Lacunar infarcts: functional and cognitive outcomes at five years in relation to MRI findings.
BACKGROUND
There are few long-term follow-up studies of patients with lacunar infarcts (LIs). The purpose of this 5-year follow-up study was to assess functional and cognitive outcome in relation to MRI findings.


METHODS
81 patients with a first-ever LI were followed for 5 years with respect to mortality, stroke recurrence, functional and cognitive outcome. T(2)-weighted MRI was performed at baseline and at 5 years. The presence of basal ganglia lesions and white matter lesions was scored according to the European Task Force rating scale. Functional outcome was assessed with the Oxford Handicap Scale (OHP). Cognition was assessed with the Mini Mental State Examination (MMSE).


RESULTS
The 5-year mortality was 19%. Predictors for death were age (OR = 1.07, 95% CI 1.03-1.11), ischemic heart disease (OR = 2.1, 95% CI 1.1-4.1) and impairment score (OR = 1.16, 95% CI 1.02-1.32). 30% of the patients had a recurrent stroke. Predictors for recurrent stroke were diabetes mellitus (OR = 1.7, 95% CI 1.2-7.4) and amount of white matter lesions (OR = 1.7, 95% CI 1.2-2.7). 36% of the patients were functionally dependent (defined as OHP >2). Predictors for functional dependency were impairment score (OR = 1.71, 95% CI 1.12-2.59), MMSE (OR = 0.55, 95% CI 0.33-0.91) and stroke recurrence (OR = 84, 95% CI 9.4-745). 16% of the patients had cognitive impairment (defined as MMSE <24). Stroke recurrence and white matter score, but not basal ganglia score, were correlated to cognitive impairment.


CONCLUSIONS
Many LI patients have a good functional outcome at 5 years. For older patients, for patients with an initial severe stroke, and with additional vascular risk factors, however, the prognosis is more severe, with an increased risk for mortality, stroke recurrence, and physical and cognitive decline.
Appelros
Peter
P
Department of Neurology, Orebro University Hospital, Orebro, Sweden. peter.appelros@orebroll.se
Samuelsson
Margareta
M
Lindell
Dan
D
D000704:Analysis of Variance; D020520:Brain Infarction / Q000401:mortality / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D002423:Cause of Death; D003071:Cognition; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D016016:Proportional Hazards Models; D012008:Recurrence; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome