title: Prevalence and cognitive impact of medial temporal atrophy in a hospital stroke service: retrospective cohort study.
abstract: BACKGROUND
  Cerebrovascular disease and neurodegeneration cause cognitive impairment and frequently coexist.
  
  
  OBJECTIVE
  Our objectives were to investigate the prevalence and cognitive impact of medial temporal lobe atrophy - a radiological marker often associated with Alzheimer's disease - in a hospital stroke service.
  
  
  METHODS
  Retrospective cohort study of patients from a hospital stroke service. Patients assessed for suspected ischemic stroke or transient ischemic attack, irrespective of final diagnosis, underwent neuropsychological testing and magnetic resonance imaging. medial temporal lobe atrophy, white matter hyperintensities, lacunes, and cerebral microbleeds were rated using established criteria and validated scales. The associations between medial temporal lobe atrophy and cognition were tested using multivariable logistic regression analyses, adjusted for age and imaging markers of cerebrovascular disease.
  
  
  RESULTS
  Three hundred and ninety-three patients were included, of whom 169 (43%; 95% confidence interval: 38·1-48·1%) had medial temporal lobe atrophy; in 38 patients (9·7%), medial temporal lobe atrophy was severe (mean score ≥2). In unadjusted logistic regression analyses in the whole cohort, mean medial temporal lobe atrophy score was associated with verbal memory, nominal and perceptual skills, executive function, and speed and attention. After adjustment for age, white matter hyperintensities, number of lacunes, presence of cerebral microbleeds, previous ischemic stroke or transient ischemic attack, and premorbid intelligence quotient, mean medial temporal lobe atrophy score remained associated with impairment in verbal memory (odds ratio: 1·64; 95% confidence interval 1·04-2·58) and nominal skills (odds ratio: 1·61; 95% confidence interval 1·04-2·48).
  
  
  CONCLUSIONS
  Medial temporal lobe atrophy is common and has an independent impact on cognitive function in a stroke service population, independent of confounding factors including age and magnetic resonance imaging markers of cerebrovascular disease. Medial temporal lobe atrophy is independently related to verbal memory and nominal skills, while small vessel pathology also contributes to speed and attention, and executive and perceptual functions.
authors.affiliation: Stroke Research Group, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London, UK.
authors.forename: Valeria
authors.initials: V
authors.lastname: Kebets
authors.affiliation: Stroke Research Group, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London, UK.
authors.forename: Simone M
authors.initials: SM
authors.lastname: Gregoire
authors.affiliation: Stroke Research Group, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London, UK.
authors.forename: Andreas
authors.initials: A
authors.lastname: Charidimou
authors.affiliation: Department of Neurodegenerative Disease, UCL Institute of Neurology, London, UK.
authors.forename: Josephine
authors.initials: J
authors.lastname: Barnes
authors.affiliation: Department of Biostatistics, Joint UCL/UCH/RFH Research Support Centre, National Hospital for Neurology and Neurosurgery, London, UK.
authors.forename: Khadija
authors.initials: K
authors.lastname: Rantell
authors.affiliation: Stroke Research Group, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London, UK.
authors.forename: Martin M
authors.initials: MM
authors.lastname: Brown
authors.affiliation: Neuroradiological Academic Unit, National Hospital for Neurology and Neurosurgery, London, UK.
authors.forename: Hans R
authors.initials: HR
authors.lastname: Jäger
authors.affiliation: Department of Neuropsychology, Università di Palermo, Palermo, Italy.|Dipartimento di Psicologia, Università di Palermo, Palermo, Italy.
authors.forename: Lisa
authors.initials: L
authors.lastname: Cipolotti
authors.affiliation: Stroke Research Group, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London, UK.
authors.forename: David J
authors.initials: DJ
authors.lastname: Werring
mesh_terms: D001284:Atrophy; D002545:Brain Ischemia / Q000453:epidemiology / Q000473:pathology / Q000628:therapy; D003072:Cognition Disorders / Q000453:epidemiology* / Q000209:etiology / Q000473:pathology* / Q000628:therapy; D005260:Female; D006760:Hospitalization; D006801:Humans; D016015:Logistic Models; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009483:Neuropsychological Tests; D015995:Prevalence; D012189:Retrospective Studies; D012720:Severity of Illness Index; D020521:Stroke / Q000453:epidemiology* / Q000473:pathology* / Q000628:therapy; D013702:Temporal Lobe / Q000473:pathology*
keywords: cerebral amyloid angiopathy; medial temporal lobe atrophy