Middle Cerebral Artery Pulsatility Index is Associated with Cognitive Impairment in Lacunar Stroke (original) (raw)
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BMC Neurology, 2013
Background The detection of early neuropsychological abnormalities as precursors of cognitive decline of vascular origin in patients with lacunar stroke is a subject of increasing interest. The objective of this study was to assess whether there were differences in the performance of a battery of neuropsychological tests in first-ever lacunar stroke patients with and without associated silent multiple lacunar infarctions found incidentally on the brain magnetic resonance imaging (MRI) scan. Methods A total of 72 consecutive patients with first-ever lacunar infarction were studied 1 month after stroke. All patients underwent a comprehensive neuropsychological evaluation, which included the California Verbal Learning Test (CVLT), Phonetic Verbal Fluency Test (PMR), Semantic Verbal Fluency Test (category “animals”), Digit Span Forward and Backward from the Wechsler Adult Intelligence Scale (WAIS-III), and Mini-Mental State Examination (MMSE). Results A total of 38 patients (52.7%) had ...
Cognitive impairments in acute lacunar stroke
Acta Neurologica Scandinavica, 2006
Although lacunar infarcts were described by French physicians in the 19th century (1), the concept of the lacunar syndrome was not introduced until the 1960s. Fisher then described the clinical presentations of this etiologic subtype of ischemic stroke as pure motor syndrome (2), pure sensory syndrome (3), and brainstem syndromes known as dysarthria-clumsy hand syndrome (4) and ataxic hemiparesis (5). In addition, the sensorimotor syndrome (6) was recognized as a clinical expression of lacunar infarcts a few years later. According to the lacunar hypothesis (7), the clinical characteristics of lacunar syndromes should not comprise cognitive deficits such as aphasia, apraxia, agnosia and neglect phenomena or homonymous hemianopia. Recurring lacunar infarcts are known to be associated with cognitive impairments (8) and in the long term with vascular dementia (9, 10). Recently, the term subcortical vascular dementia was introduced. This dementia syndrome may be progressive, even in the absence of new clinical
Natural history of dementia associated with lacunar infarctions
Journal of the Neurological Sciences, 2002
Lacunar stroke (VaD-L) is the most common stroke subtype associated with vascular dementia (VaD). To evaluate the rate of cognitive and behavioral changes in patients with probable VaD-L. We measured rates of change on the Mini-Mental State Examination (MMSE), Digit Span, Logical Memory, Controlled Oral Word Association Test, CERAD battery and the Neuropsychiatric Inventory (NPI) of 77 [age at entry 65.9+/-8.1 (mean+/-standard deviation) years] patients with probable VaD, periventricular white matter and basal ganglia lacunae, longitudinally studied for 25.7+/-11 months. Mean number of follow-up visits was 2.6. Overall annual vascular event rate was 0.25. VaD-L in mildly and moderately impaired patients is characterized by progressive cognitive and behavioral decline. The rate of cognitive and behavioral progression depends on the occurrence of vascular episodes (VE) during the course of the illness [(-1.1) MMSE and (+4.0) NPI points annually without VE vs. (-2.0) and (+10.3) points following VE]. The rates of progression are a function of the severity of the cognitive and behavioral impairment. Impaired cognition is associated with impaired behavior. A subgroup of VaD-L patients runs a progressively deteriorating course despite the absence of clinically apparent new vascular episodes. VaD-L is characterized by cognitive and behavioral decline in 83% of the patients. The rate of decline is determined mainly by the severity of the cognitive and behavioral impairment at baseline and by the occurrence of new vascular episodes.
Cognitive Impairment in Ischaemic Lacunar Stroke
European Neurological Review, 2013
Ischaemic cerebral small-vessel disease (SVD) can be visualised on brain magnetic resonance imaging (MRI) scans as lacunar infarcts, white matter hyperintensities and cerebral microbleeds, and has been recognised as the most frequent cause of cognitive impairment of vascular origin. Lacunar infarction is the most common manifestation of SVD and accounts for approximately 25 % of all brain infarctions. In patients with first-ever lacunar infarction, more than half of cases show impairment of the executive functions and meet criteria of mild vascular cognitive impairment. Lacunar stroke is an important predictor of post-stroke cognitive decline and vascular dementia. In the wellcharacterised cohort of 1,636 lacunar stroke patients of the Secondary Prevention of Small Subcortical Strokes (SPS3) trial, mild cognitive impairment was present in nearly half of participants and was an important complication of lacunar stroke more prevalent than physical disability. The cognitive profile identified to be associated with ischaemic cerebral SVD includes preserved memory with attention deficits and executive functioning impairment. However, in a recent systematic review of cognitive impairment in lacunar ischaemic stroke, impaired cognition appears less selective than previously thought, involving episodic memory and all major cognitive domains. Brain atrophy is also a feature of ischaemic cerebral SVD. Cognitive dysfunction in lacunar stroke sufferers is frequently overlooked in routine clinical practice and may be as common and clinically relevant as motor and sensory sequelae.
Cognitive impairment in lacunar strokes: The SPS3 trial
Annals of Neurology, 2012
Objective: Lacunar strokes are a leading cause of cognitive impairment and vascular dementia. However, adequate characterization of cognitive impairment is lacking. The aim of this study was to estimate the prevalence and characterize the neuropsychological impairment in lacunar stroke patients. Methods: All English-speaking participants in the Secondary Prevention of Small Subcortical Strokes (SPS3) trial (National Clinical Trial 00059306) underwent neuropsychological testing at baseline. Raw scores were converted to z scores using published norms. Those with impairment (z À1.5) in memory and/or nonmemory domains were classified as having mild cognitive impairment (MCI). Results: Among the 1,636 participants, average z scores on all tests were <0, with the largest deficits seen on tests of episodic memory (range of means, À0.65 to À0.92), verbal fluency (mean, À0.89), and motor dexterity (mean, À2.5). Forty-seven percent were classified as having MCI (36% amnestic, 37% amnestic multidomain, 28% nonamnestic). Of those with modified Rankin score 0-1 and Barthel score ¼ 100, 41% had MCI. Younger age (odds ratio [OR] per 10-year increase, 0.87), male sex (OR, 1.3), less education (OR, 0.13-0.66 for higher education levels compared to 0-4 years education), poststroke disability (OR, 1.4), and impaired activities of daily living (OR, 1.8) were independently associated with MCI. Interpretation: In this large, well-characterized cohort of lacunar stroke patients, MCI was present in nearly half, including many with minimal or no physical disabilities. Cognitive dysfunction in lacunar stroke patients may commonly be overlooked in clinical practice but may be as important as motor and sensory sequelae.
Faculty of 1000 evaluation for Cognitive impairment in lacunar strokes: The SPS3 trial
F1000 - Post-publication peer review of the biomedical literature, 2012
Objective-Lacunar strokes are a leading cause of cognitive impairment and vascular dementia. However, adequate characterization of cognitive impairment is lacking. The aim of this study was to estimate the prevalence and characterize the neuropsychological impairment in lacunar stroke patients. Methods-All English-speaking participants in the SPS3 trial (NCT: 00059306) underwent neuropsychological testing at baseline. Raw scores were converted to z-scores using published norms. Those with impairment (z≤-1.5) in memory and/or non-memory domains were classified as having Mild Cognitive Impairment (MCI). Results-Among the 1636 participants, average z scores on all tests were below zero with the largest deficits seen on tests of episodic memory (range of means-0.65 to-0.92), verbal fluency (mean-0.89), and motor dexterity (mean-2.5). Forty-seven percent were classified as having MCI: 36% amnestic, 37% amnestic multidomain, 28% non-amnestic. Of those with Rankin score 0-1 and Barthel score=100, 41% had MCI. Younger age [odds ratio (OR) per 10-yr increase=0.87], male sex (OR 1.3), less education (OR 0.13-0.66 compared to 0-4 yrs education), post-stroke disability (OR 1.4), and impaired activities of daily living (OR 1.8) were independently associated with MCI. Conclusions-In this large, well characterized cohort of lacunar stroke patients, MCI was present in nearly half, including many with minimal or no physical disabilities. Cognitive dysfunction in lacunar stroke patients may commonly be overlooked in clinical practice but may be as important as motor and sensory sequelae.
Journal of clinical neurology (Seoul, Korea), 2011
Cerebral autosomal-dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is an inherited microangiopathy caused by mutations in the Notch3 gene. Although previous studies have shown an association between lacunar infarction and cognitive impairment, the relationship between MRI parameters and cognition remains unclear. In this study we investigated the influence of MRI parameters on cognitive impairment in CADASIL. We applied a prospective protocol to 40 patients. MRI analysis included the normalized volume of white-matter hyperintensities (nWMHs), number of lacunes, and number of cerebral microbleeds. Cognition was assessed with the aid of psychometric tests [Mini-Mental State Examination (MMSE), Alzheimer's Disease Assessment Scale-cognition (ADAS-cog), Trail-Making Test, and Stroop interference (Stroop IF)]. A multivariate regression analysis revealed that the total number of lacunes influenced the performance in the MMSE, ADAS-cog, and Stroop IF, ...
High risk of early neurological worsening of lacunar infarction
Acta Neurologica Scandinavica, 2018
Background and Purpose We aimed to evaluate factors associated with neurological worsening among patients with lacunar or non-lacunar infarction admitted within 3 hours and between 3-24 hours after stroke onset. Methods All patients admitted to Haukeland university hospital between 2006-2016 with acute cerebral infarction on MRI and admission within 24 hours were included. Repeated National Institute of Health Stroke Scale (NIHSS) scoring was performed in all patients whenever possible. Neurological worsening during the hospital stay was defined as NIHSS score increase ≥3 compared to NIHSS score on admission. Results In patients with lacunar infarction admitted within 3 hours of onset neurological worsening was associated with low NIHSS score on admission, low body temperature and leukoaraiosis whereras only internal carotid artery stenosis or occlusion was associated with neurological worsening in non-lacunar infaction. For patients admitted 3-24 hours after onset neurological worsening was associated with low body temperature, high systolic blood pressure and short time from onset to admission in patients with lacunar infarction, whereas high systolic blood pressure, high NIHSS score on admission, middle cerebral artery occlusion and high blood glucose were associated with neurological worsening in patients with non-lacunar infarction (all P<.05). Conclusions Lacunar infarctions with minor neurological deficits within 3 hours of stroke onset are at high risk of neurological worsening especially if concomitant low body temperature and leukoaraiosis.