unadjusted model and OR 7.95 (95% CI 1.14-55.28) in fully-adjusted model. Adding CS-PVS to the established risk factors improved the risk reclassification for delirium (continuous net reclassification index 62.1%, P = 0.04; and integrated discrimination improvement 12.5%, P = 0.01).ConclusionsCS-PVS on MRI acquired 6 months earlier predicts subsequent delirium in older patients and may have clinical utility in delirium risk stratification to enable proactive interventions.

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Utility of white matter disease and atrophy on routinely acquired brain imaging for prediction of long-term delirium risk: population-based cohort study

Cited by 14 publications

References 45 publications

Post-stroke executive function in relation to white matter damage on clinically acquired CT brain imaging

Post-stroke executive function in relation to white matter damage on clinically acquired CT brain imaging

Poststroke Executive Function in Relation to White Matter Damage on Clinically Acquired CT Brain Imaging

Perivascular spaces visible on magnetic resonance imaging predict subsequent delirium in older patients

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