title: Stroke Location Is an Independent Predictor of Cognitive Outcome.
abstract: OBJECTIVE
  On top of functional outcome, accurate prediction of cognitive outcome for stroke patients is an unmet need with major implications for clinical management. We investigated whether stroke location may contribute independent prognostic value to multifactorial predictive models of functional and cognitive outcomes.
  
  
  METHODS
  Four hundred twenty-eight consecutive patients with ischemic stroke were prospectively assessed with magnetic resonance imaging at 24 to 72 hours and at 3 months for functional outcome using the modified Rankin Scale and cognitive outcome using the Montreal Cognitive Assessment (MoCA). Statistical maps of functional and cognitive eloquent regions were derived from the first 215 patients (development sample) using voxel-based lesion-symptom mapping. We used multivariate logistic regression models to study the influence of stroke location (number of eloquent voxels from voxel-based lesion-symptom mapping maps), age, initial National Institutes of Health Stroke Scale and stroke volume on modified Rankin Scale and MoCA. The second part of our cohort was used as an independent replication sample.
  
  
  RESULTS
  In univariate analyses, stroke location, age, initial National Institutes of Health Stroke Scale, and stroke volume were all predictive of poor modified Rankin Scale and MoCA. In multivariable analyses, stroke location remained the strongest independent predictor of MoCA and significantly improved the prediction compared with using only age, initial National Institutes of Health Stroke Scale, and stroke volume (area under the curve increased from 0.697-0.771; difference=0.073; 95% confidence interval, 0.008-0.155). In contrast, stroke location did not persist as independent predictor of modified Rankin Scale that was mainly driven by initial National Institutes of Health Stroke Scale (area under the curve going from 0.840 to 0.835). Similar results were obtained in the replication sample.
  
  
  CONCLUSIONS
  Stroke location is an independent predictor of cognitive outcome (MoCA) at 3 months post stroke.
authors.affiliation: From the Université de Bordeaux, Bordeaux, France (F.M., C.R.G., V.D., I.S., T.T.); Neuroimagerie diagnostique et thérapeutique (F.M., A.B., V.D., T.T.), Unité neurovasculaire (S.S., S.D., M.P., P.R., I.S.), and Pôle de santé publique, Unité de Soutien Méthodologique à la Recherche Clinique et Epidémiologique (J.A., P.P.), CHU de Bordeaux, Bordeaux, France; INSERM, U862, Neurocentre Magendie, Bordeaux, France (F.M., V.D., T.T.); Center for Neurological Imaging, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (C.R.G.); and INCIA, Bordeaux, France (I.S.).
authors.forename: Fanny
authors.initials: F
authors.lastname: Munsch
authors.affiliation: From the Université de Bordeaux, Bordeaux, France (F.M., C.R.G., V.D., I.S., T.T.); Neuroimagerie diagnostique et thérapeutique (F.M., A.B., V.D., T.T.), Unité neurovasculaire (S.S., S.D., M.P., P.R., I.S.), and Pôle de santé publique, Unité de Soutien Méthodologique à la Recherche Clinique et Epidémiologique (J.A., P.P.), CHU de Bordeaux, Bordeaux, France; INSERM, U862, Neurocentre Magendie, Bordeaux, France (F.M., V.D., T.T.); Center for Neurological Imaging, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (C.R.G.); and INCIA, Bordeaux, France (I.S.).
authors.forename: Sharmila
authors.initials: S
authors.lastname: Sagnier
authors.affiliation: From the Université de Bordeaux, Bordeaux, France (F.M., C.R.G., V.D., I.S., T.T.); Neuroimagerie diagnostique et thérapeutique (F.M., A.B., V.D., T.T.), Unité neurovasculaire (S.S., S.D., M.P., P.R., I.S.), and Pôle de santé publique, Unité de Soutien Méthodologique à la Recherche Clinique et Epidémiologique (J.A., P.P.), CHU de Bordeaux, Bordeaux, France; INSERM, U862, Neurocentre Magendie, Bordeaux, France (F.M., V.D., T.T.); Center for Neurological Imaging, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (C.R.G.); and INCIA, Bordeaux, France (I.S.).
authors.forename: Julien
authors.initials: J
authors.lastname: Asselineau
authors.affiliation: From the Université de Bordeaux, Bordeaux, France (F.M., C.R.G., V.D., I.S., T.T.); Neuroimagerie diagnostique et thérapeutique (F.M., A.B., V.D., T.T.), Unité neurovasculaire (S.S., S.D., M.P., P.R., I.S.), and Pôle de santé publique, Unité de Soutien Méthodologique à la Recherche Clinique et Epidémiologique (J.A., P.P.), CHU de Bordeaux, Bordeaux, France; INSERM, U862, Neurocentre Magendie, Bordeaux, France (F.M., V.D., T.T.); Center for Neurological Imaging, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (C.R.G.); and INCIA, Bordeaux, France (I.S.).
authors.forename: Antoine
authors.initials: A
authors.lastname: Bigourdan
authors.affiliation: From the Université de Bordeaux, Bordeaux, France (F.M., C.R.G., V.D., I.S., T.T.); Neuroimagerie diagnostique et thérapeutique (F.M., A.B., V.D., T.T.), Unité neurovasculaire (S.S., S.D., M.P., P.R., I.S.), and Pôle de santé publique, Unité de Soutien Méthodologique à la Recherche Clinique et Epidémiologique (J.A., P.P.), CHU de Bordeaux, Bordeaux, France; INSERM, U862, Neurocentre Magendie, Bordeaux, France (F.M., V.D., T.T.); Center for Neurological Imaging, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (C.R.G.); and INCIA, Bordeaux, France (I.S.).
authors.forename: Charles R
authors.initials: CR
authors.lastname: Guttmann
authors.affiliation: From the Université de Bordeaux, Bordeaux, France (F.M., C.R.G., V.D., I.S., T.T.); Neuroimagerie diagnostique et thérapeutique (F.M., A.B., V.D., T.T.), Unité neurovasculaire (S.S., S.D., M.P., P.R., I.S.), and Pôle de santé publique, Unité de Soutien Méthodologique à la Recherche Clinique et Epidémiologique (J.A., P.P.), CHU de Bordeaux, Bordeaux, France; INSERM, U862, Neurocentre Magendie, Bordeaux, France (F.M., V.D., T.T.); Center for Neurological Imaging, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (C.R.G.); and INCIA, Bordeaux, France (I.S.).
authors.forename: Sabrina
authors.initials: S
authors.lastname: Debruxelles
authors.affiliation: From the Université de Bordeaux, Bordeaux, France (F.M., C.R.G., V.D., I.S., T.T.); Neuroimagerie diagnostique et thérapeutique (F.M., A.B., V.D., T.T.), Unité neurovasculaire (S.S., S.D., M.P., P.R., I.S.), and Pôle de santé publique, Unité de Soutien Méthodologique à la Recherche Clinique et Epidémiologique (J.A., P.P.), CHU de Bordeaux, Bordeaux, France; INSERM, U862, Neurocentre Magendie, Bordeaux, France (F.M., V.D., T.T.); Center for Neurological Imaging, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (C.R.G.); and INCIA, Bordeaux, France (I.S.).
authors.forename: Mathilde
authors.initials: M
authors.lastname: Poli
authors.affiliation: From the Université de Bordeaux, Bordeaux, France (F.M., C.R.G., V.D., I.S., T.T.); Neuroimagerie diagnostique et thérapeutique (F.M., A.B., V.D., T.T.), Unité neurovasculaire (S.S., S.D., M.P., P.R., I.S.), and Pôle de santé publique, Unité de Soutien Méthodologique à la Recherche Clinique et Epidémiologique (J.A., P.P.), CHU de Bordeaux, Bordeaux, France; INSERM, U862, Neurocentre Magendie, Bordeaux, France (F.M., V.D., T.T.); Center for Neurological Imaging, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (C.R.G.); and INCIA, Bordeaux, France (I.S.).
authors.forename: Pauline
authors.initials: P
authors.lastname: Renou
authors.affiliation: From the Université de Bordeaux, Bordeaux, France (F.M., C.R.G., V.D., I.S., T.T.); Neuroimagerie diagnostique et thérapeutique (F.M., A.B., V.D., T.T.), Unité neurovasculaire (S.S., S.D., M.P., P.R., I.S.), and Pôle de santé publique, Unité de Soutien Méthodologique à la Recherche Clinique et Epidémiologique (J.A., P.P.), CHU de Bordeaux, Bordeaux, France; INSERM, U862, Neurocentre Magendie, Bordeaux, France (F.M., V.D., T.T.); Center for Neurological Imaging, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (C.R.G.); and INCIA, Bordeaux, France (I.S.).
authors.forename: Paul
authors.initials: P
authors.lastname: Perez
authors.affiliation: From the Université de Bordeaux, Bordeaux, France (F.M., C.R.G., V.D., I.S., T.T.); Neuroimagerie diagnostique et thérapeutique (F.M., A.B., V.D., T.T.), Unité neurovasculaire (S.S., S.D., M.P., P.R., I.S.), and Pôle de santé publique, Unité de Soutien Méthodologique à la Recherche Clinique et Epidémiologique (J.A., P.P.), CHU de Bordeaux, Bordeaux, France; INSERM, U862, Neurocentre Magendie, Bordeaux, France (F.M., V.D., T.T.); Center for Neurological Imaging, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (C.R.G.); and INCIA, Bordeaux, France (I.S.).
authors.forename: Vincent
authors.initials: V
authors.lastname: Dousset
authors.affiliation: From the Université de Bordeaux, Bordeaux, France (F.M., C.R.G., V.D., I.S., T.T.); Neuroimagerie diagnostique et thérapeutique (F.M., A.B., V.D., T.T.), Unité neurovasculaire (S.S., S.D., M.P., P.R., I.S.), and Pôle de santé publique, Unité de Soutien Méthodologique à la Recherche Clinique et Epidémiologique (J.A., P.P.), CHU de Bordeaux, Bordeaux, France; INSERM, U862, Neurocentre Magendie, Bordeaux, France (F.M., V.D., T.T.); Center for Neurological Imaging, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (C.R.G.); and INCIA, Bordeaux, France (I.S.).
authors.forename: Igor
authors.initials: I
authors.lastname: Sibon
authors.affiliation: From the Université de Bordeaux, Bordeaux, France (F.M., C.R.G., V.D., I.S., T.T.); Neuroimagerie diagnostique et thérapeutique (F.M., A.B., V.D., T.T.), Unité neurovasculaire (S.S., S.D., M.P., P.R., I.S.), and Pôle de santé publique, Unité de Soutien Méthodologique à la Recherche Clinique et Epidémiologique (J.A., P.P.), CHU de Bordeaux, Bordeaux, France; INSERM, U862, Neurocentre Magendie, Bordeaux, France (F.M., V.D., T.T.); Center for Neurological Imaging, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (C.R.G.); and INCIA, Bordeaux, France (I.S.). thomas.tourdias@chu-bordeaux.fr.
authors.forename: Thomas
authors.initials: T
authors.lastname: Tourdias
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000473:pathology*; D003072:Cognition Disorders / Q000175:diagnosis* / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000639:trends; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D020521:Stroke / Q000175:diagnosis* / Q000453:epidemiology*; D016896:Treatment Outcome
keywords: area under curve; cognition; prognosis; stroke; stroke location; stroke volume