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Pre-existing brain damage and association between severity and prior cognitive impairment in ischemic stroke patients - 25/01/23

Doi : 10.1016/j.neurad.2022.03.001 
Valentin Pinguet a, b, Gauthier Duloquin a, c, Thomas Thibault d, e, Hervé Devilliers d, e, Pierre-Olivier Comby a, b, Valentin Crespy a, f, Frédéric Ricolfi b, Catherine Vergely a, Maurice Giroud a, c, Yannick Béjot a, c,
a Dijon Stroke Registry, EA7460, Pathophysiology and Epidemiology of Cardio-cerebrovascular disease (PEC2), University of Burgundy, 14 rue Paul Gaffarel, Dijon 21079, France 
b Department of Neuroimaging, University Hospital of Dijon, France 
c Department of Neurology, University Hospital of Dijon, France 
d INSERM CIC-1432 Clinical Investigation Center, Clinical Epidemiology, University Hospital of Dijon, France 
e Internal Medicine and Systemic Diseases unit, University Hospital of Dijon, France 
f Department of Vascular Surgery, University Hospital of Dijon, France 

Correspondence author at: Dijon Stroke Registry, EA7460, Pathophysiology and Epidemiology of Cardio-cerebrovascular disease (PEC2), University of Burgundy, 14 rue Paul Gaffarel, Dijon 21079, France.Dijon Stroke RegistryEA7460Pathophysiology and Epidemiology of Cardio-cerebrovascular disease (PEC2)University of Burgundy14 rue Paul GaffarelDijon21079France

Highlights

Patients with pre-existing cognitive impairment had a greater ischemic stroke severity than patients without.
Association between cognitive impairment and severity was not mediated by pre-existing leukoaraiosis, old vascular brain lesions, cortical and central brain atrophy.
Impaired brain ischemic tolerance in patients with prior cognitive impairment could involve other mechanisms than structural brain damage visible on conventional imaging.

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Abstract

Background

We evaluated whether pre-existing brain damage may explain greater severity in cognitively-impaired patients with ischemic stroke (IS).

Methods

IS patients were retrieved from the population-based registry of Dijon, France. Pre-existing damage (leukoaraiosis, old vascular brain lesions, cortical and central brain atrophy) was assessed on initial CT-scan. Association between prestroke cognitive status defined as no impairment, mild cognitive impairment (MCI), or dementia, and clinical severity at IS onset assessed with the NIHSS score was evaluated using ordinal regression analysis. Mediation analysis was performed to assess pre-existing brain lesions as mediators of the relationship between cognitive status and severity.

Results

Among the 916 included patients (mean age 76.8 ± 15.0 years, 54.3% women), those with pre-existing MCI (n = 115, median NIHSS [IQR]: 6 [2-15]) or dementia (n = 147, median NIHSS: 6 [3-15]) had a greater severity than patients without (n = 654, median NIHSS: 3 [1-9]) in univariate analysis (OR=1.69; 95% CI: 1.18-2.42, p = 0.004, and OR=2.06; 95% CI: 1.49-2.84, p < 0.001, respectively). Old cortical lesion (OR=1.53, p = 0.002), central atrophy (OR=1.41, p = 0.005), cortical atrophy (OR=1.90, p < 0.001) and moderate (OR=1.41, p = 0.005) or severe (OR=1.84, p = 0.002) leukoaraiosis were also associated with greater severity. After adjustments, pre-existing MCI (OR=1.52; 95% CI: 1.03-2.26, p = 0.037) or dementia (OR=1.94; 95% CI: 1.32-2.86, p = 0.001) remained associated with higher severity at IS onset, independently of confounding factors including imaging variables. Association between cognitive impairment and severity was not mediated by pre-existing visible brain damages.

Conclusion

Impaired brain ischemic tolerance in IS patients with prior cognitive impairment could involve other mechanisms than pre-existing visible brain damage.

Le texte complet de cet article est disponible en PDF.

Graphical abstract




Image, graphical abstract

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Keywords : Ischemic stroke, Mild cognitive impairment, Dementia, Severity, Imaging


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Vol 50 - N° 1

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