Predicting post-stroke cognitive impairment using acute CT neuroimaging: A systematic review and meta-analysis

Will you stop predicting failure to recover and CREATE EXACT STROKE PROTOCOLS THAT PREVENT COGNITIVE IMPAIRMENT.  Do you not understand the only goal in stroke? 100% recovery! This does nothing for that.  Your mentors and senior researchers need to get remedial training in stroke.

Predicting post-stroke cognitive impairment using acute CT neuroimaging: A systematic review and meta-analysis

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Emily L Ball, Rachel Sutherland, Charlotte Squires, ...

First Published September 29, 2021 Review Article Find in PubMed 

https://doi.org/10.1177/17474930211045836

Article information

Abstract

Background

Identifying whether acute stroke patients are at risk of cognitive decline could improve prognostic discussions and management. Structural computed tomography neuroimaging is routine in acute stroke, and may identify those at risk of post-stroke dementia or post-stroke cognitive impairment (PSCI).

Aim

To systematically review the literature to identify which stroke or pre-stroke features on brain computed tomography scans, performed at the time of stroke, are associated with post-stroke dementia or PSCI.

Summary of review

We searched electronic databases to December 2020. We included studies reporting acute stroke brain computed tomography, and later diagnosis of a cognitive syndrome. We created summary estimates of size of unadjusted association between computed tomography features and cognition. Of 9536 citations, 28 studies (41 papers) were eligible (N = 7078, mean age 59.8–78.6 years). Cognitive outcomes were post-stroke dementia (10 studies), PSCI (17 studies), and one study analyzed both. Fifteen studies (N = 2952) reported data suitable for meta-analyses. White matter lesions (WML) (six studies, N = 1054, OR = 2.46, 95% CI = 1.25–4.84), cerebral atrophy (four studies, N = 558, OR = 2.80, 95% CI = 1.21–6.51), and pre-existing stroke lesions (three studies, N = 352, OR = 2.38, 95% CI = 1.06–5.32) were associated with post-stroke dementia. WML (four studies, N = 473, OR = 3.46, 95% CI = 2.17–5.52) were associated with PSCI. Other computed tomography features were either not associated with cognitive outcome, or there were insufficient data.

Conclusions

Cognitive impairment following stroke is of great concern to patients and carers(Yep, and this does nothing to fix that.). Features seen on visual assessment of acute stroke computed tomography brain scans are strongly associated with cognitive outcomes. Clinicians should consider when and how this information should be discussed with stroke survivors.(Wrong sentence: It should be: 'Clinicians should discuss with patients the EXACT PROTOCOLS THAT WILL CORRECT COGNITIVE IMPAIRMENT'.) I'd be screaming my head off at such displays of incompetence.

Keywords

Stroke, cognitive impairment, dementia, neuroimaging, computed tomography

Introduction

Cognitive decline and dementia are common following stroke.¹ According to the Stroke Association-James Lind Alliance 2021 survey, patients and carers are more concerned about cognitive impairment after stroke than having another stroke.² Identifying patients at high risk of persisting cognitive issues following stroke could allow for targeted follow-up, and assist discussions around prognosis. There are also research implications for identifying patients at risk of dementia, including creating enriched populations (i.e. people who are most at risk of subsequent dementia or cognitive impairment) for future studies of possible cognitive interventions.

The cognitive problems that follow stroke have various labels. In this review, we use the terms, post-stroke dementia (PSD – defined as a diagnosis of any type of dementia following stroke) and post-stroke cognitive impairment (PSCI – encompassing all severities of cognitive impairment).³ Classical risk factors associated with PSD include low education, atrial fibrillation, and recurrent stroke.¹

CT or MRI neuroimaging features have also shown associations with PSD/PSCI.^4,5 A systematic review describing white matter lesions (WML) and PSCI reported an approximate doubling of risk between WML and PSCI/PSD.⁵ Another review, across mixed stroke populations, reported that global and medial temporal lobe atrophy were consistently associated with PSCI.⁴ These reviews highlight that neuroimaging features are associated with cognitive outcomes, included imaging on both CT and MRI, taken up to several months after the acute stroke.

In acute stroke, the main reason for neuroimaging is to diagnose the cause of the stroke, which in turn determines hyperacute treatment. Although MRI produces a higher resolution image, structural CT neuroimaging is faster, cheaper, and remains the international standard neuroimaging technique.

Our systematic review focuses on the prognostic utility of routine CT performed at the time of stroke. We included studies of TIA, ischemic, and hemorrhagic stroke, and investigated whether pre-existing stroke features and acute stroke lesions are associated with PSD and PSCI.

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