Stroke Location Is an Independent Predictor of Cognitive Outcome.
Stroke. 2015-11-19; 47(1): 66-73
DOI: 10.1161/strokeaha.115.011242
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1. Stroke. 2016 Jan;47(1):66-73. doi: 10.1161/STROKEAHA.115.011242. Epub 2015 Nov
19.
Stroke Location Is an Independent Predictor of Cognitive Outcome.
Munsch F(1), Sagnier S(1), Asselineau J(1), Bigourdan A(1), Guttmann CR(1),
Debruxelles S(1), Poli M(1), Renou P(1), Perez P(1), Dousset V(1), Sibon I(1),
Tourdias T(2).
Author information:
(1)From the Université de Bordeaux, Bordeaux, France (F.M., C.R.G., V.D., I.S.,
T.T.); Neuroimagerie diagnostique et thérapeutique (F.M., A.B., V.D., T.T.),
Unité neurovasculaire (S.S., S.D., M.P., P.R., I.S.), and Pôle de santé publique,
Unité de Soutien Méthodologique à la Recherche Clinique et Epidémiologique (J.A.,
P.P.), CHU de Bordeaux, Bordeaux, France; INSERM, U862, Neurocentre Magendie,
Bordeaux, France (F.M., V.D., T.T.); Center for Neurological Imaging, Brigham and
Women’s Hospital, Harvard Medical School, Boston, MA (C.R.G.); and INCIA,
Bordeaux, France (I.S.).
(2)From the Université de Bordeaux, Bordeaux, France (F.M., C.R.G., V.D., I.S.,
T.T.); Neuroimagerie diagnostique et thérapeutique (F.M., A.B., V.D., T.T.),
Unité neurovasculaire (S.S., S.D., M.P., P.R., I.S.), and Pôle de santé publique,
Unité de Soutien Méthodologique à la Recherche Clinique et Epidémiologique (J.A.,
P.P.), CHU de Bordeaux, Bordeaux, France; INSERM, U862, Neurocentre Magendie,
Bordeaux, France (F.M., V.D., T.T.); Center for Neurological Imaging, Brigham and
Women’s Hospital, Harvard Medical School, Boston, MA (C.R.G.); and INCIA,
Bordeaux, France (I.S.). .
BACKGROUND AND PURPOSE: On top of functional outcome, accurate prediction of
cognitive outcome for stroke patients is an unmet need with major implications
for clinical management. We investigated whether stroke location may contribute
independent prognostic value to multifactorial predictive models of functional
and cognitive outcomes.
METHODS: Four hundred twenty-eight consecutive patients with ischemic stroke were
prospectively assessed with magnetic resonance imaging at 24 to 72 hours and at 3
months for functional outcome using the modified Rankin Scale and cognitive
outcome using the Montreal Cognitive Assessment (MoCA). Statistical maps of
functional and cognitive eloquent regions were derived from the first 215
patients (development sample) using voxel-based lesion-symptom mapping. We used
multivariate logistic regression models to study the influence of stroke location
(number of eloquent voxels from voxel-based lesion-symptom mapping maps), age,
initial National Institutes of Health Stroke Scale and stroke volume on modified
Rankin Scale and MoCA. The second part of our cohort was used as an independent
replication sample.
RESULTS: In univariate analyses, stroke location, age, initial National
Institutes of Health Stroke Scale, and stroke volume were all predictive of poor
modified Rankin Scale and MoCA. In multivariable analyses, stroke location
remained the strongest independent predictor of MoCA and significantly improved
the prediction compared with using only age, initial National Institutes of
Health Stroke Scale, and stroke volume (area under the curve increased from
0.697-0.771; difference=0.073; 95% confidence interval, 0.008-0.155). In
contrast, stroke location did not persist as independent predictor of modified
Rankin Scale that was mainly driven by initial National Institutes of Health
Stroke Scale (area under the curve going from 0.840 to 0.835). Similar results
were obtained in the replication sample.
CONCLUSIONS: Stroke location is an independent predictor of cognitive outcome
(MoCA) at 3 months post stroke.
© 2015 American Heart Association, Inc.
DOI: 10.1161/STROKEAHA.115.011242
PMID: 26585396 [Indexed for MEDLINE]