https://link.springer.com/article/10.1007/s12975-017-0576-9
Abstract
Stroke
patients have an elevated risk of developing long-term cognitive
disorders or dementia. The latter is often associated with atrophy of
the medial temporal lobe. However, it is not clear whether hippocampal
and entorhinal cortex atrophy is the sole predictor of long-term
post-stroke dementia. We hypothesized that hippocampal deformation
(rather than atrophy) is a predictive marker of long-term post-stroke
dementia on a rat model and tested this hypothesis in a prospective
cohort of stroke patients.
Male Wistar rats
were subjected to transient middle cerebral artery occlusion and
assessed 6 months later. Ninety initially dementia-free patients having
suffered a first-ever ischemic stroke were prospectively included in a
clinical study. In the rat model, significant impairments in
hippocampus-dependent memories were observed. MRI studies did not reveal
significant atrophy of the hippocampus volume, but significant
deformations were indeed observed—particularly on the ipsilateral side.
There, the neuronal surface area was significantly lower in ischemic
rats and was associated with a lower tissue density and a markedly
thinner entorhinal cortex. At 6 months post-stroke, 49 of the 90
patients displayed cognitive impairment (males 55.10%). Shape analysis
revealed marked deformations of their left hippocampus, a significantly
lower entorhinal cortex surface area, and a wider rhinal sulcus but no
hippocampal atrophy. Hence, hippocampal deformations and entorhinal
cortex atrophy were associated with long-term impaired cognitive
abilities in a stroke rat model and in stroke patients. When combined
with existing biomarkers, these markers might constitute sensitive new
tools for the early prediction of post-stroke dementia.
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