Chronic Cortical Cerebral Microinfarcts Slow Down Cognitive Recovery After Acute Ischemic Stroke.
Stroke. 2019-06-01; 50(6): 1430-1436
DOI: 10.1161/strokeaha.118.024672
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Sagnier S(1)(2), Okubo G(3), Catheline G(1), Munsch F(4), Bigourdan A(3), Debruxelles S(2), Poli M(2), Olindo S(2), Renou P(2), Rouanet F(2), Dousset V(3)(4), Tourdias T(3)(4), Sibon I(1)(2).
Author information:
(1)From the UMR 5287 CNRS, Université de Bordeaux, EPHE PSL Research University, France (S.S., G.C., I.S.).
(2)CHU de Bordeaux, Unité Neuro-vasculaire, France (S.S., S.D., M.P., S.O., P.R., F.R., I.S.).
(3)INSERM-U1215, Neurocentre Magendie, Bordeaux, France (G.O., A.B., V.D., T.T.).
(4)CHU de Bordeaux, Neuroimagerie diagnostique et thérapeutique, France (F.M., V.D., T.T.).
Background and Purpose- Cortical cerebral microinfarcts (CMIs) have been
associated with vascular dementia and Alzheimer disease. The aim of the present
study was to evaluate the role of cortical CMI detected on 3T magnetic resonance
imaging, on the evolution of cognition during the year following an acute
ischemic stroke. Methods- We conducted a prospective and monocentric study,
including patients diagnosed for a supratentorial ischemic stroke with a National
Institutes of Health Stroke Scale score ≥1, without prestroke dementia or
neurological disability. Cortical CMIs were assessed on a brain 3T magnetic
resonance imaging realized at baseline, as well as markers of small vessel
disease, stroke characteristics, and hippocampal atrophy. Cognitive assessment
was performed at 3 time points (baseline, 3 months, and 1 year) using the
Montreal Cognitive Assessment, the Isaacs set test, and the Zazzo’s cancellation
task. Generalized linear mixed models were performed to evaluate the
relationships between the number of cortical CMI and changes in cognitive scores
over 1 year. Results- Among 199 patients (65±13 years old, 68% men), 88 (44%) had
at least one cortical CMI. Hypertension was the main predictor of a higher
cortical CMI load (B=0.58, P=0.005). The number of cortical CMI was associated
with an increase time at the Zazzo’s cancellation task over 1 year (B=3.84,
P=0.01), regardless of the other magnetic resonance imaging markers, stroke
severity, and demographic factors. Conclusions- Cortical CMIs are additional
magnetic resonance imaging markers of poorer processing speed after ischemic
stroke. These results indicate that a high load of cortical CMI in patients with
stroke can be considered as a cerebral frailty condition which counteracts to the
recovery process, suggesting a reduced brain plasticity among these patients.