Normal-Appearing White Matter Deteriorates over the Year After an Ischemic Stroke and Is Associated with Global Cognition.

Sharmila Sagnier , Gwenaëlle Catheline , Bixente Dilharreguy , Pierre-Antoine Linck, Pierrick Coupé, Fanny Munsch, Antoine Bigourdan, Mathilde Poli, Sabrina Debruxelles, Pauline Renou, Stéphane Olindo, François Rouanet, Vincent Dousset , Thomas Tourdias , Igor Sibon
Transl. Stroke Res.. 2022-02-01; :
DOI: 10.1007/s12975-022-00988-8

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Sagnier S(1)(2)(3), Catheline G(4), Dilharreguy B(4), Linck PA(5), Coupé P(6), Munsch F(7), Bigourdan A(5), Poli M(8), Debruxelles S(8), Renou P(8), Olindo S(8), Rouanet F(8), Dousset V(5)(9), Tourdias T(5)(9), Sibon I(4)(8).

Author information:
(1)UMR-5287, CNRS, Université de Bordeaux, EPHE PSL Research University,
Bordeaux, France. .
(2)CHU de Bordeaux, Unité Neuro-Vasculaire, Bordeaux, France.
(3)INCIA Université Bordeaux 2, 146 rue Léo Saignat Zone Nord, Bâtiment 2A, 2e
étage, 33076, Bordeaux, France. .
(4)UMR-5287, CNRS, Université de Bordeaux, EPHE PSL Research University,
Bordeaux, France.
(5)CHU de Bordeaux, Neuroradiologie, Bordeaux, France.
(6)UMR-5800, CNRS, Université de Bordeaux, LaBRI, Talence, France.
(7)Beth Israel Deaconess Medical Center, Harvard University, Boston, USA.
(8)CHU de Bordeaux, Unité Neuro-Vasculaire, Bordeaux, France.
(9)INSERM-U1215, Neurocentre Magendie, Bordeaux, France.

Normal-appearing white matter (NAWM) is a hub of plasticity, but data relating to
its influence on post-ischemic stroke (IS) outcome remain scarce. The aim of this
study was to evaluate the relationship between NAWM integrity and cognitive
outcome after an IS. A longitudinal study was conducted including supra-tentorial
IS patients. A 3-Tesla brain MRI was performed at baseline and 1 year, allowing
the analyses of mean fractional anisotropy (FA) and mean diffusivity (MD) in NAWM
masks, along with the volume of white matter hyperintensities (WMH) and IS. A
Montreal Cognitive Assessment (MoCA), an Isaacs set test, and a Zazzo’s
cancellation task were performed at baseline, 3 months and 1 year. Mixed models
were built, followed by Tract-based Spatial Statistics (TBSS) analyses.
Ninety-five patients were included in the analyses (38% women, median age
69 ± 20). FA significantly decreased, and MD significantly increased between
baseline and 1 year, while cognitive scores improved. Patients who decreased
their NAWM FA more over the year had a slower cognitive improvement on MoCA
(β =  - 0.11, p = 0.05). The TBSS analyses showed that patients who presented the
highest decrease of FA in various tracts of white matter less improved their MoCA
performances, regardless of WMH and IS volumes, demographic confounders, and
clinical severity. NAWM integrity deteriorates over the year after an IS, and is
associated with a cognitive recovery slowdown. The diffusion changes recorded
here in patients starting with an early preserved white matter structure could
have long term impact on cognition.

© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.


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