title: Risk Factors and Cognitive Relevance of Cortical Cerebral Microinfarcts in Patients With Ischemic Stroke or Transient Ischemic Attack.
abstract: It was recently demonstrated that cerebral microinfarcts (CMIs) can be detected in vivo using 3.0 tesla (T) magnetic resonance imaging. We investigated the prevalence, risk factors, and the longitudinal cognitive consequence of cortical CMIs on 3.0T magnetic resonance imaging, in patients with ischemic stroke or transient ischemic attack.
  
  
  
  A total of 231 patients undergoing 3.0T magnetic resonance imaging were included. Montreal Cognitive Assessment was used to evaluate global cognitive functions and cognitive domains (memory, language, and attention visuospatial and executive functions). Cognitive changes were represented by the difference in Montreal Cognitive Assessment score between baseline and 28-month after stroke/transient ischemic attack. The cross-sectional and longitudinal associations between cortical CMIs and cognitive functions were explored using ANCOVA and regression models.
  
  
  
  Cortical CMIs were observed in 34 patients (14.7%), including 13 patients with acute (hyperintense on diffusion-weighted imaging) and 21 with chronic CMIs (isointense on diffusion-weighted imaging). Atrial fibrillation was a risk factor for all cortical CMIs (odds ratio, 4.8; 95% confidence interval, 1.5-14.9; P=0.007). Confluent white matter hyperintensities was associated with chronic CMIs (odds ratio, 2.8; 95% confidence interval, 1.0-7.8; P=0.047). The presence of cortical CMIs at baseline was associated with worse visuospatial functions at baseline and decline over 28-month follow-up (β=0.5; 95% confidence interval, 0.1-1.0; P=0.008, adjusting for brain atrophy, white matter hyperintensities, lacunes, and microbleeds).
  
  
  
  Cortical CMIs are a common finding in patients with stroke/transient ischemic attack. Associations between CMI with atrial fibrillation and white matter hyperintensities suggest that these lesions have a heterogeneous cause, involving microembolism and cerebral small vessel disease. CMI seemed to preferentially impact visuospatial functions as assessed by a cognitive screening test.
authors.affiliation: From the Department of Medicine and Therapeutics (Z.W., A.W., W.L., L.S., A.L., V.C.T.M.), Therese Pei Fong Chow Research Centre for Prevention of Dementia (A.W., L.S., V.C.T.M.), Lui Che Woo Institute of Innovative Medicine (A.W., L.S., V.C.T.M.), The Chinese University of Hong Kong, China; Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, China (Z.W.); Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands (S.J.v.V., G.J.B.); Institute of Neuroscience and the Second Affiliated Hospital of Guangzhou Medical University and Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, China (J.Y.); and Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, China (Y.X.).
authors.forename: Zhaolu
authors.initials: Z
authors.lastname: Wang
authors.affiliation: From the Department of Medicine and Therapeutics (Z.W., A.W., W.L., L.S., A.L., V.C.T.M.), Therese Pei Fong Chow Research Centre for Prevention of Dementia (A.W., L.S., V.C.T.M.), Lui Che Woo Institute of Innovative Medicine (A.W., L.S., V.C.T.M.), The Chinese University of Hong Kong, China; Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, China (Z.W.); Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands (S.J.v.V., G.J.B.); Institute of Neuroscience and the Second Affiliated Hospital of Guangzhou Medical University and Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, China (J.Y.); and Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, China (Y.X.).
authors.forename: Susanne J
authors.initials: SJ
authors.lastname: van Veluw
authors.affiliation: From the Department of Medicine and Therapeutics (Z.W., A.W., W.L., L.S., A.L., V.C.T.M.), Therese Pei Fong Chow Research Centre for Prevention of Dementia (A.W., L.S., V.C.T.M.), Lui Che Woo Institute of Innovative Medicine (A.W., L.S., V.C.T.M.), The Chinese University of Hong Kong, China; Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, China (Z.W.); Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands (S.J.v.V., G.J.B.); Institute of Neuroscience and the Second Affiliated Hospital of Guangzhou Medical University and Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, China (J.Y.); and Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, China (Y.X.).
authors.forename: Adrian
authors.initials: A
authors.lastname: Wong
authors.affiliation: From the Department of Medicine and Therapeutics (Z.W., A.W., W.L., L.S., A.L., V.C.T.M.), Therese Pei Fong Chow Research Centre for Prevention of Dementia (A.W., L.S., V.C.T.M.), Lui Che Woo Institute of Innovative Medicine (A.W., L.S., V.C.T.M.), The Chinese University of Hong Kong, China; Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, China (Z.W.); Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands (S.J.v.V., G.J.B.); Institute of Neuroscience and the Second Affiliated Hospital of Guangzhou Medical University and Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, China (J.Y.); and Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, China (Y.X.).
authors.forename: Wenyan
authors.initials: W
authors.lastname: Liu
authors.affiliation: From the Department of Medicine and Therapeutics (Z.W., A.W., W.L., L.S., A.L., V.C.T.M.), Therese Pei Fong Chow Research Centre for Prevention of Dementia (A.W., L.S., V.C.T.M.), Lui Che Woo Institute of Innovative Medicine (A.W., L.S., V.C.T.M.), The Chinese University of Hong Kong, China; Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, China (Z.W.); Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands (S.J.v.V., G.J.B.); Institute of Neuroscience and the Second Affiliated Hospital of Guangzhou Medical University and Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, China (J.Y.); and Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, China (Y.X.).
authors.forename: Lin
authors.initials: L
authors.lastname: Shi
authors.affiliation: From the Department of Medicine and Therapeutics (Z.W., A.W., W.L., L.S., A.L., V.C.T.M.), Therese Pei Fong Chow Research Centre for Prevention of Dementia (A.W., L.S., V.C.T.M.), Lui Che Woo Institute of Innovative Medicine (A.W., L.S., V.C.T.M.), The Chinese University of Hong Kong, China; Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, China (Z.W.); Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands (S.J.v.V., G.J.B.); Institute of Neuroscience and the Second Affiliated Hospital of Guangzhou Medical University and Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, China (J.Y.); and Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, China (Y.X.).
authors.forename: Jie
authors.initials: J
authors.lastname: Yang
authors.affiliation: From the Department of Medicine and Therapeutics (Z.W., A.W., W.L., L.S., A.L., V.C.T.M.), Therese Pei Fong Chow Research Centre for Prevention of Dementia (A.W., L.S., V.C.T.M.), Lui Che Woo Institute of Innovative Medicine (A.W., L.S., V.C.T.M.), The Chinese University of Hong Kong, China; Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, China (Z.W.); Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands (S.J.v.V., G.J.B.); Institute of Neuroscience and the Second Affiliated Hospital of Guangzhou Medical University and Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, China (J.Y.); and Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, China (Y.X.).
authors.forename: Yunyun
authors.initials: Y
authors.lastname: Xiong
authors.affiliation: From the Department of Medicine and Therapeutics (Z.W., A.W., W.L., L.S., A.L., V.C.T.M.), Therese Pei Fong Chow Research Centre for Prevention of Dementia (A.W., L.S., V.C.T.M.), Lui Che Woo Institute of Innovative Medicine (A.W., L.S., V.C.T.M.), The Chinese University of Hong Kong, China; Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, China (Z.W.); Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands (S.J.v.V., G.J.B.); Institute of Neuroscience and the Second Affiliated Hospital of Guangzhou Medical University and Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, China (J.Y.); and Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, China (Y.X.).
authors.forename: Alexander
authors.initials: A
authors.lastname: Lau
authors.affiliation: From the Department of Medicine and Therapeutics (Z.W., A.W., W.L., L.S., A.L., V.C.T.M.), Therese Pei Fong Chow Research Centre for Prevention of Dementia (A.W., L.S., V.C.T.M.), Lui Che Woo Institute of Innovative Medicine (A.W., L.S., V.C.T.M.), The Chinese University of Hong Kong, China; Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, China (Z.W.); Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands (S.J.v.V., G.J.B.); Institute of Neuroscience and the Second Affiliated Hospital of Guangzhou Medical University and Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, China (J.Y.); and Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, China (Y.X.). g.j.biessels@umcutrecht.nl vctmok@cuhk.edu.hk.
authors.forename: Geert Jan
authors.initials: GJ
authors.lastname: Biessels
authors.affiliation: From the Department of Medicine and Therapeutics (Z.W., A.W., W.L., L.S., A.L., V.C.T.M.), Therese Pei Fong Chow Research Centre for Prevention of Dementia (A.W., L.S., V.C.T.M.), Lui Che Woo Institute of Innovative Medicine (A.W., L.S., V.C.T.M.), The Chinese University of Hong Kong, China; Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, China (Z.W.); Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands (S.J.v.V., G.J.B.); Institute of Neuroscience and the Second Affiliated Hospital of Guangzhou Medical University and Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, China (J.Y.); and Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, China (Y.X.). g.j.biessels@umcutrecht.nl vctmok@cuhk.edu.hk.
authors.forename: Vincent C T
authors.initials: VC
authors.lastname: Mok
mesh_terms: D000368:Aged; D002545:Brain Ischemia / Q000000981:diagnostic imaging / Q000473:pathology / Q000523:psychology*; D002540:Cerebral Cortex / Q000000981:diagnostic imaging / Q000473:pathology*; D003071:Cognition / Q000502:physiology*; D003430:Cross-Sectional Studies; D056344:Executive Function / Q000502:physiology; D005260:Female; D006801:Humans; D002546:Ischemic Attack, Transient / Q000000981:diagnostic imaging / Q000473:pathology / Q000523:psychology*; D008279:Magnetic Resonance Imaging; D008297:Male; D008568:Memory / Q000502:physiology; D008875:Middle Aged; D009483:Neuropsychological Tests; D012307:Risk Factors; D020521:Stroke / Q000000981:diagnostic imaging / Q000473:pathology / Q000523:psychology*
keywords: atrial fibrillation; cognition; magnetic resonance imaging; stroke; white matter