White Matter Hyperintensity Volume and Poststroke Cognition: An Individual Patient Data Pooled Analysis of 9 Ischemic Stroke Cohort Studies.
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de Kort Floor A S, Coenen Mirthe, Weaver Nick A, Kuijf Hugo J, Aben Hugo P, Bae Hee-Joon, Bordet Régis, Cammà Guido, Chen Christopher P L H, Dewenter Anna, Duering Marco, Fang Rong, van der Giessen Ruben S, Hamilton Olivia K L, Hilal Saima, Huenges Wajer Irene M C, Kan Cheuk Ni, Kim Jonguk, Kim Beom Joon, Köhler Sebastian, de Kort Paul L M, Koudstaal Peter J, Lim Jae-Sung, Lopes Renaud, Mok Vincent C T, Staals Julie, Venketasubramanian Narayanaswamy, Verhagen Charlotte M, Verhey Frans R J, Wardlaw Joanna M, Xu Xin, Yu Kyung-Ho, Biesbroek J Matthijs, Biessels Geert Jan
Аннотация
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 (Z 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, P=0.01] for verbal memory to -0.19 [SE, 0.03, P<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.