Age-Related Brain Changes Influence Recovery After Stroke

 My doctor told me I had a bunch of white matter hyperintensities but never showed me them on any scan, so I don't know the size, location or any intervention needed, because my doctor knew nothing and did nothing.

This told me nothing useful. Like how to reverse white matter hyperintensities.

Age-Related Brain Changes Influence Recovery After Stroke

White matter hyperintensities (WMH) are associated with motor outcomes after stroke -- a phenomenon that may be under-recognised in stroke research, according to a study published in Neurology.

“WMHs are present in more than half of people [aged ≥60 years],” wrote Jennifer Ferris, PhD, University of British Columbia, Vancouver, British Columbia, and colleagues. “Individuals with WMHs are more likely to experience a stroke [and] there is growing evidence that WMHs can also affect functional outcomes after stroke.”

“The relationship between WMHs and post-stroke cognitive impairment has been well established; however, there have been few investigations of the specific impact of WMHs on motor outcomes after stroke,” they added.

For the current study, the researchers analysed data from 223 patients with stroke across 4 countries.

They found that larger WMHs were associated with more severe motor impairment after a stroke, independent of corticospinal tract (CST) damage (beta = 0.178; 95% confidence interval [CI], 0.025-0.331; P = .022).

Interestingly, the relationship between CST damage and motor impairment varied based on WMH severity. In patients with mild WMHs, motor impairment was related to CST lesion load (CST-LL; beta = 0.888; 95% CI, 0.604-1.172; P < .001), with a CST-LL × WMH interaction (beta = -0.211; 95% CI, -0.340 to -0.026; P = .026).

Conversely, patients with moderate-to-severe WMHs did not have this relationship. In this population, motor impairment related to WMH volume (beta = 0.299; 95% CI, 0.008-0.590; P = .044), but did not significantly relate to CST-LL or a CST-LL × WMH interaction.

The findings suggest that WMHs, indicative of cerebrovascular damage from a variety of sources, could provide additional context to understand an individual’s potential for recovery post-stroke. Therefore, assessing WMH volume could improve predictive models for stroke recovery.

“WMHs are related to overall cardiovascular and brain health as we age,” said Dr. Ferris. “By integrating assessments of age-related brain health, we may be better able to predict stroke recovery and tailor rehabilitation to individual needs. This personalised approach could open avenues to improve outcomes after stroke.”

Next, the researchers plan to pursue longitudinal studies to confirm their findings.

“[This] work is integral to our mission to advance stroke research and discovery by using novel imaging technologies to study the structural and functional changes in the brain,” concluded Arthur Toga, PhD, University of Southern California, Los Angeles, California. “We know that stroke is a leading cause of serious long-term disability, which has a considerable impact on public health. Studies such as this are a part of our goal to usher in a new era of precision rehabilitation that uses data-driven decision-making based on brain imaging and other non-invasive measures to identify personalised rehabilitation strategies.”

Reference: https://www.neurology.org/doi/10.1212/WNL.0000000000209387

SOURCE: Keck School of Medicine of USC