title: Clinical impact of leukoaraiosis burden and chronological age on neurological deficit recovery and 90-day outcome after minor ischemic stroke.
abstract: OBJECTIVE
  Ischemic stroke remains a leading cause of disability, particularly among the elderly, but this association has not been consistently noted among patients with minor stroke. We sought to determine the association of chronological age and leukoaraiosis, which is considered a marker of biological age, with the degree of neurological deficit recovery and 90-day disability after minor ischemic stroke.
  
  
  METHODS
  We retrospectively analyzed 185 patients with a minor ischemic stroke (National Institutes of Health Stroke Scale [NIHSS] score ≤ 5). Leukoaraiosis severity was graded according to the van Swieten scale. NIHSS was assessed at baseline, discharge, and 90-days. Multivariable linear and ordinal logistic regression analyses were constructed to identify independent predictors of the degree of NIHSS-improvement (ΔNIHSS) and 90-day outcome as assessed by the modified Rankin Scale (mRS).
  
  
  RESULTS
  Patients with severe leukoaraiosis had attenuated ΔNIHSS at 90 days as compared to patients with none-to-mild leukoaraiosis (p=0.028). After adjustment, leukoaraiosis severity (p<0.001) but not chronological age (p=0.771) was independently associated with the ΔNIHSS by day 90. Severe leukoaraiosis (p=0.003, OR 3.1, 95%-CI 1.5-6.4), older age (p=0.001, OR 1.0 95%-CI 1.0-1.1), and admission NIHSS (p<0.001, OR 1.5, 95%-CI 1.2-1.8) were independent predictors of the 90-day mRS.
  
  
  CONCLUSIONS
  Leukoaraiosis is a more sensitive predictor for neurological deficit recovery after ischemic stroke than chronological age. Further study is required to establish the specific contribution of leukoaraiosis to functional outcome after minor ischemic stroke beyond its impact on recovery mechanisms.
authors.affiliation: Department of Neurology, University of Massachusetts Medical School, Worcester, MA, United States.
authors.forename: Sanjeeva R
authors.initials: SR
authors.lastname: Onteddu
authors.affiliation: Department of Neurology, University of Massachusetts Medical School, Worcester, MA, United States.
authors.forename: Richard P
authors.initials: RP
authors.lastname: Goddeau
authors.affiliation: Department of Neurology, University of Massachusetts Medical School, Worcester, MA, United States.
authors.forename: Artin
authors.initials: A
authors.lastname: Minaeian
authors.affiliation: Department of Neurology, University of Massachusetts Medical School, Worcester, MA, United States; Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, United States. Electronic address: nils.henninger@umassmed.edu.
authors.forename: Nils
authors.initials: N
authors.lastname: Henninger
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D002545:Brain Ischemia / Q000150:complications; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D049292:Leukoaraiosis / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000188:drug therapy / Q000209:etiology*; D010960:Plasminogen Activators / Q000627:therapeutic use; D020127:Recovery of Function / Q000502:physiology*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D020521:Stroke / Q000150:complications* / Q000209:etiology; D014057:Tomography, X-Ray Computed
chemical_list: D010960:Plasminogen Activators
keywords: Brain frailty; Ischemic stroke; Leukoaraiosis; Old age; Outcome; Recovery; Small vessel disease