Intracranial Atherosclerotic Stenosis is Related to Post-stroke Cognitive Impairment: A Cross-sectional Study of Minor Stroke

Author(s): Li Gong, Haichao Wang, Qiong Dong, Xiaoping Zhu, Xiaoran Zheng, Yongzhe Gu, Wangli Cai, Yanxin Zhao*, Xueyuan Liu*

Journal Name: Current Alzheimer Research

Volume 17 , Issue 2 , 2020

DOI : 10.2174/1567205017666200303141920

  Journal Home
Translate in Chinese
Become EABM
Become Reviewer

Abstract:

Background: Intracranial Atherosclerotic Stenosis (ICAS) is an important risk factor for cognitive impairment. However, it is unclear whether patients with ICAS are more likely to develop cognitive impairment after an acute, non-disabling ischemic stroke (minor stroke).

Objective: We aimed to investigate the association between ICAS and post-stroke cognitive impairment.

Methods: In this cross-sectional study, patients with acute, non-disabling ischemic stroke underwent two cognitive tests and imaging evaluation for ICAS, within two weeks after the stroke. To determine the association between ICAS and post-stroke cognitive impairment, we performed a multivariate logistic regression analysis adjusted for several demographic and vascular risk factors.

Results: Of the 164 patients with minor stroke in this study, 98 (59.76%) were diagnosed with poststroke cognitive impairment (Montreal Cognitive Assessment score<26). After adjusting for potential confounders, we found that patients with ICAS were more likely to develop cognitive impairment after an acute, non-disabling ischemic stroke, compared to patients without ICAS (Odds Ratio: 2.13; 95% Confidence Interval: 1.07-4.26), and underperformed in the tests of visuospatial and executive function.

Conclusion: In this cross-sectional study of a population that has experienced a minor stroke, our findings demonstrated a positive association between ICAS and post-stroke cognitive impairment.

Keywords: Minor stroke, intracranial stenosis, post stroke cognitive impairment, vascular cognitive impairment, dementia, cross-sectional study.

[1]
Pendlebury ST, Rothwell PM. Prevalence, incidence, and factors associated with pre-stroke and post-stroke dementia: a systematic review and meta-analysis. Lancet Neurol 8(11): 1006-18. (2009).
[http://dx.doi.org/10.1016/S1474-4422(09)70236-4] [PMID: 19782001]
[2]
Sun JH, Tan L, Yu JT. Post-stroke cognitive impairment: epidemiology, mechanisms and management. Ann Transl Med 2(8): 80. (2014).
[PMID: 25333055]
[3]
Divya KP, Menon RN, Varma RP, et al. Post-stroke cognitive impairment - A cross-sectional comparison study between mild cognitive impairment of vascular and non-vascular etiology. J Neurol Sci 372: 356-62. (2017).
[http://dx.doi.org/10.1016/j.jns.2016.10.031] [PMID: 27836108]
[4]
Arba F, Quinn TJ, Hankey GJ, et al. Enlarged perivascular spaces and cognitive impairment after stroke and transient ischemic attack. Int J Stroke 13(1): 47-56. (2018).
[http://dx.doi.org/10.1177/1747493016666091] [PMID: 27543501]
[5]
Guo J, Su W, Fang J, et al. Elevated CRP at admission predicts post-stroke cognitive impairment in Han Chinese patients with intracranial arterial stenosis. Neurol Res 40(4): 292-6. (2018).
[http://dx.doi.org/10.1080/01616412.2018.1438224] [PMID: 29451096]
[6]
OBrien RJ. Vascular dementia: atherosclerosis, cognition and Alzheimer’s disease. Curr Alzheimer Res 8(4): 341-4. (2011).
[http://dx.doi.org/10.2174/156720511795745267] [PMID: 21557721]
[7]
Zhu J, Wang Y, Li J, Deng J, Zhou H. Intracranial artery stenosis and progression from mild cognitive impairment to Alzheimer disease. Neurology 82(10): 842-9. (2014).
[http://dx.doi.org/10.1212/WNL.0000000000000185] [PMID: 24489130]
[8]
Wang A, Liu X, Chen G, Hao H, Wang Y, Wang Y. Association between carotid plaque and cognitive impairment in Chinese stroke population: The SOS-Stroke Study. Sci Rep 7(1): 3066. (2017).
[http://dx.doi.org/10.1038/s41598-017-02435-3] [PMID: 28596524]
[9]
Pantoni L, Poggesi A, Basile AM, et al. Leukoaraiosis predicts hidden global functioning impairment in nondisabled older people: the LADIS (Leukoaraiosis and Disability in the Elderly) Study. J Am Geriatr Soc 54(7): 1095-101. (2006).
[http://dx.doi.org/10.1111/j.1532-5415.2006.00798.x] [PMID: 16866681]
[10]
Johnston SC, Gress DR, Browner WS, Sidney S. Short-term prognosis after emergency department diagnosis of TIA. JAMA 284(22): 2901-6. (2000).
[http://dx.doi.org/10.1001/jama.284.22.2901] [PMID: 11147987]
[11]
Lees R, Corbet S, Johnston C, Moffitt E, Shaw G, Quinn TJ. Test accuracy of short screening tests for diagnosis of delirium or cognitive impairment in an acute stroke unit setting. Stroke 44(11): 3078-83. (2013).
[http://dx.doi.org/10.1161/STROKEAHA.113.001724] [PMID: 23988641]
[12]
Chiti G, Pantoni L. Use of Montreal Cognitive Assessment in patients with stroke. Stroke 45(10): 3135-40. (2014).
[http://dx.doi.org/10.1161/STROKEAHA.114.004590] [PMID: 25116881]
[13]
Kleindorfer D, Panagos P, Pancioli A, et al. Incidence and short-term prognosis of transient ischemic attack in a population-based study. Stroke 36(4): 720-3. (2005).
[http://dx.doi.org/10.1161/01.STR.0000158917.59233.b7] [PMID: 15731465]
[14]
Pollock A, St George B, Fenton M, Firkins L. Top ten research priorities relating to life after stroke. Lancet Neurol 11(3): 209. (2012).
[http://dx.doi.org/10.1016/S1474-4422(12)70029-7] [PMID: 22341029]
[15]
Giudetti AM, Romano A, Lavecchia AM, Gaetani S. The role of brain cholesterol and its oxidized products in Alzheimer’s disease. Curr Alzheimer Res 13(2): 198-205. (2016).
[http://dx.doi.org/10.2174/1567205012666150921103426] [PMID: 26391039]
[16]
Zheng L, Duan J, Duan X, et al. Association of apolipoprotein E (ApoE) pPolymorphism with Alzheimer’s disease in chinese population. Curr Alzheimer Res 13(8): 912-7. (2016).
[http://dx.doi.org/10.2174/1567205013666160401115307] [PMID: 27033052]
[17]
Cui X, Chopp M, Zhang Z, et al. ABCA1/ApoE/HDL pathway mediates GW3965-induced neurorestoration after stroke. Stroke 48(2): 459-67. (2017).
[http://dx.doi.org/10.1161/STROKEAHA.116.015592] [PMID: 28028143]
[18]
Albert M, Soldan A, Gottesman R, et al. Cognitive changes preceding clinical symptom onset of mild cognitive impairment and relationship to ApoE genotype. Curr Alzheimer Res 11(8): 773-84. (2014).
[http://dx.doi.org/10.2174/156720501108140910121920] [PMID: 25212916]
[19]
Oveisgharan S, Buchman AS, Yu L, et al. APOE ε2ε4 genotype, incident AD and MCI, cognitive decline, and AD pathology in older adults. Neurology 90(24): e2127-34. (2018).
[http://dx.doi.org/10.1212/WNL.0000000000005677] [PMID: 29752306]
[20]
Di Battista AM, Heinsinger NM, Rebeck GW. Alzheimer’s disease genetic risk factor APOE-ε4 also affects normal brain function. Curr Alzheimer Res 13(11): 1200-7. (2016).
[http://dx.doi.org/10.2174/1567205013666160401115127] [PMID: 27033053]
[21]
Crystal HA, Schneider JA, Bennett DA, Leurgans S, Levine SR. Associations of cerebrovascular and Alzheimer’s disease pathology with brain atrophy. Curr Alzheimer Res 11(4): 309-16. (2014).
[http://dx.doi.org/10.2174/1567205011666140302194358] [PMID: 24597507]
[22]
Brainin M, Tuomilehto J, Heiss WD, Bornstein NM, Bath PMW, Teuschl Y, et al. Post-stroke cognitive decline: an update and perspectives for clinical research. Eur J Neurol 22(2): 229-238, e13-e16. (2015).
[http://dx.doi.org/10.1111/ene.12626] [PMID: 25492161]
[23]
Huang YN, Gao S, Li SW, et al. Vascular lesions in Chinese patients with transient ischemic attacks. Neurology 48(2): 524-5. (1997).
[http://dx.doi.org/10.1212/WNL.48.2.524] [PMID: 9040750]
[24]
Li H, Wong KS. Racial distribution of intracranial and extracranial atherosclerosis. J Clin Neurosci 10(1): 30-4. (2003).
[http://dx.doi.org/10.1016/S0967-5868(02)00264-3] [PMID: 12464517]
[25]
Wong KS, Ng PW, Tang A, Liu R, Yeung V, Tomlinson B. Prevalence of asymptomatic intracranial atherosclerosis in high-risk patients. Neurology 68(23): 2035-8. (2007).
[http://dx.doi.org/10.1212/01.wnl.0000264427.09191.89] [PMID: 17548555]
[26]
De Silva DA, Ancalan M, Doshi K, Chang HM, Wong MC, Chen C. Intracranial large artery disease in Alzheimer’s disease and vascular dementia among ethnic Asians. Eur J Neurol 16(5): 643-5. (2009).
[http://dx.doi.org/10.1111/j.1468-1331.2009.02551.x] [PMID: 19222553]
[27]
Kim TW, Song IU, Jeong DS, Lee KS. Clinical effect of cerebrovascular atherosclerosis on cognition in Alzheimer’s disease. Arch Gerontol Geriatr 63: 55-8. (2016).
[http://dx.doi.org/10.1016/j.archger.2015.11.009] [PMID: 26631627]
[28]
Hilal S, Xu X, Ikram MK, Vrooman H, Venketasubramanian N, Chen C. Intracranial stenosis in cognitive impairment and dementia. J Cereb Blood Flow Metab 37(6): 2262-9. (2017).
[http://dx.doi.org/10.1177/0271678X16663752] [PMID: 27488908]
[29]
Man BL, Fu YP, Wong A, et al. Cognitive and functional impairments in ischemic stroke patients with concurrent small vessel and large artery disease. Clin Neurol Neurosurg 113(8): 612-6. (2011).
[http://dx.doi.org/10.1016/j.clineuro.2011.04.001] [PMID: 21530070]
[30]
Suri MFK, Zhou J, Qiao Y, et al. Cognitive impairment and intracranial atherosclerotic stenosis in general population. Neurology 90(14): e1240-7. (2018).
[http://dx.doi.org/10.1212/WNL.0000000000005250] [PMID: 29523643]
[31]
Li P, Quan W, Lu D, et al. Association between metabolic syndrome and cognitive impairment after acute ischemic stroke: a cross-sectional study in a chinese population. PLoS One 11(12)e0167327 (2016).
[http://dx.doi.org/10.1371/journal.pone.0167327] [PMID: 27936074]
[32]
Pantoni L, Poggesi A, Inzitari D. The relation between white-matter lesions and cognition. Curr Opin Neurol 20(4): 390-7. (2007).
[http://dx.doi.org/10.1097/WCO.0b013e328172d661] [PMID: 17620872]
[33]
Gong L, Liu XY, Fang M. Recent progress on small vessel disease with cognitive impairment. Int J Clin Exp Med 8(5): 7701-9. (2015).
[PMID: 26221320]
[34]
Suri MF, Qiao Y, Ma X, et al. Prevalence of intracranial atherosclerotic stenosis using high-resolution magnetic resonance angiography in the general population: the atherosclerosis risk in communities study. Stroke 47(5): 1187-93. (2016).
[http://dx.doi.org/10.1161/STROKEAHA.115.011292] [PMID: 27056984]
[35]
Wang Y, Wang Y, Zhao X, et al. Clopidogrel with aspirin in acute minor stroke or transient ischemic attack. N Engl J Med 369(1): 11-9. (2013).
[http://dx.doi.org/10.1056/NEJMoa1215340] [PMID: 23803136]
[36]
Levine DA, Galecki AT, Langa KM, et al. Trajectory of cognitive decline after incident stroke. JAMA 314(1): 41-51. (2015).
[http://dx.doi.org/10.1001/jama.2015.6968] [PMID: 26151265]
[37]
Gottesman RF, Hillis AE. Predictors and assessment of cognitive dysfunction resulting from ischaemic stroke. Lancet Neurol 9(9): 895-905. (2010).
[http://dx.doi.org/10.1016/S1474-4422(10)70164-2] [PMID: 20723846]
[38]
Boehm-Sturm P, Füchtemeier M, Foddis M, et al. Neuroimaging biomarkers predict brain structural connectivity change in a mouse model of vascular cognitive impairment. Stroke 48(2): 468-75. (2017).
[http://dx.doi.org/10.1161/STROKEAHA.116.014394] [PMID: 28070001]
[39]
Iadecola C, Gorelick PB. Converging pathogenic mechanisms in vascular and neurodegenerative dementia. Stroke 34(2): 335-7. (2003).
[http://dx.doi.org/10.1161/01.STR.0000054050.51530.76] [PMID: 12574528]


Rights & PermissionsPrintExport Cite as

Article Details

VOLUME: 17
ISSUE: 2
Year: 2020
Published on: 25 April, 2020
Page: [177 - 184]
Pages: 8
DOI: 10.2174/1567205017666200303141920
Price: $65

Article Metrics

PDF: 28
HTML: 2



Related Article(s)

Most Downloaded Article(s)