Infarct volume as a predictor and therapeutic target in post-stroke cognitive impairment

 Your competent? doctor has known of this a long time. Was any protocol created to alleviate the problem? NO? So, you DON'T have a functioning stroke doctor, do you? And the hospital board of directors is also incompetent in not setting correct goals on doctors keeping up to date on all stroke research and implementing it!

24 to 70% post-stroke cognitive impairment (1 post to November 2019)

Infarct volume as a predictor and therapeutic target in post-stroke cognitive impairment

Lingjia Xu^1†Dan Shan^2†Danling Wu^1*

• ¹Department of Neurology, Shaoxing Second Hospital, Shaoxing, Zhejiang, China
• ²Department of Biobehavioral Sciences, Columbia University, New York, NY, United States

Post-stroke cognitive impairment is one of the most common consequences of stroke, affecting more than half of stroke patients, especially in the geriatric population. Post-ischemic stroke cognitive impairment (PISCI) is particularly detrimental, as it can exacerbate a patient’s disability. Given that the severe consequences of adverse life outcomes are major contributors to disability and death among survivors of ischemic stroke, preventing stroke and PISCI remains a fundamental strategy for maintaining optimal brain health. Recent studies have extensively investigated the epidemiology, diagnosis, and management of PISCI. Nevertheless, significant gaps persist in our understanding of its pathophysiological mechanisms and potential therapeutic targets, which warrants further research. Factors such as baseline brain health, cerebral small vessel disease, and stroke characteristics (e.g., infarct location, severity, and morphology) have been associated with PISCI. However, its pathophysiology remains inadequately understood. Recent research suggests that infarct volume may serve as a novel indicator for predicting(Predicting this DOES NOTHING FOR RECOVERY! Solve the fucking problem by PREVNTING IT!) and managing PISCI. Thus, this review aims to expand our understanding of factors influencing PISCI and to elucidate its pathophysiological mechanisms. In particular, infarct volume has been proposed as a potential target and may play a critical role in predicting and managing PISCI. We advocate for improved and timely predictions of PISCI to enhance the quality of life for patients and reduce the economic and emotional burden on caregivers.

Introduction

Ischemic stroke is a major cause of disability and mortality worldwide (1). The prevalence of post-ischemic stroke cognitive impairment (PISCI) has been extensively studied, but reported rates vary significantly due to differences in the applicability of cognitive assessment tools and the heterogeneity of study populations (2). A seminal meta-analysis estimated the prevalence of PISCI to be 53%, with approximately two-thirds of cases involving mild cognitive impairment and one-third classified as dementia (3). Notably, the prevalence in hospitalized patients, estimated at around 50%, may be underestimated, as 4–25% of patients deemed unevaluable remain at high risk for developing PISCI (4–6). An increasing number of research projects and clinical trials are now focused on enhancing acute-phase treatment for ischemic stroke (7–9). However, it is important to note that post-stroke complications continue to be the primary contributors to post-stroke morbidity and mortality on a global scale. PISCI is a common consequence of stroke that directly affects the patient’s function and quality of life and places a heavy burden on caregivers and healthcare systems. The occurrence and development of PISCI are influenced by multiple factors, including modifiable and unmodifiable risk factors, comorbidities, stroke characteristics, baseline brain health, and other elements (10, 11). As a result, early diagnosis, precise therapy, and comprehensive management of PISCI have become central research priorities.

The potential pathogenesis of PISCI is complex, with stroke characteristics such as severity, location, morphology, and a history of prior strokes being closely associated with its development. The significance of infarct location in PISCI is highlighted by lesions in areas critical for cognitive function processing in cerebral infarctions (12). Recent studies have shown a strong correlation between PISCI and infarctions in the left frontotemporal and thalamic regions, as well as the right parietal area (13). Morevoer, a notable link exists between PISCI and vertebrobasilar artery stenosis in the posterior circulation, likely resulting from insufficient perfusion to the hippocampus and posterior cingulate cortex (14). However, infarct location alone may not suffice to predict PISCI accurately, prompting researchers to suggest more comprehensive approaches, such as combining infarct volume with lesion location and lesion network mapping, to enhance prediction capabilities. Overall, the potential important role of infarct volume in PISCI has not been fully explored. Infarct volume may influence overall brain health and cognitive function, representing a key area for future research in the prediction and management of PISCI.

More at link.