Heterogeneity of White Matter Hyperintensity and Cognitive Impairment in Patients with Acute Lacunar Stroke
Abstract
:1. Introduction
2. Materials and Methods
2.1. Patients
2.2. Data Collection and Baseline Evaluation
2.3. MRI Imaging
2.4. CSVD Imaging Markers
2.5. Neuropsychological Assessment and Follow-Up Visit
2.6. Statistical Analysis
3. Results
3.1. Baseline Clinical Features and MRI Characteristics
3.2. Independent Risk Factors for Cognitive Impairment in ALS Patients
3.3. Comparison of Clinical Features and CSVD Characteristics between Mismatch and Match Types
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Abbreviations
References
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Total Patients (n = 213) | With Cognitive Impairment (n = 66) | Without Cognitive Impairment (n = 147) | p Value | BH-Adjusted p Values (q Value) | |
---|---|---|---|---|---|
Demographic and clinical characteristics | |||||
Age (years) | 64 (56–72) | 68 (62–76) | 62 (53–72) | p = 0.001 * | q = 0.004 # |
Male, n (%) | 136 (63.8%) | 35 (53.0%) | 101 (68.7%) | p = 0.028 * | q = 0.061 # |
Medical history | |||||
Cerebral infarction, n (%) | 46 (21.6%) | 21 (31.8%) | 25 (17.0%) | p = 0.015 * | q = 0.043 # |
Hypertension, n (%) | 159 (74.6%) | 53 (80.3%) | 106 (72.1%) | p = 0.204 | q = 0.295 |
Diabetes mellitus, n (%) | 59 (27.7%) | 22 (33.3%) | 37 (25.2%) | p = 0.218 | q = 0.298 |
MOCA score | 22 (19–25) | 20 (16–24) | 24 (23–26) | p < 0.001 * | q = 0.001 # |
Depression, n (%) | 18 (8.5%) | 8 (12.1%) | 10 (6.8%) | p = 0.197 | q = 0.295 |
NIHSS score | 3 (1–3) | 4 (1–5) | 2(1–3) | p = 0.018 * | q = 0.043 # |
Laboratory examination | |||||
Thrombocyte (109/L) | 201 ± 58 | 201 ± 60 | 202 ± 59 | p = 0.793 | q = 0.825 |
LDL-C (mmol/L) | 2.64 (2.07–3.14) | 2.63 (2.08–3.05) | 2.65 (2.07–3.16) | p = 0.360 | q = 0.446 |
Hemoglobin (g/L) | 134 (124–144) | 131 (121–142) | 135 (126–146) | p = 0.035 * | q = 0.070 # |
Creatinine (μmol/L) | 71 (57–80) | 70 (60–81) | 71 (57–80) | p = 0.685 | q = 0.759 |
hs-CRP (mg/L) | 3.75 (0.76–4.71) | 4.21 (0.85–4.97) | 3.59 (0.66–4.59) | p = 0.136 | q = 0.236 |
Fibrinogen (g/L) | 2.72 (2.14–3.13) | 1.75 (2.37–3.37) | 1.64 (2.00–3.04) | p = 0.001 * | q = 0.004 # |
Imaging features | |||||
Infarction lesions | |||||
Thalamus | 25 (11.7%) | 8 (12.1%) | 17 (11.6%) | p = 0.907 | q = 0.907 |
Basal ganglia/internal capsule | 82 (38.5) | 27 (40.9%) | 55 (37.4%) | p = 0.628 | q = 0.742 |
Centrum ovale/corona radiata | 70 (32.9%) | 18 (27.3%) | 52 (35.4%) | p = 0.244 | q = 0.317 |
Medulla/midbrain/pons/cerebellum | 52 (24.4%) | 15 (22.7%) | 37 (25.2%) | p = 0.701 | q = 0.759 |
WMH Fazekas score (0–6) | 2 (0–4) | 3 (1–4) | 2 (0–3) | p = 0.067 | q = 0.124 |
Lacune, n (%) | 114 (53.5%) | 44 (66.7%) | 70 (47.6%) | p = 0.011 * | q = 0.036 # |
Microbleeds, n (%) | 52 (24.4%) | 28 (42.4%) | 24 (16.3%) | p < 0.001 * | q = 0.001 # |
EPVS (N > 10), n (%) | 109 (51.2%) | 42 (63.6%) | 67 (45.6%) | p = 0.017 * | q = 0.043 # |
Moderate to severe WMH, n (%) | 76 (35.7%) | 37 (56.1%) | 39 (26.5%) | p < 0.001 * | q = 0.001 # |
Periventricular WMH | 1 (0–2) | 2 (1–3) | 1 (0–2) | p = 0.189 | q = 0.295 |
Deep WMH | 1 (0–1) | 1 (0–2) | 0 (0–1) | p < 0.001 * | q = 0.001 # |
Total CSVD score (0–4) | 2 (1–3) | 2 (1–3) | 1 (0–2) | p = 0.001 * | q = 0.004 # |
OR | 95% CI | B | p Value | |
---|---|---|---|---|
Age(years) | 1.044 | 1.009–1.080 | 0.043 | p = 0.014 * |
Male, n (%) | 0.379 | 0.176–0.817 | −0.970 | p = 0.013 * |
NIHSS score | 1.124 | 0.995–1.268 | 0.116 | p = 0.060 |
Cerebral infarction history, n (%) | 2.359 | 1.027–5.419 | 0.858 | p = 0.043 * |
Fibrinogen (g/L) | 1.810 | 1.242–2.639 | 0.594 | p = 0.002 * |
Moderate to severe WMH | 3.485 | 1.656–7.333 | 1.248 | p = 0.001 * |
Deep WMH | 6.037 | 2.600–14.020 | 1.798 | p < 0.001 * |
Total CSVD score (0–4) | p = 0.005 * | |||
0 | Ref. | Ref. | Ref. | Ref. |
1 | 0.558 | 0.189–1.654 | −0.583 | p = 0.293 |
2 | 1.116 | 0.388–3.211 | 0.110 | p = 0.839 |
3 | 1.878 | 0.598–5.898 | 0.630 | p = 0.281 |
4 | 7.309 | 1.872–28.530 | 1.989 | p = 0.004 * |
Mismatch Type (n = 40) | Match Type (n = 115) | p Value | |
---|---|---|---|
Demographic and clinical characteristics | |||
Age (years) | 67 ± 10 | 61 ± 12 | p = 0.012 * |
Male, n (%) | 25(62.5%) | 73 (63.5%) | p = 0.912 |
Depression, n (%) | 7(17.5%) | 7 (6.1%) | p = 0.030 * |
Medical history | |||
Cerebral infarction, n (%) | 12(30.0%) | 22 (19.1%) | p = 0.152 |
Hypertension, n (%) | 31(77.5%) | 83 (72.2%) | p = 0.511 |
Diabetes mellitus, n (%) | 13(32.5%) | 31 (27.0%) | p = 0.503 |
Laboratory examination | |||
Thrombocyte (109/L) | 194 ± 45 | 204 ± 63 | p = 0.285 |
LDL-C (mmol/L) | 2.59 (1.91–3.11) | 2.65 (2.08–3.10) | p = 0.343 |
Hemoglobin (g/L) | 135 (125–145) | 134 (125–145) | p = 0.864 |
Creatinine (μmol/L) | 72 (59–81) | 71 (56–79) | p = 0.193 |
hs-CRP (mg/L) | 3.70 (0.79–4.92) | 3.77 (0.77–4.47) | p = 0.852 |
Fibrinogen (g/L) | 2.55 (2.09–2.91) | 2.70 (2.15–3.06) | p = 0.422 |
Imaging features | |||
Periventricular WMH | 1 (0–3) | 1 (0–1) | p = 0.109 |
Deep WMH | 1 (0–2) | 1 (0–1) | p = 0.038 * |
Lacune, n (%) | 22 (55.0%) | 59 (51.3%) | p = 0.724 |
Microbleeds, n (%) | 10 (25.0%) | 25 (21.7%) | p = 0.690 |
EPVS (N > 10), n (%) | 22 (55.0%) | 49 (42.6%) | p = 0.190 |
Total CSVD score (0–4) | 2 (1–3) | 1 (0–2) | p = 0.082 |
Type 1 | Type 2 | |||||
---|---|---|---|---|---|---|
Mismatch (n = 27) | Match (n = 98) | p Value | Mismatch (n = 13) | Match (n = 17) | p Value | |
Age (years) | 64 (55–73) | 59 (51–68) | p = 0.081 | 73 ± 7 | 73 ± 9 | p = 0.971 |
Male, n (%) | 13 (48.2%) | 63 (64.3%) | p = 0.128 | 12 (92.3%) | 10 (58.8%) | p = 0.040 * |
NIHSS score | 4 (1–4) | 2 (1–3) | p = 0.018 * | 3 (0–3) | 2 (0–4) | p = 0.915 |
Depression, n (%) | 6 (22.2%) | 6 (6.1%) | p = 0.012 * | 1 (7.7%) | 1 (5.9%) | p = 0.844 |
Medical history | ||||||
Cerebral infarction, n (%) | 8 (29.6%) | 17 (17.4%) | p = 0.158 | 4 (30.8%) | 5 (29.4%) | p = 0.936 |
Hypertension, n (%) | 20 (74.1%) | 69 (70.4%) | p = 0.710 | 11 (84.6%) | 14 (82.4%) | p = 0.869 |
Diabetes mellitus, n (%) | 11 (40.7%) | 25 (25.5%) | p = 0.122 | 2 (15.4%) | 6 (35.3%) | p = 0.222 |
Laboratory examination | ||||||
Thrombocyte (109/L) | 195 ± 48 | 204 ± 63 | p = 0.275 | 191 ± 38 | 203 ± 66 | p = 0.572 |
LDL-C (mmol/L) | 2.62 ± 1.04 | 2.64 ± 0.77 | p = 0.091 | 2.54 (2.28–3.12) | 2.71 (2.37–3.10) | p = 0.967 |
Hemoglobin (g/L) | 134 (124–143) | 135 (126–146) | p = 0.477 | 136 ± 13 | 129 ± 15 | p = 0.184 |
Creatinine (μmol/L) | 69 (57–78) | 71 (56–78) | p = 0.732 | 78 ± 13 | 72 ± 16 | p = 0.287 |
hs-CRP (mg/L) | 3.42 (0.79–3.57) | 3.67 (0.67–4.43) | p = 0.859 | 4.26 (0.75–7.23) | 4.36 (0.92–4.97) | p = 0.706 |
Fibrinogen (g/L) | 2.85 (2.27–3.14) | 2.67 (2.08–3.06) | p = 0.339 | 1.93 (1.36–2.45) | 2.89 (2.48–3.11) | p = 0.005 * |
Imaging features | ||||||
Periventricular WMH | 1 (0–1) | 0 (0–1) | p = 0.613 | 3 (3–3) | 3 (2–3) | p = 0.035 * |
Deep WMH | 0 (0–0) | 0 (0–0) | p = 0.560 | 2 (2–3) | 3 (2–3) | p = 0.026 * |
Lacune, n (%) | 15 (55.6%) | 45 (45.9%) | p = 0.399 | 7 (53.8%) | 14 (82.4%) | p = 0.091 |
Microbleeds, n (%) | 8 (29.6%) | 13 (13.3%) | p = 0.047 * | 2 (15.4%) | 12 (70.6%) | p = 0.003 * |
EPVS (N > 10), n (%) | 13 (48.1%) | 36 (36.7%) | p = 0.300 | 9 (69.2%) | 13 (76.5%) | p = 0.657 |
Total CSVD score | 1 (0–2) | 1 (0–2) | p = 0.184 | 2 (2–3) | 3 (3–4) | p = 0.017 * |
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Ye, M.; Zhou, Y.; Chen, H.; Zhu, S.; Diao, S.; Zhao, J.; Kong, Y.; Li, T. Heterogeneity of White Matter Hyperintensity and Cognitive Impairment in Patients with Acute Lacunar Stroke. Brain Sci. 2022, 12, 1674. https://doi.org/10.3390/brainsci12121674
Ye M, Zhou Y, Chen H, Zhu S, Diao S, Zhao J, Kong Y, Li T. Heterogeneity of White Matter Hyperintensity and Cognitive Impairment in Patients with Acute Lacunar Stroke. Brain Sciences. 2022; 12(12):1674. https://doi.org/10.3390/brainsci12121674
Chicago/Turabian StyleYe, Mengfan, Yun Zhou, Huiru Chen, Sijia Zhu, Shanshan Diao, Jieji Zhao, Yan Kong, and Tan Li. 2022. "Heterogeneity of White Matter Hyperintensity and Cognitive Impairment in Patients with Acute Lacunar Stroke" Brain Sciences 12, no. 12: 1674. https://doi.org/10.3390/brainsci12121674