Chronic Cortical Cerebral Microinfarcts Slow Down Cognitive Recovery After Acute Ischemic Stroke
Chronic Cortical Cerebral Microinfarcts Slow Down Cognitive Recovery After Acute Ischemic Stroke
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DOI：
10.1161/strokeaha.118.024672
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发表时间：
2019-06-01
期刊：
影响因子：
8.3
通讯作者：
Sibon, Igor
中科院分区：
文献类型：
--
作者：
Sagnier, Sharmila;Okubo, Gosuke;Sibon, Igor
背景和目的皮质脑微梗塞（CMI）与血管性痴呆和阿尔茨海默病有关。本研究的目的是评估 3T 磁共振成像检测到的皮质 CMI 对急性缺血性中风后一年内认知演变的作用。方法我们进行了一项前瞻性单中心研究，包括被诊断为幕上缺血性中风、美国国立卫生研究院中风量表评分为 1、无中风前痴呆或神经功能障碍的患者。通过基线时实现的大脑 3T 磁共振成像以及小血管疾病、中风特征和海马萎缩的标志物来评估皮质 CMI。使用蒙特利尔认知评估、Isaacs 集合测试和 Zazzo 取消任务在 3 个时间点（基线、3 个月和 1 年）进行认知评估。采用广义线性混合模型来评估皮质 CMI 的数量与一年内认知评分变化之间的关系。结果 在 199 名患者（6513 岁，68% 男性）中，88 名患者（44%）至少患有一次皮质 CMI。高血压是皮质 CMI 负荷较高的主要预测因素（B=0.58，P=0.005）。无论其他磁共振成像标志物、卒中严重程度和人口因素如何，皮质 CMI 的数量与 1 年以上 Zazzo 取消任务时间的增加相关（B=3.84，P=0.01）。 结论 皮质 CMI 是缺血性卒中后处理速度较差的附加磁共振成像标志物。这些结果表明，中风患者皮质 CMI 的高负荷可被视为脑衰弱状况，会阻碍恢复过程，表明这些患者的大脑可塑性降低。
Background and Purpose Cortical cerebral microinfarcts (CMIs) have been associated with vascular dementia and Alzheimer disease. The aim of the present study was to evaluate the role of cortical CMI detected on 3T magnetic resonance imaging, on the evolution of cognition during the year following an acute ischemic stroke.Methods We conducted a prospective and monocentric study, including patients diagnosed for a supratentorial ischemic stroke with a National Institutes of Health Stroke Scale score 1, without prestroke dementia or neurological disability. Cortical CMIs were assessed on a brain 3T magnetic resonance imaging realized at baseline, as well as markers of small vessel disease, stroke characteristics, and hippocampal atrophy. Cognitive assessment was performed at 3 time points (baseline, 3 months, and 1 year) using the Montreal Cognitive Assessment, the Isaacs set test, and the Zazzo's cancellation task. Generalized linear mixed models were performed to evaluate the relationships between the number of cortical CMI and changes in cognitive scores over 1 year.Results Among 199 patients (6513 years old, 68% men), 88 (44%) had at least one cortical CMI. Hypertension was the main predictor of a higher cortical CMI load (B=0.58, P=0.005). The number of cortical CMI was associated with an increase time at the Zazzo's cancellation task over 1 year (B=3.84, P=0.01), regardless of the other magnetic resonance imaging markers, stroke severity, and demographic factors.Conclusions Cortical CMIs are additional magnetic resonance imaging markers of poorer processing speed after ischemic stroke. These results indicate that a high load of cortical CMI in patients with stroke can be considered as a cerebral frailty condition which counteracts to the recovery process, suggesting a reduced brain plasticity among these patients.