Admission Brain Cortical Volume: An Independent Determinant of Poststroke Cognitive Vulnerability.
Stroke. 2017-06-16; 48(8): 2113-2120
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BACKGROUND AND PURPOSE: Several markers of poststroke cognitive impairment have
been reported. The role of brain cortical volume remains uncertain. The aim of
this study was to evaluate the influence of brain cortical volume on cognitive
outcomes using a voxel-based morphometry approach in subjects without prestroke
METHODS: Ischemic stroke patients were prospectively recruited 24 to 72 hours
post stroke (M0). Cognition was evaluated at M0, 3 months, and 1 year (M12) using
the Montreal Cognitive Assessment, the Isaacs set test, and the Zazzo’s
cancellation task. A 3-T brain magnetic resonance imaging was performed at M0.
Grey matter (GM) was segmented using Statistical Parametric Mapping 12 software.
Association between global GM volume and cognitive score slopes between M0 and
M12 was evaluated using a linear mixed model. Correlations between focal GM
volumes and changes in cognitive performance were evaluated using Statistical
Parametric Mapping 12.
RESULTS: Two-hundred forty-eight patients were included (mean age 65±SD 14 years
old, 66% men). Global GM volume was significantly associated with changes in
Montreal Cognitive Assessment scores (β=0.01; P=0.04) and in the number of errors
on the Zazzo’s cancellation task (β=-0.02; P=0.04) independently of other
clinical/radiological confounders. Subjects with lower GM volumes in the left
fronto-temporo-insular cortex were more vulnerable to transient Montreal
Cognitive Assessment and Isaacs set test impairment. Subjects with lower GM
volumes in right temporo-insular cortex, together with basal ganglia, were more
vulnerable to transient cognitive impairment on the Zazzo’s cancellation task.
CONCLUSIONS: Smaller cortical volumes in fronto-temporo-insular areas measured 24
to 72 hours post stroke are associated with cognitive vulnerability in the
subacute stroke phase.
© 2017 American Heart Association, Inc.