Will you blithering idiots do something useful like creating protocols that prevent cognitive impairment rather than this useless crapola of predicting impairment? Do you tell your patients; 'Oh, you're going to be cognitively impaired but we have nothing to prevent it.'? Will you fucking idiots actually rub your two functioning neurons together and think for once?
Predictors of post-stroke cognitive impairment using acute structural MRI neuroimaging: A systematic review and meta-analysis
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 3 months after stroke. We synthesized 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 (three studies, N = 453, ORu = 2.48, 95% CI = 1.15–4.62), presence of microbleeds (two studies, N = 9151, ORa = 1.36, 95% CI = 1.08–1.70), and increasing severity of white matter hyperintensities (three 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 (two studies, N = 499, ORu = 1.34, 95%CI = 1.12–1.61; three 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.
Conclusion:
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.
Introduction
Cognitive problems after stroke are of major concern to stroke survivors and their families.1
Identifying who is at risk at the time of stroke may enable healthcare
professionals to arrange appropriate follow-up, inform patients and
their carers, and plan for possible future health outcomes(Nothing on how to prevent that cognitive impairment! Aren't you glad your doctors know nothing?). Individuals
at risk of post-stroke cognitive problems could also be targeted for
clinical trials with cognitive endpoints.
The
cognitive consequences of stroke are conventionally described as
post-stroke cognitive impairment (PSCI—impaired performance on a
structured cognitive assessment) and the subcategory of post-stroke
dementia (PSD—a clinical diagnosis of a cognitive change sufficient to
interfere with daily life).
International guidelines for PSCI highlight that there are currently no prediction tools suitable for clinical practice.2
A survey of 60 UK healthcare professionals reported that respondents
were aware that imaging features could predict PSCI, but they did not
use these features in clinical practice.3 Acute stroke neuroimaging could help healthcare professionals to identify who is at risk of PSCI.
Acute
stroke computed tomography (CT) brain imaging is routinely performed in
clinical practice to determine the cause of stroke. CT brain imaging is
inexpensive and quick to perform but has lower resolution than magnetic
resonance imaging (MRI). Recently, MRI has become more available for
stroke diagnosis in clinical practice. MRI also allows the
identification of neuroimaging features such as cerebral microbleeds
(CMB) that are rarely visible on CT brain scans. MRI may help identify
neuroimaging features associated with post-stroke cognitive problems.
Cerebral small vessel disease (cSVD) is commonly associated with stroke and dementia.4
Neuroimaging features include white matter hyperintensities (WMH), CMB,
lacunes, perivascular spaces (PVS), recent small subcortical infarcts,
and cerebral atrophy.5 Three systematic reviews have described the associations between neuroimaging features and PSD/PSCI.6–8 One review found that stroke survivors with moderate to severe WMH had a two-to-three-fold increased risk in PSD/PSCI.7
Another review reported that medial temporal lobe atrophy (MTLA) and
global atrophy were associated with increased risk of PSCI,6 and the third review highlighted an association between MTLA, WMH, and PSCI.8
These reviews included studies that performed brain imaging up to
several months after a stroke, which does not reflect what happens in
clinical practice. Only one review performed a sensitivity analysis
comparing the association between severity of WMH and PSD when
identified on CT versus MRI.7
The reviews did not report the association between acute stroke lesions
and post-stroke cognitive outcome. However, a multicohort study of 2950
stroke survivors reported that infarcts in the left thalamus, left
frontotemporal lobes, and right parietal lobe were associated with PSCI.9
Our previous systematic review focused on the prognostic utility of
acute stroke CT finding that presence of atrophy, WMH, and pre-existing
stroke lesions were associated with a two-to-three-fold increase in risk
of PSD, and WMH was associated with a three-fold increased risk in
PSCI.10 MRI is increasingly being used in clinical practice and is recommended for suspected TIA.11 A similar review focusing on MRI was needed.
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