Predictors of post-stroke cognitive impairment using acute structural MRI neuroimaging: A systematic review and meta-analysis

• Published in: International Journal of Stroke Vol. 18; no. 5; pp. 543 - 554
• Main Authors: Ball, Emily L, Shah, Mahnoor, Ross, Eilidh, Sutherland, Rachel, Squires, Charlotte, Mead, Gillian E, Wardlaw, Joanna M, Quinn, Terence J, Religa, Dorota, Lundström, Erik, Cheyne, Joshua, Shenkin, Susan D
• Format: Book Review Journal Article
• Language: English
• Published: London, England SAGE Publications 01-06-2023
• Subjects: Adult; Aged; Aged, 80 and over; Brain - diagnostic imaging; Brain - pathology; Cerebral Small Vessel Diseases - complications; Cognitive Dysfunction - complications; Cognitive Dysfunction - etiology; Cognitive impairment; Dementia; Dementia - etiology; Female; Humans; Magnetic Resonance Imaging; Male; Medical Science; Medicin och hälsovetenskap; Medicinsk vetenskap; Middle Aged; MRI; Neuroimaging; Post-stroke cognitive impairment; Stroke; Stroke - complications; Stroke - diagnostic imaging; Systematic Review; dementia; Stroke; cognitive impairment; MRI; neuroimaging
• ISSN: 1747-4930; 1747-4949; 1747-4949
• DOI: 10.1177/17474930221120349

Background:
Stroke survivors are at an increased risk of developing post-stroke cognitive impairment and post-stroke dementia; those at risk could be identified by brain imaging routinely performed at stroke onset.
Aim:
This systematic review aimed to identify features which are associated with post-stroke cognitive impairment (including dementia) on magnetic resonance imaging (MRI) performed at stroke diagnosis.
Summary of review:
We searched the literature from inception to January 2022 and identified 10,284 records. We included studies that performed MRI at the time of stroke (0–30 days after a stroke) and assessed cognitive outcome at least 3 months after stroke. We synthesized findings from 26 papers, comprising 27 stroke-populations (N = 13,114, average age range = 40–80 years, 19–62% female). When data were available, we pooled unadjusted (ORu) and adjusted (ORa) odds ratios.
We found associations between cognitive outcomes and presence of cerebral atrophy (three studies, N = 453, ORu = 2.48, 95% CI = 1.15–4.62), presence of microbleeds (two studies, N = 9151, ORa = 1.36, 95% CI = 1.08–1.70), and increasing severity of white matter hyperintensities (three studies, N = 704, ORa = 1.26, 95% CI = 1.06–1.49). Increasing cerebral small vessel disease score was associated with cognitive outcome following unadjusted analysis only (two studies, N = 499, ORu = 1.34, 95%CI = 1.12–1.61; three studies, N = 950, ORa = 1.23, 95% CI = 0.96–1.57). Associations remained after controlling for pre-stroke cognitive impairment. We did not find associations between other stroke features and cognitive outcome, or there were insufficient data.
Conclusion:
Acute stroke MRI features may enable healthcare professionals to identify patients at risk of post-stroke cognitive problems. However, there is still substantial uncertainty about the prognostic utility of acute MRI for this.