TY - JOUR
T1 - Strategic white matter hyperintensity locations associated with post-stroke cognitive impairment
T2 - A multicenter study in 1568 stroke patients
AU - Coenen, Mirthe
AU - de Kort, Floor A.S.
AU - Weaver, Nick A.
AU - Kuijf, Hugo J.
AU - Aben, Hugo P.
AU - Bae, Hee Joon
AU - Bordet, Régis
AU - Chen, Christopher P.L.H.
AU - Dewenter, Anna
AU - Doeven, Thomas
AU - Dondaine, Thibaut
AU - Duering, Marco
AU - Fang, Rong
AU - van der Giessen, Ruben S.
AU - Kim, Jonguk
AU - Kim, Beom Joon
AU - de Kort, Paul L.M.
AU - Koudstaal, Peter J.
AU - Lee, Minwoo
AU - Lim, Jae Sung
AU - Lopes, Renaud
AU - van Oostenbrugge, Robert J.
AU - Staals, Julie
AU - Yu, Kyung Ho
AU - Biessels, Geert Jan
AU - Biesbroek, J. Matthijs
N1 - Publisher Copyright:
© 2024 World Stroke Organization.
PY - 2024/10
Y1 - 2024/10
N2 - Background: Post-stroke cognitive impairment (PSCI) occurs in up to 50% of stroke survivors. Presence of pre-existing vascular brain injury, in particular the extent of white matter hyperintensities (WMH), is associated with worse cognitive outcome after stroke, but the role of WMH location in this association is unclear. Aims: We determined if WMH in strategic white matter tracts explain cognitive performance after stroke. Methods: Individual patient data from nine ischemic stroke cohorts with magnetic resonance imaging (MRI) were harmonized through the Meta VCI Map consortium. The association between WMH volumes in strategic tracts and domain-specific cognitive functioning (attention and executive functioning, information processing speed, language and verbal memory) was assessed using linear mixed models and lasso regression. We used a hypothesis-driven design, primarily addressing four white matter tracts known to be strategic in memory clinic patients: the left and right anterior thalamic radiation, forceps major, and left inferior fronto-occipital fasciculus. Results: The total study sample consisted of 1568 patients (39.9% female, mean age = 67.3 years). Total WMH volume was strongly related to cognitive performance on all four cognitive domains. WMH volume in the left anterior thalamic radiation was significantly associated with cognitive performance on attention and executive functioning and information processing speed and WMH volume in the forceps major with information processing speed. The multivariable lasso regression showed that these associations were independent of age, sex, education, and total infarct volume and had larger coefficients than total WMH volume. Conclusion: These results show tract-specific relations between WMH volume and cognitive performance after ischemic stroke, independent of total WMH volume. This implies that the concept of strategic lesions in PSCI extends beyond acute infarcts and also involves pre-existing WMH. Data access statement: The Meta VCI Map consortium is dedicated to data sharing, following our guidelines.
AB - Background: Post-stroke cognitive impairment (PSCI) occurs in up to 50% of stroke survivors. Presence of pre-existing vascular brain injury, in particular the extent of white matter hyperintensities (WMH), is associated with worse cognitive outcome after stroke, but the role of WMH location in this association is unclear. Aims: We determined if WMH in strategic white matter tracts explain cognitive performance after stroke. Methods: Individual patient data from nine ischemic stroke cohorts with magnetic resonance imaging (MRI) were harmonized through the Meta VCI Map consortium. The association between WMH volumes in strategic tracts and domain-specific cognitive functioning (attention and executive functioning, information processing speed, language and verbal memory) was assessed using linear mixed models and lasso regression. We used a hypothesis-driven design, primarily addressing four white matter tracts known to be strategic in memory clinic patients: the left and right anterior thalamic radiation, forceps major, and left inferior fronto-occipital fasciculus. Results: The total study sample consisted of 1568 patients (39.9% female, mean age = 67.3 years). Total WMH volume was strongly related to cognitive performance on all four cognitive domains. WMH volume in the left anterior thalamic radiation was significantly associated with cognitive performance on attention and executive functioning and information processing speed and WMH volume in the forceps major with information processing speed. The multivariable lasso regression showed that these associations were independent of age, sex, education, and total infarct volume and had larger coefficients than total WMH volume. Conclusion: These results show tract-specific relations between WMH volume and cognitive performance after ischemic stroke, independent of total WMH volume. This implies that the concept of strategic lesions in PSCI extends beyond acute infarcts and also involves pre-existing WMH. Data access statement: The Meta VCI Map consortium is dedicated to data sharing, following our guidelines.
KW - White matter hyperintensities
KW - post-stroke cognition
KW - strategic lesion location
UR - http://www.scopus.com/inward/record.url?scp=85195138883&partnerID=8YFLogxK
U2 - 10.1177/17474930241252530
DO - 10.1177/17474930241252530
M3 - Article
C2 - 38651756
AN - SCOPUS:85195138883
SN - 1747-4930
VL - 19
SP - 916
EP - 924
JO - International Journal of Stroke
JF - International Journal of Stroke
IS - 8
ER -