title: Medial temporal lobe atrophy, white matter hyperintensities and cognitive impairment among Nigerian African stroke survivors.
abstract: BACKGROUND
  Neuroimaging features associated with vascular cognitive impairment have not been examined in sub-Saharan Africans. We determined magnetic resonance imaging (MRI) features associated with cognitive impairment in a sample of Nigerian stroke survivors.
  
  
  METHODS
  Stroke survivors underwent brain MRI with standardized assessment of brain volumes and visual rating of medial temporal lobe atrophy (MTA), and white matter hyperintensities (WMH) at 3 months post-stroke. Demographic, clinical and psychometric assessments of global cognitive function, executive function, mental speed and memory were related to changes in structural MRI.
  
  
  RESULTS
  In our pilot sample of 58 stroke survivors (60.1 ± 10.7 years old) MTA correlated significantly with age (r = 0.525), WMH (r = 0.461), memory (r = -0.702), executive function (r = -0.369) and general cognitive performance (r = -0.378). On univariate analysis, age >60 years (p = 0.016), low educational attainment (p < 0.001 to p < 0.003), total brain volume (p < 0.024 and p < 0.025) and MTA (p < 0.003 to p < 0.007) but not total WMH (p < 0.073, p = 0.610) were associated with cognitive outcome. In a two-step multivariate regression analysis, MTA (p < 0.035 and p < 0.016) and low educational attainment (p < 0.012 and p < 0.019) were sustained as independent statistical predictors of cognitive outcome.
  
  
  CONCLUSIONS
  Medial temporal lobe atrophy was a significant neuroimaging predictor of early post-stroke cognitive dysfunction in the Nigerian African stroke survivors. These observations have implications for a vascular basis of MTA in older stroke survivors among sub-Saharan Africans.
authors.affiliation: Division of Neurology, Department of Medicine, Federal Medical Centre Abeokuta, Abeokuta, Nigeria. rufusakinyemi@yahoo.com.|Institute of Neuroscience, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK. rufusakinyemi@yahoo.com.
authors.forename: Rufus O
authors.initials: RO
authors.lastname: Akinyemi
authors.affiliation: Institute of Neuroscience, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK. michael.firbank@ncl.ac.uk.
authors.forename: Michael
authors.initials: M
authors.lastname: Firbank
authors.affiliation: Department of Radiology, University of Ibadan, Ibadan, Nigeria. gogbole@gmail.com.
authors.forename: Godwin I
authors.initials: GI
authors.lastname: Ogbole
authors.affiliation: Institute of Neuroscience, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK. louise.allan@ncl.ac.uk.
authors.forename: Louise M
authors.initials: LM
authors.lastname: Allan
authors.affiliation: Department of Medicine, University of Ibadan, Ibadan, Nigeria. mayowaowolabi@yahoo.com.
authors.forename: Mayowa O
authors.initials: MO
authors.lastname: Owolabi
authors.affiliation: Department of Epidemiology and Medical Statistics, University of Ibadan, Ibadan, Nigeria. jakinyemi@yahoo.com.
authors.forename: Joshua O
authors.initials: JO
authors.lastname: Akinyemi
authors.affiliation: Department of Radiology, University of Ibadan, Ibadan, Nigeria. bysusf@hotmail.co.uk.
authors.forename: Bolutife P
authors.initials: BP
authors.lastname: Yusuf
authors.affiliation: Department of Radiology, University of Ibadan, Ibadan, Nigeria. OOgunseyinde@gmail.com.
authors.forename: Oluremi
authors.initials: O
authors.lastname: Ogunseyinde
authors.affiliation: Department of Medicine, University of Ibadan, Ibadan, Nigeria. aogunniyi53@yahoo.com.
authors.forename: Adesola
authors.initials: A
authors.lastname: Ogunniyi
authors.affiliation: Institute of Neuroscience, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK. r.n.kalaria@ncl.ac.uk.
authors.forename: Raj N
authors.initials: RN
authors.lastname: Kalaria
mesh_terms: D000368:Aged; D001284:Atrophy / Q000473:pathology; D003072:Cognition Disorders / Q000209:etiology / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009549:Nigeria; D010865:Pilot Projects; D012042:Registries; D020521:Stroke / Q000150:complications / Q000473:pathology* / Q000503:physiopathology*; D017741:Survivors; D013702:Temporal Lobe / Q000473:pathology*; D066127:White Matter / Q000473:pathology*