Severe Lesions Involving Cortical Cholinergic Pathways Predict Poorer Functional Outcome in Acute Ischemic Stroke

NO, this just means your doctor and stroke hospital have a lot of followup work to do to initiate research into solving this problem. There should never be a throwing up hands in defeat. You formulate the problem to be solved in the form that researchers can understand and accomplish. Must I explain everything in stroke? I don't get paid enough to solve rehab problems for 10 million yearly stroke survivors. Stop with this lazy prediction crapola. Survivors want rehab that works, NOT THIS CRAP!

Severe Lesions Involving Cortical Cholinergic Pathways Predict Poorer Functional Outcome in Acute Ischemic Stroke

Jian-Feng Qu

,

Yang-Kun Chen

,

Gen-Pei Luo

,

Jiang-Hao Zhao

,

Huo-Hua Zhong

, and

Han-Peng Yin

Originally published1 Nov 2018Stroke. 2018;0:STROKEAHA.118.023196

Abstract

Background and Purpose—

The aim of the study was to assess the effect of lesion severity in cortical cholinergic pathways in acute ischemic stroke patients on functional outcomes.

Methods—

The study sample consisted of 214 men (70.9%) and 88 women (29.1%) with acute ischemic stroke. We used the Cholinergic Pathways Hyperintensities Scale (CHIPS) to assess the severity of lesions in cortical cholinergic pathways using brain magnetic resonance imaging. The other magnetic resonance imaging parameters included infarction, white matter lesions, and medial temporal lobe atrophy. Functional outcome was assessed using the Lawton activities of daily living (ADL) scale at 3 and 6 months after the index stroke. We also assessed disability status using the modified Rankin Scale.

Results—

Univariate analysis showed that patients with poor functional outcomes were older, more likely to be men, had a higher National Institutes of Health Stroke Scale (NIHSS) score on admission, and had more frequent histories of previous stroke and infection complications. They also had significantly more frequent cortical infarcts, left subcortical infarcts, a larger infarct volume, more severe medial temporal lobe atrophy, and periventricular hyperintensities, and higher CHIPS scores. In the multiple regression analysis, model 1 showed that age and NIHSS score on admission were significant predictors of poor ADL at 3 months, with an R² of 45.4% fitting the model. Age, NIHSS score on admission and stroke subtype were also significant predictors of poor ADL at 6 months, with an R² of 37.9% fitting the model. In model 2, sex, previous stroke, NIHSS score on admission, right cortical infarcts, left subcortical infarcts and CHIPS score were significant predictors for poor ADL at 3 months, with an R² of 53.5%. NIHSS score on admission, stroke subtype, and CHIPS score were significant predictors for poor ADL at 6 months, with an R² of 40.2%. After adjustment for confounders, CHIPS score was also a significant predictor for poor modified Rankin Scale, both at 3 and 6 months. Even after removing patients with moderate-to-severe white matter lesions, higher CHIPS scores still correlated with poorer ADL and modified Rankin Scale both at both 3 and 6 months.

Conclusions—

In patients with acute ischemic stroke, cortical cholinergic pathways impairment is common, and the severity of lesions in the cortical cholinergic pathways may significantly predict a poorer functional outcome.

Clinical Trial Registration—

URL: http://www.chictr.org.cn/index.aspx. Unique identifier: ChiCTR1800014982.

Footnotes

The online-only Data Supplement is available with this article at https://www.ahajournals.org/doi/suppl/10.1161/STROKEAHA.118.023196.

Correspondence to Yang-Kun Chen, MD, PhD, Department of Neurology, Dongguan People’s Hospital (Affiliated Dongguan Hospital, South Medical University), Dongguan City, Guangdong Province, China. Email cykun78@163.com