Vascular Mild Cognitive Impairment Is Highly Prevalent after Lacunar Stroke but Does Not Increase over Time: A 2-Year Follow-Up Study

Rasquin, S.M.C.; Oostenbrugge, Robert J. van; Verhey, Frans R.J.; Lodder, J.

doi:10.1159/000109747

Cited by 25 publications

(24 citation statements)

References 61 publications

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“…29 Other reports in MCI patients did not find an association between lacunes and progression to dementia. 9,31 In this study, Cox analysis of lacunes in the basal ganglia was, although borderline significant; suggestive of a Ͼ2-fold elevated risk of progression to a non-Alzheimer dementia. We did not find a predictive value of large-vessel infarcts on progression of MCI to dementia.…”

Section: Discussionmentioning

confidence: 51%

Progression of Mild Cognitive Impairment to Dementia

Staekenborg

Koedam

Henneman

et al. 2009

Stroke

123

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Background and Purpose-We sought to determine the predictive value of magnetic resonance imaging measures of vascular disease (white matter hyperintensities [WMHs], lacunes, microbleeds, and infarcts) compared with atrophy on the progression of mild cognitive impairment to dementia. Methods-We included 152 consecutive patients with mild cognitive impairment. Baseline magnetic resonance imaging was used to determine the presence of medial temporal lobe atrophy and vascular disease (presence of lacunes, microbleeds, and infarcts was determined, and WMHs were rated on a semiquantitative scale). Patients were followed up for 2Ϯ1 years. Results-Seventy-two (47%) patients progressed to dementia during follow-up. Of these, 56 (37%) patients were diagnosed with Alzheimer's disease, and 16 (10%) patients were diagnosed with a non-Alzheimer dementia (including vascular dementia, frontotemporal lobar degeneration, and Parkinson dementia). Converters were older and had a lower Mini-Mental State Examination score at baseline. On baseline magnetic resonance imaging, patients who progressed to a non-Alzheimer dementia showed more severe WMHs and had a higher prevalence of lacunes in the basal ganglia and microbleeds compared with nonconverters. Cox proportional-hazard models showed that, adjusted for age and sex, baseline medial temporal lobe atrophy (hazard ratioϭ2.9; 95% CI, 1.7 to 5.3), but not vascular disease, was associated with progression to Alzheimer's disease. By contrast, deep WMHs (hazard ratioϭ5.7; 95% CI, 1.2 to 26.7) and periventricular hyperintensities (hazard ratioϭ6.5; 95% CI, 1.4 to 29.8) predicted progression to non-Alzheimer dementia. Furthermore, microbleeds (hazard ratioϭ2.6; 95% CI, 0.9 to 7.5) yielded a Ͼ2-fold increased, though nonsignificant, risk of non-Alzheimer dementia. Conclusion-Medial

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Section: Discussionmentioning

confidence: 51%

Progression of Mild Cognitive Impairment to Dementia

Staekenborg

Koedam

Henneman

et al. 2009

Stroke

123

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“…At follow-up, regardless of the severity of baseline impairment or time between assessments, all studies reported that stroke patients showed similar performance to baseline across domains, whether assessed by comparison to controls, 31,32,35 within-group, 33 or as a diagnostic classification. 34 Thus, data extraction revealed no consistent evidence that individuals with lacunar stroke show greater or different decline than controls over time.…”

Section: Imagingmentioning

confidence: 95%

“…12,13,15,[22][23][24][25][26][27][28][29][30][31][32][33][34][35][36] Results showed high interrater reliability for article selection (Cohen k 5 0.78). Percent positive agreement was also excellent, with 83.3% agreement on article selection between the primary and independent raters.…”

Section: Imagingmentioning

confidence: 99%

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A quantitative systematic review of domain-specific cognitive impairment in lacunar stroke

et al. 2013

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Objective: To quantitatively characterize domain-specific cognition in individuals with symptomatic lacunar stroke in a systematic review.Methods: Systematic searches of MEDLINE and EMBASE were conducted. Inclusion criteria were all articles published prior to December 2011 evaluating domain-specific cognitive status in individuals with a symptomatic lacunar infarct. Data extraction identified cognitive domains with reported impairment and effect size calculations and heterogeneity analyses were completed to assess the magnitude of this impairment for all studies with control group data.Results: Results of the search yielded 12 cross-sectional and 5 longitudinal studies that met inclusion criteria. Effect size calculations revealed small to medium effect sizes (ES) estimations for impairment after stroke in the domains of executive function (ES 20.44 Conclusions: Results of this systematic review are consistent with previous characterizations of cognitive impairment associated with lacunar strokes. However, impaired cognition in this stroke subtype appears less selective than previously thought, involving all major cognitive domains. Neurology Lacunar stroke is the most common manifestation of cerebral small-vessel disease (SVD) 1 and is an important predictor of poststroke cognitive decline and vascular dementia.2 Approximately onethird of individuals develop cognitive impairment after stroke. 3 There is an estimated 11%-23% risk 4,5 of developing dementia following a lacunar stroke, and this risk increases with recurrent lacunar events 3 and the presence of concurrent white matter disease. [6][7][8] Dementia is a leading cause of dependency after stroke and has a devastating impact on poststroke quality of life. 9The cognitive profile generally considered to be associated with cerebral SVD involves preserved memory with impairment in attentional and executive functioning.10,11 A number of cross-sectional studies have examined the relationship between lacunar stroke and cognitive impairment.12-15 In addition, relatively few studies have investigated longitudinal changes in cognitive function following lacunar stroke. To date, no quantitative systematic review has been conducted to investigate the cognitive impairment associated with lacunar stroke and its relation to the profile associated with SVD.We present a quantitative systematic review of studies evaluating domain-specific cognition in individuals with symptomatic lacunar infarct. The objectives of this review were to identify and describe the cognitive domains subject to impairment in individuals with symptomatic lacunar Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

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“…37 It also is possible that the risk of cognitive decline or MCI in cognitively normal participants with infarcts will increase with longer follow-up and subsequent infarcts affecting cognition, as demonstrated previously. 7,38 Another reason, however, may be nonparticipation bias. Although all MCSA participants were offered MRI/MRS examinations, only 61% of the sample with a follow-up visit participated in the MRI/MRS study.…”

Section: Mrimentioning

confidence: 99%

MRI and MRS predictors of mild cognitive impairment in a population-based sample

et al. 2013

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Objective: To investigate MRI and proton magnetic resonance spectroscopy (MRS) predictors of mild cognitive impairment (MCI) in cognitively normal older adults.Methods: Subjects were cognitively normal older adults (n 5 1,156) who participated in the population-based Mayo Clinic Study of Aging MRI/MRS study from August 2005 to December 2010 and had at least one annual clinical follow-up. Single-voxel MRS was performed from the posterior cingulate gyri, and hippocampal volumes and white matter hyperintensity volumes were quantified using automated methods. Brain infarcts were assessed on MRI. Cox proportional hazards regression, with age as the time scale, was used to assess the effect of MRI and MRS markers on the risk of progression from cognitively normal to MCI. Linear mixed-effects models were used to assess the effect of MRI and MRS markers on cognitive decline.Results: After a median follow-up of 2.8 years, 214 participants had progressed to MCI or dementia (estimated incidence rate 5 6.1% per year; 95% confidence interval 5 5.3%-7.0%). In univariable modeling, hippocampal volume, white matter hyperintensity volume, and N-acetylaspartate/myo-inositol were significant predictors of MCI in cognitively normal older adults. In multivariable modeling, only decreased hippocampal volume and N-acetylaspartate/myo-inositol were independent predictors of MCI. These MRI/MRS predictors of MCI as well as infarcts were associated with cognitive decline (p , 0.05). Magnetic resonance markers of preclinical dementia-related pathologies are needed for identifying individuals who may benefit from preventive interventions. Conclusion:1 The most common dementia-related pathologies observed in cognitively normal older adults are Alzheimer disease (AD) and vascular disease.2-4 MRI and proton magnetic resonance spectroscopic ( 1 H-MRS) findings typically associated with early neurodegenerative pathology of AD include hippocampal atrophy on structural MRI as well as elevated glial metabolite myo-inositol (mI) and decreased neuronal metabolite N-acetylaspartate (NAA) on MRS.5,6 MRI findings associated with vascular disease include brain infarcts and white matter hyperintensities (WMH) on T2-weighted or fluid-attenuated inversion recovery (FLAIR) MRI. Brain infarcts and WMH are associated with cognitive decline and dementia in older adults without dementia, 7-11 and may increase the risk of mild cognitive impairment (MCI) along with the MRI and MRS abnormalities associated with preclinical AD. Hippocampal volumes and MRS abnormalities were complementary in differentiating MCI from

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Vascular Mild Cognitive Impairment Is Highly Prevalent after Lacunar Stroke but Does Not Increase over Time: A 2-Year Follow-Up Study

Cited by 25 publications

References 61 publications

Progression of Mild Cognitive Impairment to Dementia

Progression of Mild Cognitive Impairment to Dementia

A quantitative systematic review of domain-specific cognitive impairment in lacunar stroke

MRI and MRS predictors of mild cognitive impairment in a population-based sample

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