title: Cognitive and functional impairments in ischemic stroke patients with concurrent small vessel and large artery disease.
abstract: OBJECTIVE
  Concurrent small vessel, intracranial and extracranial large artery disease (SLAD) is common in Asian but its impact on cognitive and functional outcomes is unclear. We aimed to evaluate the clinical, cognitive and functional outcomes in ischemic stroke patients with SLAD.
  
  
  METHODS
  Chinese ischemic stroke patients with diffuse white matter lesions (WMLs) were recruited as part of the VITATOPS Trial. They were studied with MRI and MRA of brain. Various neuropsychiatric batteries were used to assess the cognitive functions.
  
  
  RESULTS
  Totally 97 patients with acute ischemic stroke and diffuse WMLs were included, of whom 44 (45%) had SLAD. Patients with SLAD had lower Mini Mental State Examination (MMSE) when compared with the patients without SLAD. They had more behavioral symptoms and caused more stress in caregivers as assessed by the Neuropsychiatric Inventory (NPI). Multivariate regression analysis showed SLAD contributed significantly to MMSE, NPI Patient (NPI P) and NPI Care Giver (NPI CG). Among 44 patients with SLAD, 30 (68%) had severe cognitive impairment. They were older and less educated. They had more diabetes and poorer performance in neuropsychiatric tests including Mattis Dementia Rating Scale Initiation/Perseveration subset (MDRS I/P) and Clinical Dementia Rating (CDR). They also had poorer functional outcomes as assessed by Barthel Index (BI) and Instrumental activities of daily living (IADL).
  
  
  CONCLUSIONS
  This was the first MRA-based study to take into consideration the clinical, cognitive and functional outcomes in ischemic stroke patients with SLAD. Patients with SLAD had poorer cognitive and functional outcomes when compared to patients without SLAD.
authors.affiliation: Division of Neurology, Department of Medicine and Geriatrics, Tuen Mun Hospital, Hong Kong, China. manbikling@gmail.com
authors.forename: B L
authors.initials: BL
authors.lastname: Man
authors.forename: Y P
authors.initials: YP
authors.lastname: Fu
authors.forename: A
authors.initials: A
authors.lastname: Wong
authors.forename: Y Y
authors.initials: YY
authors.lastname: Chan
authors.forename: Wynnie
authors.initials: W
authors.lastname: Lam
authors.forename: A C F
authors.initials: AC
authors.lastname: Hui
authors.forename: W H
authors.initials: WH
authors.lastname: Leung
authors.forename: V
authors.initials: V
authors.lastname: Mok
authors.forename: K S
authors.initials: KS
authors.lastname: Wong
mesh_terms: D000368:Aged; D001007:Anxiety / Q000150:complications / Q000523:psychology; D044466:Asian People; D001921:Brain / Q000473:pathology; D002545:Brain Ischemia / Q000150:complications / Q000473:pathology / Q000523:psychology*; D002196:Capillaries / Q000473:pathology*; D002339:Carotid Arteries / Q000473:pathology; D002533:Cerebral Angiography; D002536:Cerebral Arteries / Q000473:pathology*; D002560:Cerebrovascular Circulation / Q000502:physiology; D003072:Cognition Disorders / Q000209:etiology* / Q000473:pathology; D003704:Dementia / Q000523:psychology; D003863:Depression / Q000150:complications / Q000523:psychology; D005260:Female; D006723:Hong Kong; D006801:Humans; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D008297:Male; D009483:Neuropsychological Tests; D011569:Psychiatric Status Rating Scales; D020521:Stroke / Q000209:etiology / Q000473:pathology / Q000523:psychology*; D016896:Treatment Outcome