Predictors of post-stroke cognitive impairment using acute structural MRI neuroimaging: A systematic review and meta-analysis

 You blithering idiots, survivors don't want predictions of cognitive impairment, they want prevention of that. Do you even have two neurons to rub together to think at all? When 50% of survivors have cognitive impairment, don't you think just maybe you should solve that problem?  I'd have you all fired.

Oops, I'm not playing by the polite rules of Dale Carnegie,  'How to Win Friends and Influence People'. 

Telling supposedly smart stroke medical persons they know nothing about stroke is a no-no even if it is true. 

Politeness will never solve anything in stroke. Yes, I'm a bomb thrower and proud of it. Someday a stroke 'leader' will try to ream me out for making them look bad by being truthful, I look forward to that day.

Predictors of post-stroke cognitive impairment using acute structural MRI neuroimaging: A systematic review and meta-analysis 

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Emily Louise Ball, Mahnoor Shah, Eilidh Ross, ...

First Published August 4, 2022 Research Article 

https://doi.org/10.1177/17474930221120349

Article information

Abstract

Background:

Stroke survivors are at an increased risk of developing post-stroke cognitive impairment and post-stroke dementia; those at risk could be identified by brain imaging routinely performed at stroke onset.

Aim:

This systematic review aimed to identify features which are associated with post-stroke cognitive impairment (including dementia), on magnetic resonance imaging (MRI) performed at stroke diagnosis.

Summary of review:

We searched the literature from inception to January 2022 and identified 10,284 records. We included studies that performed MRI at the time of stroke (0-30 days after a stroke) and assessed cognitive outcome at least three months after stroke. We synthesised findings from 26 papers, comprising 27 stroke-populations (N=13,114, average age range=40-80 years, 19-62% female). When data were available, we pooled unadjusted (ORu) and adjusted (ORa) odds ratios.

We found associations between cognitive outcomes and presence of cerebral atrophy (3 studies, N=453, ORu=2.48, 95%CI=1.15-4.62), presence of microbleeds (2 studies, N=9151, ORa=1.36, 95%CI=1.08-1.70), and increasing severity of white matter hyperintensities (3 studies, N=704, ORa=1.26, 95%CI=1.06-1.49). Increasing cerebral small vessel disease score was associated with cognitive outcome following unadjusted analysis only (2 studies, N=499, ORu=1.34, 95%CI=1.12-1.61; 3 studies, N=950, ORa=1.23, 95%CI=0.96-1.57). Associations remained after controlling for pre-stroke cognitive impairment. We did not find associations between other stroke features and cognitive outcome, or there were insufficient data.

Conclusions:

Acute stroke MRI features may enable healthcare professionals to identify patients at risk of post-stroke cognitive problems. However, there is still substantial uncertainty about the prognostic utility of acute MRI for this.

Keywords

Stroke, Cognitive impairment, Dementia, Neuroimaging, MRI, Post-stroke cognitive impairment

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