The Impact of Covert Lacunar Infarcts and White Matter Hyperintensities on Cognitive and Motor Outcomes After Stroke
The Impact of Covert Lacunar Infarcts and White Matter Hyperintensities on Cognitive and Motor Outcomes After Stroke
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DOI：
10.1016/j.jstrokecerebrovasdis.2018.10.009
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发表时间：
2019-02-01
影响因子：
2.5
通讯作者：
Boyd, Lara A.
中科院分区：
文献类型：
--
作者：
Auriat, Angela M.;Ferris, Jennifer K.;Boyd, Lara A.
背景和目标：除了显性卒中病变外，同时发生的隐性病变，包括白色高信号（WMH）和隐性腔隙性梗死（CLI），也影响卒中后结局。本研究的目的是探讨慢性卒中患者隐性病变与运动和认知结果之间的关系。研究方法：使用结构磁共振成像对临床明显中风、隐性病变（室周和深部：pWMH、dWMH、pCLI、dCLI）、心室和脑沟CSF（vCSF、sCSF）以及正常外观的白色（NAWM）和灰质（NAGM）进行体积量化。我们评估了运动障碍和功能，以及整体认知，记忆和其他认知领域。当相关性分析确定了一个以上与卒中结局相关的MR参数时，我们使用回归建模来确定哪个因素具有最强的影响。结果：神经心理学和脑成像数据收集了30名参与者至少6个月后，临床诊断中风。与vCSF相关的记忆性能（r =-0.52，P = .004）。非记忆域的最强预测因子是pCLI（r（2）= 0.28，P = .004）。运动障碍和功能最强预测卒中量和NAWM（r（2）= 0.36; P = 0.001），和dWMH（r（2）= 0.39; P = 0.001）分别。结论：隐性病变的类型和位置对卒中后认知和运动功能的预后有重要影响。限制老年人群隐性病变的进展可能会提高卒中后的恢复程度。
Background and Aims: In addition to overt stroke lesions, co-occurring covert lesions, including white matter hyperintensities (WMH) and covert lacunar infarcts (CLI), contribute to poststroke outcome. The purpose of this study was to examine the relationship between covert lesions, and motor and cognitive outcomes in individuals with chronic stroke. Methods: Volumetric quantification of clinically overt strokes, covert lesions (periventricular and deep: pWMH, dWMH, pCLI, dCLI), ventricular and sulcal CSF (vCSF, sCSF), and normal appearing white (NAWM) and gray matter (NAGM) was performed using structural magnetic resonance imaging. We assessed motor impairment and function, and global cognition, memory, and other cognitive domains. When correlation analysis identified more than one MR parameter relating to stroke outcomes, we used regression modeling to identify which factor had the strongest impact. Results: Neuropsychological and brain imaging data were collected from 30 participants at least 6 months following a clinically diagnosed stroke. Memory performance related to vCSF (r = -0.52, P = .004). The strongest predictor of nonmemory domains was pCLI (r(2) = 0.28, P = .004). Motor impairment and function were most strongly predicted by the volume of stroke and NAWM (r(2) = 0.36; P = .001), and dWMH (r(2) = 0.39; P = .001) respectively. Conclusions: Covert lesion type and location have important consequences for post-stroke cognitive and motor outcome. Limiting the progression of covert lesions in aging populations may enhance the degree of recovery post-stroke.