TY - JOUR
T1 - White Matter Hyperintensity Volume and Poststroke Cognition
T2 - An Individual Patient Data Pooled Analysis of 9 Ischemic Stroke Cohort Studies
AU - de Kort, Floor A S
AU - Coenen, Mirthe
AU - Weaver, Nick A
AU - Kuijf, Hugo J
AU - Aben, Hugo P
AU - Bae, Hee-Joon
AU - Bordet, Régis
AU - Cammà, Guido
AU - Chen, Christopher P L H
AU - Dewenter, Anna
AU - Duering, Marco
AU - Fang, Rong
AU - van der Giessen, Ruben S
AU - Hamilton, Olivia K L
AU - Hilal, Saima
AU - Huenges Wajer, Irene M C
AU - Kan, Cheuk Ni
AU - Kim, Jonguk
AU - Kim, Beom Joon
AU - Köhler, Sebastian
AU - de Kort, Paul L M
AU - Koudstaal, Peter J
AU - Lim, Jae-Sung
AU - Lopes, Renaud
AU - Mok, Vincent C T
AU - Staals, Julie
AU - Venketasubramanian, Narayanaswamy
AU - Verhagen, Charlotte M
AU - Verhey, Frans R J
AU - Wardlaw, Joanna M
AU - Xu, Xin
AU - Yu, Kyung-Ho
AU - Biesbroek, J Matthijs
AU - Biessels, Geert Jan
PY - 2023/12
Y1 - 2023/12
N2 - BACKGROUND: White matter hyperintensities (WMH) are associated with cognitive dysfunction after ischemic stroke. Yet, uncertainty remains about affected domains, the role of other preexisting brain injury, and infarct types in the relation between WMH burden and poststroke cognition. We aimed to disentangle these factors in a large sample of patients with ischemic stroke from different cohorts. METHODS: We pooled and harmonized individual patient data (n=1568) from 9 cohorts, through the Meta VCI Map consortium (www.metavcimap.org). Included cohorts comprised patients with available magnetic resonance imaging and multidomain cognitive assessment <15 months poststroke. In this individual patient data meta-analysis, linear mixed models were used to determine the association between WMH volume and domain-specific cognitive functioning ( scores; attention and executive functioning, processing speed, language and verbal memory) for the total sample and stratified by infarct type. Preexisting brain injury was accounted for in the multivariable models and all analyses were corrected for the study site as a random effect. RESULTS: In the total sample (67 years [SD, 11.5], 40% female), we found a dose-dependent inverse relationship between WMH volume and poststroke cognitive functioning across all 4 cognitive domains (coefficients ranging from -0.09 [SE, 0.04, =0.01] for verbal memory to -0.19 [SE, 0.03, <0.001] for attention and executive functioning). This relation was independent of acute infarct volume and the presence of lacunes and old infarcts. In stratified analyses, the relation between WMH volume and domain-specific functioning was also largely independent of infarct type. CONCLUSIONS: In patients with ischemic stroke, increasing WMH volume is independently associated with worse cognitive functioning across all major domains, regardless of old ischemic lesions and infarct type.
AB - BACKGROUND: White matter hyperintensities (WMH) are associated with cognitive dysfunction after ischemic stroke. Yet, uncertainty remains about affected domains, the role of other preexisting brain injury, and infarct types in the relation between WMH burden and poststroke cognition. We aimed to disentangle these factors in a large sample of patients with ischemic stroke from different cohorts. METHODS: We pooled and harmonized individual patient data (n=1568) from 9 cohorts, through the Meta VCI Map consortium (www.metavcimap.org). Included cohorts comprised patients with available magnetic resonance imaging and multidomain cognitive assessment <15 months poststroke. In this individual patient data meta-analysis, linear mixed models were used to determine the association between WMH volume and domain-specific cognitive functioning ( scores; attention and executive functioning, processing speed, language and verbal memory) for the total sample and stratified by infarct type. Preexisting brain injury was accounted for in the multivariable models and all analyses were corrected for the study site as a random effect. RESULTS: In the total sample (67 years [SD, 11.5], 40% female), we found a dose-dependent inverse relationship between WMH volume and poststroke cognitive functioning across all 4 cognitive domains (coefficients ranging from -0.09 [SE, 0.04, =0.01] for verbal memory to -0.19 [SE, 0.03, <0.001] for attention and executive functioning). This relation was independent of acute infarct volume and the presence of lacunes and old infarcts. In stratified analyses, the relation between WMH volume and domain-specific functioning was also largely independent of infarct type. CONCLUSIONS: In patients with ischemic stroke, increasing WMH volume is independently associated with worse cognitive functioning across all major domains, regardless of old ischemic lesions and infarct type.
KW - brain
KW - cerebral small vessel diseases
KW - cognition
KW - infarcts
KW - ischemic stroke
KW - neuroimaging
U2 - 10.1161/STROKEAHA.123.044297
DO - 10.1161/STROKEAHA.123.044297
M3 - Article
SN - 0039-2499
VL - 54
SP - 3021
EP - 3029
JO - Stroke
JF - Stroke
IS - 12
ER -