脑梗死急性期梗死部位及白质病变与认知功能关系的临床分析

【摘要】
目的 研究急性脑梗死患者梗死部位及是否合并脑白质病变对患者早期认知功能的影响。
方法 采用临床痴呆评定量表、简易精神状态检查量表和中文版蒙特利尔认知评估量表对连续入组的急性脑梗死患者进行认知心理学评估,分析患者不同梗死部位包括皮层梗死、皮层下关键部位梗死和皮层下非关键部位梗死及是否合并白质病变对患者认知功能的影响。
结果 急性脑梗死患者血管性认知功能障碍组的平均年龄显著高于无认知功能障碍组（67.31 10.88 vs 57.09 9.91,P=0.015）,神经功能缺损评分显著高于无认知功能障碍组［3.0（2.0～4.0） vs 1.0（1.0～2.0）,P=0.012］。认知功能障碍组的日常生活能力评分显著低于无认知功能障碍组（81.67 23.55 vs 95.91 12.00,P=0.029）。两组患者梗死部位有显著差异（P=0.042）,皮层梗死更多见于血管性认知功能障碍组,皮层梗死患者的视空间与执行功能显著低于皮层下非关键位置梗死患者［1.5（0.0～3.0） vs 3.0（2.0～4.0）,P=0.016］。白质病变与认知障碍的发生无明显相关性。
结论 急性脑梗死患者早期认知障碍与年龄、严重的神经功能缺损、皮层梗死、日常生活能力下降密切相关。     

缺血性脑血管病患者脑微出血危险因素及与认知功能的相关性

目的：探讨缺血性脑血管病患者脑微出血（CMBs）的危险因素及其对认知功能的影响方法183例缺血性脑血管病患者依据头部MRI梯度回波T2加权像分为CMBs组（66例）和Non‐CMBs组（117例）,观察2组患者的一般资料、并发症及腔隙性梗死数目和脑白质疏松程度,并进行蒙特利尔认知评估（MoCA）量表评分。结果 CMBs组患者平均年龄大于Non‐CMBs组患者（72.9±5.3 vs 69.6±4.9,t＝4.25,P＜0.001）;CMBs组患者腔隙性脑梗死数目和脑白质疏松程度均高于Non‐CMBs组（3.98±0.85 vs 3.05±0.77,t＝7.55,P＜0.001;4.91±1.02 vs 3.67±0.74,t＝9.46,P＜0.001）;高血压（OR＝2.324）、年龄（OR＝1.118）、腔隙性梗死数目（OR＝1.645）及脑白质疏松程度（OR＝2.347）为CMBs的危险因素;CMBs患者MoCA评分低于Non‐CMBs患者（22.41±2.30 vs 24.22±2.48,t＝4.86,P＜0.001）,分别在视空间执行能力、命名、注意和定向4个维度中差异有统计学意义（P＜0.05）。结论年龄、合并高血压、腔隙性梗死数目和脑白质疏松程度为CMBs的独立危险因素,CMBs患者伴随一定程度的认知功能障碍。     

高压氧治疗前交通动脉瘤术后认知功能障碍的效果分析

目的探讨高压氧治疗（HOT）前交通动脉瘤患者术后认知功能障碍的效果。方法50例前交通动脉瘤术后出现认知功能障碍患者,随机分为HOT组（26例）和对照组（24例）。两组患者治疗前及治疗后30d均采用简明精神状态检查量表（MMSE）和日常活动能力量表（ADL）评估认知功能。结果HOT组治疗前后MMSE评分分别为（23±4．1）分和（28±3．2）分,两者差异显著（P〈0．05）。对照组治疗前后MMSE评分分别为（22±2.3）分和（24±2．1）分,差异显著（P〈0．05）。HOT组治疗前后ADL评分分别为（47±2．3）分和（24±1．2）分,两者差异显著（P〈0．05）。对照组治疗前后ADL评分分别为（46±4．23）分和（37±2．4）分,两者差异显著（P〈0．05）。治疗后HOT组MMSE、ADL评分与对照组比较,均差异显著（P〈0．05）。结论早期HOT可有效改善前交通动脉瘤患者术后认知功能障碍。     

尼莫地平改善脑血管病患者认知功能的有效性观察

目的 该研究旨在观察尼莫地平片对血管性认知损害的短期疗效。方法 前瞻性开放性自身对照研究。64例神经内科门诊脑血管病患者,在常规二级预防药物的基础上,口服尼莫地平60～90 mg/d,12～24周。应用简明精神状态量表（mini mental state examination,MMSE）和北京版蒙特利尔认知评估量表（Montreal cognitive assessment,MoCA）作为认知评估工具,观察治疗前后患者认知功能的变化。结果 三个月治疗后认知成绩总分显著高于治疗前,分别为：MMSE（26.3±2.7）vs（25.6±2.9）,P =0.039;MoCA（20.5±4.6）vs（19.0±4.1）,P =0.000,差异有显著性;治疗后MoCA的记忆分测验成绩显著高于治疗前,分别为（1.8±1.7）vs（1.1±1.2）,P =0.000,差异有显著性。结论 尼莫地平可有效地提高脑血管病患者的认知功能     

糖尿病伴发脑梗死患者急性期认知损害及其相关因素分析

目的探讨2型糖尿病伴发脑梗死患者急性期认知损害及其影响因素。方法选择发病时间≤7d且诊断明确的急性期单纯脑梗死和糖尿病伴发脑梗死患者,酶放大化学发光法检测血浆同型半胱氨酸水平。简易智能状态检查量表（MMSE）评价认知损害程度。结果糖尿病伴发脑梗死组患者血浆同型半胱氨酸水平：（17．06±4．4t）μmol／L高于、MMSE评分（25．36±3．11）低于单纯脑梗死组[（15．49±4．1t）μmol／L和（26．48±2．26）],且组间差异有统计学意义（t=2．185,p≤0．031;t=．2．502,P=0．013）;以完全,部分前循环梗死患者血浆同型半胱氨酸水平最高、MMSE评分最低,其次为后循环梗死和腔隙性梗死。糖尿病伴发脑梗死组患者MMSE评分分别与年龄、糖尿病病程、血压、总胆固醇、三酰甘油、低密度脂蛋白．胆固醇、糖化血红蛋白、同型半胱氨酸和脑卒中亚型呈负相关（均P=0．000）;与吸烟、心血管病病史、受教育程度和高密度脂蛋白-胆固醇呈正相关（P〈0．05或P〈0．01）.结论糖尿病伴发脑梗死患者认知损害可能与高同型半胱氨酸血症导致的神经毒性、脑卒中类型、脑血管病相关危险因素．以及糖尿病病程和血糖控制状态具有密切关系.     

天智颗粒对血管性痴呆认知功能及事件相关电位P300的影响

目的观察天智颗粒对认知功能及事件相关电位P300的影响。方法 60例血管性痴呆患者随机分为治疗组和对照组各30例,应用简易智力状态检查量表（MMSE）和日常生活能力量表（ADL）检测2组治疗前后认知功能状态及日常生活能力,并进行治疗前后P300检查,共观察30d。结果治疗前2组MMSE、ADL评分及P300潜伏期和波幅差异均无统计学意义（P〉0.05）;治疗后治疗组P300潜伏期缩短、波幅提高,MMSE、ADL评分优于对照组（P〈0.05）。结论天智颗粒能改善VaD患者认知功能、提高患者的日常生活能力。     

老年性痴呆患者开展康复护理对MMSE、ADL评分的影响

目的 探讨老年性痴呆患者实施康复护理方案对MMSE、ADL评分的影响,为临床护理积累经验.方法 选取我院神经内科于2010-03-2013-02收治的100例老年性痴呆患者,按随机数字表法分为研究组和对照组,每组50例.对照组开展常规护理措施,研究组开展康复护理.2组患者在住院当天、实施护理干预第4周末和第8周末分别采用简易智能精神状况量表（MMSE）和日常生活能力量表（ADL）进行评分.结果 （1） 2组住院当天MMSE评分比较差异无统计学意义（P＞0.05）;住院第4周末和第8周末的MMSE评分较住院当天均有所提高（P＜0.05）;研究组在第4周末和第8周末MMSE评分分别为（17.56±0.40）、（19.11±0.42）分,对照组分别为（16.01±0.41）、（16.91±0.39）分,差异有统计学意义（P＜0.05）.（2） 2组住院当天MBI指数比较差异无统计学意义（P＞0.05）;住院第4周末和第8周末的MBI指数较住院当天均有所提高（P＜0.05）;研究组在第4周末和第8周末MBI指数分别为（17.56±0.40）、（19.11±0.42）分,对照组分别为（16.01±0.41）、（16.91±0.39）分,2组比较差异有统计学意义（P＜0.05）.结论 康复护理对老年性痴呆患者而言,是一项行之有效的干预方案,能够改善患者的认知能力,并提高其生活质量,值得临床进一步推广.     

MoCA与MMSE对首发脑梗死患者认知功能的评估应用

目的探讨蒙特利尔认知评估量表（MoCA）与简易智能状态检查量表（MMSE）在脑梗死患者认知功能评估中的应用。方法选择首发单一病灶脑梗死患者160例,在其发病3个月后,用MoCA与MMSE进行认知功能检测,并将不同性别、年龄段、受教育程度患者的MoCA与MMSE评分进行比较。结果不同性别、年龄、受教育程度患者的MoCA评分均低于MMSE评分,差异有统计学意义（P〈0.01）。年龄（β=-3.176,P=0.000）、性别（β=2.189,P=0.002）、受教育程度（β=2.032,P=0.000）为MoCA评分的影响因素。结论与MMSE相比,MoCA更适用于脑梗死后认知功能障碍诊断,其评分受患者年龄、性别、受教育程度影响。     

阿尔茨海默病患者神经精神症状与脑白质高信号的相关性分析

目的 分析阿尔茨海默病（AD）患者脑白质高信号（WMH）与神经精神症状（NPSs）的相关 性。方法 选取 2021 年 4 月至 2022 年 3 月在成都市第四人民医院记忆门诊就诊的 97 例 AD 患者为研究 对象。采用简易精神状态检查（MMSE）、日常生活活动能力量表（ADL）、神经精神科问卷（NPI）评估患者 的认知功能、日常生活活动能力和 NPSs。对患者的头部进行 3T MRI 扫描后,采用 UBO-Detctor 软件提 取患者各脑区 WMH 体积。采用偏相关分析 AD 患者各脑区 WMH 体积与 MMSE、ADL、NPI 评分的相关 性。结果 97 例 AD 患者的 MMSE 评分为 11.0（5.5,19.0）分,ADL 评分为 38.0（26.0,54.0）分,NPI 评分为 16.0（3.0,34.0）分。AD 患者的 MMSE 评分与全脑、脑室周围、左侧颞叶、右侧颞叶 WMH 体积呈负相关（r= -0.240、-0.239、-0.332、-0.208;P＜ 0.05）;ADL 评分与左侧颞叶、右侧颞叶 WMH 体积呈正相关（r=0.352、 0.257;P＜ 0.05）;NPI 评分与左侧颞叶 WMH 体积呈正相关（r=0.373,P＜ 0.05）。NPI 的 12 项症状中, AD 患者妄想与左侧枕叶 WMH 体积呈正相关（r=0.214,P＜ 0.05）;幻觉、激越 / 攻击性与左侧颞叶、顶叶 WMH 体积呈正相关（r=0.354、0.212、0.460、0.254;P＜ 0.05）;焦虑、情感高涨 / 欣快、睡眠 / 夜间行为、食 欲 / 进食障碍与左侧颞叶 WMH 体积呈正相关（r=0.222、0.422、0.295、0.222;P＜ 0.05）。结论 脑白质 的损伤程度与 AD 患者的认知功能、日常生活能力及 NPSs 存在相关性,不同脑区的白质损伤与不同的 NPSs 相关,预防脑白质的损伤或能改善 AD 患者的 NPSs。     

急性腔隙性脑梗死患者血清胱抑素C与认知功能的相关性研究

目的探讨急性腔隙性脑梗死患者血清胱抑素C(cystatin C,CysC)水平与认知功能的相关性。方法123例住院治疗的小血管病变所致急性腔隙性脑梗死患者根据CysC水平被分为低、中、高三组(各组均为n=41例)。根据认知功能评测分为认知功能正常组(n=64),血管性轻度认知功能障碍(vascular mild cognitive impairment,VaMCI)组(n=36)及血管性痴呆(vascular dementia,VaD)组(n=23)。比较组间血清CysC、估算的肾小球滤过率(estimated glomerular filtration rate,eGFR)、血清肌酐(serum creatinine,Scr)、血脂、空腹血糖、糖化血红蛋白A1C、血压、美国国立卫生研究院卒中量表(NIHSS)评分、简易精神状态量表(MMSE)、阿尔兹海默病评定量表认知分量表(ADAS-cog)、汉密尔顿抑郁量表(HAMD)得分的差异。采用Logistic回归方法分析CysC与认知功能障碍的相关性。结果高水平血清CysC组较中、低水平血清CysC组的MMSE得分更低(21.98±6.08 vs.25.02±4.69 vs.25.10±3.95),ADAS-cog得分更高(17.73±14.23 vs.12.51±10.39 vs.10.67±7.53),差异有统计学意义(P0.05)。随着血清CysC升高,SCr逐渐升高,e GFR逐渐减低(P0.05)。CysC(0.93±0.21 vs.1.10±0.45 vs.1.34±0.58)、MMSE、ADAS-cog在认知正常组、VaMCI组和VaD三组间两两比较差异均具有统计学意义(P0.05),认知损害越重,CysC越高。多元Logistic回归分析显示CysC的回归系数为7.06(P0.05)。结论血清CysC升高是小血管病变所致急性腔隙性脑梗死患者认知功能障碍的危险因素之一,且与认知障碍的严重程度相关。     

Gender-specificities in Alzheimer's disease and mild cognitive impairment

Background Amnestic Mild Cognitive Impairment (MCI) is a condition with an increased risk for developing Alzheimer's disease (AD). Presently, gender differences are neglected in the assessment of MCI and AD. Methods We examined verbal and visuospatial episodic memory in 143 subjects diagnosed as healthy controls (HC; N = 48, Mini-Mental State Examination (MMSE) 29.2 ± 1.0 (mean ± standard deviation)), MCI (N = 43,MMSE 28.5 ± 1.4), and AD (N = 49, MMSE 25.1 ± 2.2). Findings Female HC and MCI subjects performed better on verbal episodic memory tasks than males. In contrast, visuospatial episodic memory was better in male than female AD patients. Conclusions We interpret the results in light of a genderspecific cognitive reserve and conclude that the gender-specificity of neuropsychological performance needs to be accounted for in clinical diagnosis of Alzheimer’s disease.     

Predictors of depressive symptoms among spouse caregivers in Parkinson's disease.

The objective of this work was to determine the predictors of depressive symptoms among spouse caregivers of Parkinson's disease (PD) patients. Little is known about the strain in giving care to PD patients and how the motor, cognitive, and behavioral complications of PD contribute to depression among spouse caregivers. Forty-five consecutive PD patients and their spouse caregivers agreed to be evaluated after a routine clinic visit. Patient demographic data and the presence of hallucinations, delusions, incontinence, and sleep disturbances were obtained. The patients were assessed using the Unified Parkinson's Disease Rating Scale (UPDRS-motor section), Hoehn and Yahr (H&Y) staging, and the Mini-Mental State Examination (MMSE). Depressive symptoms were assessed using the 17-item Hamilton Depression Scale (HAMD-17) and the Beck Depression Inventory-II (BDI-II) on patients and spouses. Thirty men and 15 women had a mean age of 71.5 years (range 53-85), average PD duration of 10 years (range 1-26), a mean "on" H&Y stage of 2.8 and an MMSE mean score of 26 (range 13-30). There was good correlation between the HAMD-17 and the BDI-II scores in both patients (r = 0.69, P = 0.001) and spouses (r = 0.66, P < 0.001). A moderate correlation was noted between the spouse HAMD-17 score and the patient UPDRS-motor score (r = 0.34; P = 0.02), the age of PD onset (r = 0.33; P = 0.02) and patient HAMD-17 scores (r= 0.29; P = 0.05). A stronger correlation was noted between spouse HAMD-17 scores and the years of PD duration (r= 0.43; P = 0.003). There was a significant difference in the mean spouse HAMD-17 scores among PD patients with sleep disturbances versus those who did not (10.2 vs. 6.4; P = 0.04). However, on stepwise regression analysis, only the duration of PD remained significant (adjusted r = 0.17; P = 0.003). No difference was noted with hallucinations, delusions or incontinence. We concluded that the duration of PD appears to be the strongest predictor of depressive symptoms among spouse-caregivers in this small cohort.     

European neuroborreliosis: neuropsychological findings 30 months post-treatment

Background: The aim of this study was to compare neuropsychological (NP) functioning in patients with Lyme neuroborreliosis (LNB) 30 months after treatment to matched controls. Methods: We tested 50 patients with LNB and 50 controls with the trail‐making test (TMT), Stroop test, digit symbol test, and California Verbal Learning test (CVLT). A global NP sumscore was calculated to express the number of low scores on 23 NP subtasks. Results: Mean scores were lower amongst LNB‐treated patients than amongst controls on tasks assessing attention/executive functions: (Stroop test 4: 77.6 vs. 67.0, P = 0.015), response/processing speed (TMT 5: 23.4 vs. 19.2, P = 0.004), visual memory (digit symbol recall: 6.6 vs. 7.2, P = 0.038), and verbal memory (CVLT list B: 4.68 vs. 5.50, P = 0.003). The proportion of patients and controls with NP sumscores within one SD from the mean in the control group (defined as normal) and between one and two SD (defined as deficit) were similar, but more LNB‐treated patients than controls had a sumscore more than two SD from the mean (defined as impairment) (8 vs. 1, P = 0.014). Conclusions: As a group, LNB‐treated patients scored lower on four NP subtasks assessing processing speed, visual and verbal memory, and executive/attention functions, as compared to matched controls. The distribution of NP dysfunctions indicates that most LNB‐treated patients perform comparable to controls, whilst a small subgroup have a debilitating long‐term course with cognitive problems.     

Characterisation of DWI-MRI confirmed cerebral infarcts in patients with subarachnoid haemorrhage and their association with MMP-9 levels

Abstract

Objectives:

It has been suggested that metalloproteinase-9 (MMP-9) could predict the onset of cerebral vasospasm after subarachnoidal haemorrhage (SAH). The aim of this study was to analyse, in patients with SAH, the difference between patients with MRI ischaemic infarcts and patients without, and to investigate the role of metalloproteases as a prognostic factor for ischaemic infarcts.

Methods:

Sixty eight consecutive patients with SAH and diffusion-weighted magnetic resonance imaging (DWI-MRI) done 3 weeks after SAH. We define two groups, with and without DWI-MRI infarcts. Blood samples were taken at entry, 3 days and 1 week MMP-9 was determined through ELISA method.

Results:

Forty per cent were male, with a mean age of 54?±?14 years. Twenty five patients, 36.8%, had DWI-MRI infarcts; in patients with MRI infarcts, SAH was more severe (Fisher?=?4 52 vs 25.6%, P?=?0.037), with more morbi-mortality (Rankin>3 48 vs 18.6%, P?=?0.014), and more symptomatic vasospasm (28 vs 7%, P?=?0.031). Levels of MMP-9 were higher than controls, but there were no significant differences between patients with and without infarcts (first determination no infarcts 39.40?ng/ml?±?35.40 vs infarcts 49.75?ng/ml?±?34.54, P>0.005, 3 days no infarcts 72.10?ng/ml?±?70.95 vs infarcts 62.28?±?33.84, P>0.005, 1 week no infarcts 148.48?ng/ml?±?142.73 vs infarcts 91.51?ng/ml?±?41.20, P>0.005).

Conclusion:

Thirty eight percent in a well-studied series of patients with SAH have DWI-MRI infarcts; the infarcts were associated to SAH severity, SAH outcome and symptomatic vasospasm. Metalloproteinase-9 was higher in SAH patients than in controls, but it could not discriminate the infarct patients.     

The role of rectal chloride secretion in childhood constipation

Background Disturbance in fluid secretion, driven by chloride secretion, might play a role in constipation. However, disturbed chloride secretion in those patients has yet to be evaluated. Therefore, the aim of this study was to compare chloride secretion in rectal biopsies of children with functional constipation (FC) to those without constipation. Methods To measure changes in short circuit current (I_sc in μA cm^?2) reflecting chloride secretion, intestinal biopsies from children with constipation, to either exclude or diagnose Hirschsprung’s disease, and from children without constipation (controls) undergoing colonoscopy for screening of familial adenomatous polyposis, juvenile polyps or inflammatory bowel disease (IBD), were compared and studied in Ussing chambers. Following electrogenic sodium absorption blockade by amiloride, chloride secretory responses to calcium‐linked (histamine, carbachol) and cAMP‐linked (IBMX/forskolin) secretagogues were assessed. Key Results Ninety‐six patients (46 FC) participated; nine FC patients (n = 1 congenital syndrome and n = 8 technical problems) and 13 controls (n = 6 IBD; n = 7 technical problems) were excluded. No significant difference was found in mean (±SE) basal chloride currents between children with FC and controls (9.6 ± 1.1 vs 9.2 ± 0.8; P = 0.75, respectively). Responses to calcium‐linked chloride secretagogues (histamine and carbachol) were significantly higher in controls (33.0 ± 3.0 vs 24.5 ± 2.3; P = 0.03 and 33.6 ± 3.4 vs 26.4 ± 2.7; P = 0.05 following histamine and carbachol, respectively). Conclusions & Inferences Calcium‐linked chloride secretion is disturbed in children with FC. Whether this defect occurs at the level of histamine receptors, components of receptor‐linked signal transduction pathways or basolateral Ca²⁺‐sensitive K⁺ channels enhancing the electrical driving force for apical chloride secretion, remains to be explored.     

Differential Impact of Executive Dysfunction on Verbal List Learning and Story Recall

The California Verbal Learning Test (CVLT) and the Logical Memory (LM) subtest from the Wechsler Memory Scale-Revised (WMS-R) are generally thought to be interchangeable measures of verbal memory. However, little is known about the effects of executive dysfunction on these tasks. The present study involved 96 patients referred for neuropsychological evaluation who were classified as having either significant executive dysfunction (SED) or minimal executive dysfunction (MED) based on the number of impaired executive tasks. Results showed that the SED group performed significantly worse on CVLT total words learned and most of the recall conditions compared to the MED patients (p &lt; .01). However, performance on both immediate and delayed LM did not significantly differentiate the groups. CVLT measures of semantic clustering, perseveration, intrusions, and false positive errors did not appear to account for the group differences. The current study strongly suggests that the CVLT and the LM subtest are differentially associated with executive dysfunction, and argues for the inclusion of both types of tasks in a comprehensive neuropsychological evaluation. &lt;/.01).&gt;     

Differential impact of executive dysfunction on verbal list learning and story recall

The California Verbal Learning Test (CVLT) and the Logical Memory (LM) subtest from the Wechsler Memory Scale-Revised (WMS-R) are generally thought to be interchangeable measures of verbal memory. However, little is known about the effects of executive dysfunction on these tasks. The present study involved 96 patients referred for neuropsychological evaluation who were classified as having either significant executive dysfunction (SED) or minimal executive dysfunction (MED) based on the number of impaired executive tasks. Results showed that the SED group performed significantly worse on CVLT total words learned and most of the recall conditions compared to the MED patients (p <.01). However, performance on both immediate and delayed LM did not significantly differentiate the groups. CVLT measures of semantic clustering, perseveration, intrusions, and false positive errors did not appear to account for the group differences. The current study strongly suggests that the CVLT and the LM subtest are differentially associated with executive dysfunction, and argues for the inclusion of both types of tasks in a comprehensive neuropsychological evaluation.     

Verbal memory disorders provoked by a variety of stokes

In recent years a consensus has been reached about the neuroanatomical substrate of verbal memory, but this state of knowledge has not yet been implemented in clinical practice. One reason for this may be that most of the neuroscientific studies on verbal memory used different neuropsychological instruments and that only a small set of patient groups with the same etiology but different lesion sites were analysed. Returning to three earlier studies, we analyse the possibility to make differential judgements on the verbal memory impairments of four different patient groups by using the California Verbal Learning Test (CVLT). We compare patients with left-sided (n = 16) and right-sided (n = 10) posterior cerebral artery infarcts and patients with infarcts of the left (n = 10) or right (n = 21) frontal lobe, and we integrated data about their retention errors that had not been analysed so far. Our findings reveal significant differences between these patient groups, concerning the quantitative aspects of impairments, and also the profiles of memory errors (recall, interference and perseverations). Our study documents a relation between the site of the lesion and the type of verbal memory impairment, agreeing with some of the most recent neuroscientific findings. Starting from this observation we try to define a neuropsychological pattern of memory impairment which enables differential clinical diagnoses using the CVLT as a memory test.     

Secondary thalamic atrophy related to brain infarction may contribute to post-stroke cognitive impairment

Background and purposeThe thalamus is a key brain hub that is globally connected to many cortical regions. Previous work highlights thalamic contributions to multiple cognitive functions, but few studies have measured thalamic volume changes or cognitive correlates. This study investigates associations between thalamic volumes and post-stroke cognitive function.MethodsParticipants with non-thalamic brain infarcts (3-42 months) underwent MRI and cognitive testing. Focal infarcts and thalami were traced manually. In cases with bilateral infarcts, the side of the primary infarct volume defined the hemisphere involved. Brain parcellation and volumetrics were extracted using a standardized and previously validated neuroimaging pipeline. Age and gender-matched healthy controls provided normal comparative thalamic volumes. Thalamic atrophy was considered when the volume exceeded 2 standard deviations greater than the controls.ResultsThalamic volumes ipsilateral to the infarct in stroke patients (n=55) were smaller than left (4.4 ± 1.4 vs. 5.4 ± 0.5 cc, p < 0.001) and right (4.4 ± 1.4 vs. 5.5 ± 0.6 cc, p < 0.001) thalamic volumes in the controls. After controlling for head-size and global brain atrophy, infarct volume independently correlated with ipsilateral thalamic volume (β= -0.069, p=0.024). Left thalamic atrophy correlated significantly with poorer cognitive performance (β = 4.177, p = 0.008), after controlling for demographics and infarct volumes.ConclusionsOur results suggest that the remote effect of infarction on ipsilateral thalamic volume is associated with global post-stroke cognitive impairment