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Open Access 01-12-2021 | Stroke | Research

Pre-stroke cognitive impairment is associated with vascular imaging pathology: a prospective observational study

Authors: Till Schellhorn, Manuela Zucknick, Torunn Askim, Ragnhild Munthe-Kaas, Hege Ihle-Hansen, Yngve M. Seljeseth, Anne-Brita Knapskog, Halvor Næss, Hanne Ellekjær, Pernille Thingstad, Torgeir Bruun Wyller, Ingvild Saltvedt, Mona K. Beyer

Published in: BMC Geriatrics | Issue 1/2021

Abstract

Background

Chronic brain pathology and pre-stroke cognitive impairment (PCI) is predictive of post-stroke dementia. The aim of the current study was to measure pre-stroke neurodegenerative and vascular disease burden found on brain MRI and to assess the association between pre-stroke imaging pathology and PCI, whilst also looking for potential sex differences.

Methods

This prospective brain MRI cohort is part of the multicentre Norwegian cognitive impairment after stroke (Nor-COAST) study. Patients hospitalized with acute ischemic or hemorrhagic stroke were included from five participating stroke units. Visual rating scales were used to categorize baseline MRIs (N = 410) as vascular, neurodegenerative, mixed, or normal, based on the presence of pathological imaging findings. Pre-stroke cognition was assessed by interviews of patients or caregivers using the Global Deterioration Scale (GDS). Stroke severity was assessed with the National Institute of Health Stroke Scale (NIHSS). Univariate and multiple logistic regression analyses were performed to investigate the association between imaging markers, PCI, and sex.

Results

Patients’ (N = 410) mean (SD) age was 73.6 (±11) years; 182 (44%) participants were female, the mean (SD) NIHSS at admittance was 4.1 (±5). In 68% of the participants, at least one pathological imaging marker was found. Medial temporal lobe atrophy (MTA) was present in 30% of patients, white matter hyperintensities (WMH) in 38% of patients and lacunes in 35% of patients. PCI was found in 30% of the patients. PCI was associated with cerebrovascular pathology (OR 2.5; CI = 1.4 to 4.5, p = 0.001) and mixed pathology (OR 3.4; CI = 1.9 to 6.1, p = 0.001) but was not associated with neurodegeneration (OR 1.0; CI = 0.5 to 2.2; p = 0.973). Pathological MRI markers, including MTA and lacunes, were more prevalent among men, as was a history of clinical stroke prior to the index stroke. The OR of PCI for women was not significantly increased (OR 1.2; CI = 0.8 to 1.9; p = 0.3).

Conclusions

Pre-stroke chronic brain pathology is common in stroke patients, with a higher prevalence in men. Vascular pathology and mixed pathology are associated with PCI. There were no significant sex differences for the risk of PCI.

Trial registration

NCT02650531, date of registration: 08.01.2016.

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Title: Pre-stroke cognitive impairment is associated with vascular imaging pathology: a prospective observational study
Authors: Till Schellhorn
Manuela Zucknick
Torunn Askim
Ragnhild Munthe-Kaas
Hege Ihle-Hansen
Yngve M. Seljeseth
Anne-Brita Knapskog
Halvor Næss
Hanne Ellekjær
Pernille Thingstad
Torgeir Bruun Wyller
Ingvild Saltvedt
Mona K. Beyer
Publication date: 01-12-2021
Publisher: BioMed Central
Keywords: Stroke
Dementia
Pathology
Dementia
Published in: BMC Geriatrics / Issue 1/2021
Electronic ISSN: 1471-2318
DOI: https://doi.org/10.1186/s12877-021-02327-2

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