Prevalence of, and risk factors for, cognitive impairment in lacunar stroke

 Are you that fucking clueless that you think telling us risks rather than providing solutions that prevent those risks is of any use at all to survivors recovery? And your mentors and senior researchers are also that clueless? No wonder stroke never gets solved. We have blithering idiots in stroke.

Prevalence of, and risk factors for, cognitive impairment in lacunar stroke

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Laura Ohlmeier, Stefania Nannoni, Claudia Pallucca, ...

First Published January 5, 2022 Research Article 

https://doi.org/10.1177/17474930211064965

Article information

Abstract

Background:

Small vessel disease (SVD) is associated with vascular cognitive impairment (VCI) but why VCI occurs in some, but not other patients, is uncertain. We determined the prevalence of, and risk factors for, VCI in a large cohort of patients with lacunar stroke.

Methods:

Participants with magnetic resonance imaging (MRI)-confirmed lacunar stroke were recruited in the multicenter DNA Lacunar 2 study and compared with healthy controls. A logistic regression model was used to determine which vascular risk factors and MRI parameters were independent predictors of VCI, assessed using the Brief Memory and Executive Test (BMET).

Results:

A total of 912 lacunar stroke patients and 425 controls were included, with mean (SD) age of 64.6 (12.26) and 64.7 (12.29) years, respectively. VCI was detected in 38.8% lacunar patients and 13.4% controls. In a logistic regression model, diabetes mellitus (odds ratio (OR) = 1.98 (95% confidence interval (CI) = 1.40–2.80), p < 0.001) and higher body mass index (BMI) (OR = 1.03 (95% CI = 1.00–1.05), p = 0.029) were independently associated with increased risk of VCI, and years of full-time education with lower risk (OR = 0.92 (95% CI = 0.86–0.99), p = 0.018). When entering both lacune count and white matter hyperintensity (WMH) in the same logistic regression model, only WMH grade was significantly associated with VCI (OR = 1.46 (95% CI = 1.24–1.72), p < 0.001).

Conclusion:

VCI is common in lacunar stroke patients, affecting almost 40%. This prevalence suggests that it should be routinely screened for in clinical practice. Risk factors for VCI in patients with lacunar stroke include diabetes mellitus, depressive symptoms, higher BMI, and WMH severity, while education is protective.

Keywords

Vascular cognitive impairment, small vessel disease, lacunar stroke, white matter hyperintensities

Introduction

Lacunar stroke, usually caused by cerebral small vessel disease (SVD), accounts for a quarter of all ischemic strokes. SVD is characterized radiologically by lacunar infarcts, white matter hyperintensities (WMHs), cerebral microbleeds (CMBs), and enlarged perivascular spaces.¹ SVD is the most common pathology underlying vascular cognitive impairment (VCI) and vascular dementia.¹

VCI is characterized by executive dysfunction and slowing of information processing speed while episodic memory and orientation in space, time, and person are relatively preserved.² Simple cognitive screening batteries commonly used in clinical practice, such as the Mini-Mental State Examination (MMSE), focus primarily on deficits in orientation and episodic memory, and are less sensitive to the cognitive profile in SVD.^2,3 When tests more sensitive to executive function and processing speed are used, such as the Brief Memory and Executive Test (BMET), a higher prevalence of cognitive impairment is detected in patients with SVD.²

Cardiovascular risk factors, particularly hypertension and diabetes, increase the risk of stroke⁴ and are associated with post-stroke dementia and VCI.⁵ However, most studies include all stroke subtypes, and less data are available specifically on lacunar stroke. Apathy, a decline in goal-directed behavior, which is common in SVD, has been associated with both the degree of white matter damage and dementia in SVD.⁶ Previous studies have reported associations between VCI and the range and severity of magnetic resonance imaging (MRI) markers, such as WMH, lacunar infarcts, and CMB.⁷ Furthermore, the pathology underlying SVD may be heterogeneous and it has been suggested that there are two major pathological subtypes⁸: focal atheroma resulting in larger isolated lacunar infarcts (ILIs) and more diffuse arterial disease associated with multiple smaller lacunar infarcts. More recent studies suggest that a similar distinction can be made on MRI with patients with single lacunar infarcts, those with multiple lacunar infarcts (MLI) and with confluent WMH having distinct risk factor profiles.⁹

Most previous studies have been small, and many have used computed tomography (CT)-based phenotyping, which is less accurate in the diagnosis of lacunar stroke. Furthermore, cognitive tests sensitive to the deficit seen in SVD were not always used. In addition, whether the cognitive profile differs for the different subtypes of VCI is uncertain.

In a large prospective multicenter cohort of almost 1000 patients with MRI-confirmed lacunar stroke, we determined the prevalence of VCI measured using the BMET. We further determined risk factors associated with VCI, including cardiovascular and lifestyle risk factors, as well as MRI features.