Risk factors and clinical significance of post-stroke incident ischemic lesions.

Autor: Fang R; Institute for Stroke and Dementia Research (ISD), LMU University Hospital, LMU Munich, Munich, Germany., Duering M; Institute for Stroke and Dementia Research (ISD), LMU University Hospital, LMU Munich, Munich, Germany.; Medical Image Analysis Center (MIAC AG) and Department of Biomedical Engineering, University of Basel, Basel, Switzerland., Bode FJ; German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany.; Department of Vascular Neurology, University Hospital Bonn, Bonn, Germany., Stösser S; German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany.; Department of Vascular Neurology, University Hospital Bonn, Bonn, Germany., Meißner JN; German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany.; Department of Vascular Neurology, University Hospital Bonn, Bonn, Germany., Hermann P; Universitätsmedizin Göttingen, Klinik für Neurologie, Göttingen, Germany.; German Center for Neurodegenerative Diseases (DZNE), Göttingen, Germany., Liman TG; Center for Stroke Research Berlin (CSB), Charité - Universitätsmedizin Berlin, Berlin, Germany.; German Center for Neurodegenerative Diseases (DZNE, Berlin), Berlin, Germany.; Department of Neurology, Carl Von Ossietzky University, Oldenburg, Germany., Nolte CH; German Center for Neurodegenerative Diseases (DZNE, Berlin), Berlin, Germany.; Department of Neurology with Experimental Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany.; Berlin Institute of Health (BIH), Berlin, Germany., Kerti L; Center for Stroke Research Berlin (CSB), Charité - Universitätsmedizin Berlin, Berlin, Germany.; German Center for Neurodegenerative Diseases (DZNE, Berlin), Berlin, Germany., Ikenberg B; Department of Neurology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany., Bernkopf K; Department of Neurology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany., Glanz W; Department of Neurology, University Hospital, Otto-von-Guericke University Magdeburg, Magdeburg, Germany.; German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany., Janowitz D; Institute for Stroke and Dementia Research (ISD), LMU University Hospital, LMU Munich, Munich, Germany., Wagner M; German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany.; Department of Old Age Psychiatry and Cognitive Disorders, University Hospital Bonn, Bonn, Germany., Neumann K; Department of Neurology, University Hospital, Otto-von-Guericke University Magdeburg, Magdeburg, Germany., Speck O; German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany.; Department of Biomedical Magnetic Resonance, Institute for Physics, Otto-von-Guericke University Magdeburg, Magdeburg, Germany.; Leibniz Institute for Neurobiology, Magdeburg, Germany.; Center for Behavioral Brain Sciences, Magdeburg, Germany., Düzel E; German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany., Gesierich B; Institute for Stroke and Dementia Research (ISD), LMU University Hospital, LMU Munich, Munich, Germany.; Medical Image Analysis Center (MIAC AG) and Department of Biomedical Engineering, University of Basel, Basel, Switzerland., Dewenter A; Institute for Stroke and Dementia Research (ISD), LMU University Hospital, LMU Munich, Munich, Germany., Spottke A; German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany.; Department of Vascular Neurology, University Hospital Bonn, Bonn, Germany., Waegemann K; Institute for Stroke and Dementia Research (ISD), LMU University Hospital, LMU Munich, Munich, Germany.; German Center for Neurodegenerative Diseases (DZNE, Munich), Munich, Germany., Görtler M; Department of Neurology, University Hospital, Otto-von-Guericke University Magdeburg, Magdeburg, Germany.; German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany., Wunderlich S; Department of Neurology, TUM School of Medicine, Technical University of Munich, Munich, Germany., Zerr I; Universitätsmedizin Göttingen, Klinik für Neurologie, Göttingen, Germany.; German Center for Neurodegenerative Diseases (DZNE), Göttingen, Germany., Petzold GC; German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany.; Department of Vascular Neurology, University Hospital Bonn, Bonn, Germany., Endres M; Center for Stroke Research Berlin (CSB), Charité - Universitätsmedizin Berlin, Berlin, Germany.; German Center for Neurodegenerative Diseases (DZNE, Berlin), Berlin, Germany.; German Centre for Cardiovascular Research (DZHK), partner site Berlin, Berlin, Germany.; German Center for Mental Health (DZPG), partner site Berlin, Berlin, Germany.; Klinik und Hochschulambulanz für Neurologie, Charité - Universitätsmedizin Berlin, Berlin, Germany., Georgakis MK; Institute for Stroke and Dementia Research (ISD), LMU University Hospital, LMU Munich, Munich, Germany.; Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA., Dichgans M; Institute for Stroke and Dementia Research (ISD), LMU University Hospital, LMU Munich, Munich, Germany.; German Center for Neurodegenerative Diseases (DZNE, Munich), Munich, Germany.; Munich Cluster for Systems Neurology (SyNergy), Munich, Germany.; German Centre for Cardiovascular Research (DZHK, Munich), Munich, Germany.
Jazyk: angličtina
Zdroj: Alzheimer's & dementia : the journal of the Alzheimer's Association [Alzheimers Dement] 2024 Dec; Vol. 20 (12), pp. 8412-8428. Date of Electronic Publication: 2024 Oct 17.
DOI: 10.1002/alz.14274
Abstrakt: Introduction: While incident ischemic lesions (IILs) are not unusual on follow-up magnetic resonance imaging (MRI) following stroke, their risk factors and prognostic significance remain unknown.
Methods: In a prospective multicenter study of 503 acute stroke patients, we assessed IILs on registered MRI images at baseline and 6 months, analyzing risk factors and clinical outcomes across 36 months.
Results: At 6 months, 78 patients (15.5%) had IILs, mostly diffusion-weighted imaging-positive (72%) and clinically covert (91%). Older age and small vessel disease (SVD) lesions were baseline risk factors for IILs. IILs were associated with worse cognitive (beta for global cognition: -0.31, 95% confidence interval [CI]: -0.48 to -0.14) and functional outcomes (beta for modified Rankin scale [mRS]: 0.36, 95% CI: 0.14 to 0.58), and higher recurrent stroke risk (hazard ratio: 3.81, 95% CI: 1.35 to 10.69). IILs partially explained the relationship between SVD and poor cognition.
Discussion: IILs are common and are associated with worse cognitive and functional outcomes and stroke recurrence risk. Assessing IILs following stroke might aid prognostication.
Highlights: Incident ischemic lesions (IILs) were assessed with registered baseline and 6-month magnetic resonance imaging (MRI) scans in a stroke cohort. IILs 6 months after stroke are present in one-sixth of patients and are mostly clinically silent. Small vessel disease burden is the main baseline risk factor for IILs. IILs are associated with cognitive and functional impairment and stroke recurrence. Assessing IILs by follow-up MRI aids long-term prognostication for stroke patients.
(© 2024 The Author(s). Alzheimer's & Dementia published by Wiley Periodicals LLC on behalf of Alzheimer's Association.)
Databáze: MEDLINE
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