TY - JOUR
T1 - Lesion locations are associated with cognitive impairment after ischemic stroke in young adults
AU - Schellekens, Mijntje M.I.
AU - Li, Hao
AU - Wijnands, Maartje
AU - Papounidou, Anastasia
AU - Boot, Esther M.
AU - Verhoeven, Jamie I.
AU - Ekker, Merel S.
AU - van Alebeek, Mayte E.
AU - Brouwers, Paul J.A.M.
AU - Arntz, Renate M.
AU - van Dijk, Gert W.
AU - Gons, Rob A.R.
AU - van Uden, Inge W.M.
AU - Heijer, Tom den
AU - van Tuijl, Julia H.
AU - de Laat, Karlijn F.
AU - van Norden, Anouk G.W.
AU - Vermeer, Sarah E.
AU - van Zagten, Marian S.G.
AU - van Oostenbrugge, Robert J.
AU - Wermer, Marieke J.H.
AU - Nederkoorn, Paul J.
AU - van Rooij, Frank G.
AU - van den Wijngaard, Ido R.
AU - de Kort, Paul L.M.
AU - Piai, Vitória
AU - de Leeuw, Frank Erik
AU - Kessels, Roy P.C.
AU - Tuladhar, Anil M.
N1 - Publisher Copyright:
© 2025 The Author(s).
PY - 2026/1/1
Y1 - 2026/1/1
N2 - Introduction Stroke location is an important determinant of post-stroke cognitive impairment (PSCI). In young adults, a comprehensive map of lesion patterns and their relations to PSCI is lacking. This study aims to identify lesion locations associated with poorer cognitive performance in patients with stroke at a young age. Methods We conducted a multicenter prospective cohort study between 2013 and 2021, enrolling patients aged 18–49 years with first-ever ischemic stroke and a visible stroke lesion on MRI. Cognitive assessments were performed within six months post-stroke, covering seven domains. We categorized patients as having no/mild or major vascular cognitive disorder (VCD), defined as a Z-score ' -2.0 in one or more domains. We assessed aphasia by the NIHSS language subscale. We performed multivariate lesion-symptom mapping to identify lesion locations associated with major VCD, poorer cognitive performance in each domain, and aphasia. Results Among 522 patients (median age 44.3 years [IQR 37.7–41.5]; 257 [49.2 %] women), 168 (32.2 %) had major VCD. Lesions in both hemispheres and cerebellar regions were associated with presence of a major VCD, and lower performance in episodic memory, processing speed, executive functioning, language, and attention and working memory. Aphasia had the strongest relationship with left fronto-temporo-parietal regions, while the left angular gyrus was the region most associated with major VCD. Discussion We show that lesion locations associated with poorer cognitive performance in young stroke patients are widely distributed, including cerebellar regions. This study showcases the complexity in the relationships between affected brain regions and cognitive symptoms, explaining the variability in post-stroke cognitive outcome.
AB - Introduction Stroke location is an important determinant of post-stroke cognitive impairment (PSCI). In young adults, a comprehensive map of lesion patterns and their relations to PSCI is lacking. This study aims to identify lesion locations associated with poorer cognitive performance in patients with stroke at a young age. Methods We conducted a multicenter prospective cohort study between 2013 and 2021, enrolling patients aged 18–49 years with first-ever ischemic stroke and a visible stroke lesion on MRI. Cognitive assessments were performed within six months post-stroke, covering seven domains. We categorized patients as having no/mild or major vascular cognitive disorder (VCD), defined as a Z-score ' -2.0 in one or more domains. We assessed aphasia by the NIHSS language subscale. We performed multivariate lesion-symptom mapping to identify lesion locations associated with major VCD, poorer cognitive performance in each domain, and aphasia. Results Among 522 patients (median age 44.3 years [IQR 37.7–41.5]; 257 [49.2 %] women), 168 (32.2 %) had major VCD. Lesions in both hemispheres and cerebellar regions were associated with presence of a major VCD, and lower performance in episodic memory, processing speed, executive functioning, language, and attention and working memory. Aphasia had the strongest relationship with left fronto-temporo-parietal regions, while the left angular gyrus was the region most associated with major VCD. Discussion We show that lesion locations associated with poorer cognitive performance in young stroke patients are widely distributed, including cerebellar regions. This study showcases the complexity in the relationships between affected brain regions and cognitive symptoms, explaining the variability in post-stroke cognitive outcome.
KW - Cognitive impairment
KW - Lesion-symptom mapping
KW - Stroke
U2 - 10.1016/j.nicl.2025.103930
DO - 10.1016/j.nicl.2025.103930
M3 - Article
SN - 2213-1582
VL - 49
JO - NeuroImage: Clinical
JF - NeuroImage: Clinical
M1 - 103930
ER -