Remote Lower White Matter Integrity Increases the Risk of Long-Term Cognitive Impairment After Ischemic Stroke in Young Adults.
Poststroke cognitive impairment occurs frequently in young patients with ischemic stroke (18 through 50 years of age). Accumulating data suggest that stroke is associated with lower white matter integrity remote from the stroke impact area, which might explain why some patients have good long-term cognitive outcome and others do not. Given the life expectancy of decades in young patients, we therefore investigated remote white matter in relation to long-term cognitive function.



We included all consecutive first-ever ischemic stroke patients, left/right hemisphere, without recurrent stroke or transient ischemic attack during follow-up, aged 18 through 50 years, admitted to our university medical center between 1980 and 2010. One hundred seventeen patients underwent magnetic resonance imaging scanning including a T1-weighted scan, a diffusion tensor imaging scan, and completed a neuropsychological assessment. Patients were compared with a matched stroke-free control group (age, sex, and education matched). Cognitive impairment was defined as >1.5 SD below the mean cognitive index score of controls and no cognitive impairment as ≤1 SD. Tract-Based Spatial Statistics was used to assess the white matter integrity (fractional anisotropy and mean diffusivity).



About 11 years after ischemic stroke, lower remote white matter integrity was associated with a worse long-term cognitive performance. A lower remote white matter integrity, even in the contralesional hemisphere, was observed in cognitively impaired patients (n=25) compared with cognitively unimpaired patients (n=71).



These findings indicate that although stroke has an acute onset, it might have long lasting effects on remote white matter integrity and thereby increases the risk of long-term cognitive impairment.
From the Departments of Neurology (P.S., A.M.T., R.M.A., S.F., N.A.M.M., H.C.S., E.J.v.D., F.-E.d.L.) and Medical Psychology (R.P.C.K.), Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands; Department of Clinical Neurosciences, University of Cambridge, United Kingdom (L.C.A.R.-J.); and Department of Neurology, Medisch Spectrum Twente, Enschede, The Netherlands (L.D.A.D.).
Pauline
P
Schaapsmeerders
From the Departments of Neurology (P.S., A.M.T., R.M.A., S.F., N.A.M.M., H.C.S., E.J.v.D., F.-E.d.L.) and Medical Psychology (R.P.C.K.), Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands; Department of Clinical Neurosciences, University of Cambridge, United Kingdom (L.C.A.R.-J.); and Department of Neurology, Medisch Spectrum Twente, Enschede, The Netherlands (L.D.A.D.).
Anil M
AM
Tuladhar
From the Departments of Neurology (P.S., A.M.T., R.M.A., S.F., N.A.M.M., H.C.S., E.J.v.D., F.-E.d.L.) and Medical Psychology (R.P.C.K.), Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands; Department of Clinical Neurosciences, University of Cambridge, United Kingdom (L.C.A.R.-J.); and Department of Neurology, Medisch Spectrum Twente, Enschede, The Netherlands (L.D.A.D.).
Renate M
RM
Arntz
From the Departments of Neurology (P.S., A.M.T., R.M.A., S.F., N.A.M.M., H.C.S., E.J.v.D., F.-E.d.L.) and Medical Psychology (R.P.C.K.), Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands; Department of Clinical Neurosciences, University of Cambridge, United Kingdom (L.C.A.R.-J.); and Department of Neurology, Medisch Spectrum Twente, Enschede, The Netherlands (L.D.A.D.).
Sieske
S
Franssen
From the Departments of Neurology (P.S., A.M.T., R.M.A., S.F., N.A.M.M., H.C.S., E.J.v.D., F.-E.d.L.) and Medical Psychology (R.P.C.K.), Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands; Department of Clinical Neurosciences, University of Cambridge, United Kingdom (L.C.A.R.-J.); and Department of Neurology, Medisch Spectrum Twente, Enschede, The Netherlands (L.D.A.D.).
Noortje A M
NA
Maaijwee
From the Departments of Neurology (P.S., A.M.T., R.M.A., S.F., N.A.M.M., H.C.S., E.J.v.D., F.-E.d.L.) and Medical Psychology (R.P.C.K.), Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands; Department of Clinical Neurosciences, University of Cambridge, United Kingdom (L.C.A.R.-J.); and Department of Neurology, Medisch Spectrum Twente, Enschede, The Netherlands (L.D.A.D.).
Loes C A
LC
Rutten-Jacobs
From the Departments of Neurology (P.S., A.M.T., R.M.A., S.F., N.A.M.M., H.C.S., E.J.v.D., F.-E.d.L.) and Medical Psychology (R.P.C.K.), Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands; Department of Clinical Neurosciences, University of Cambridge, United Kingdom (L.C.A.R.-J.); and Department of Neurology, Medisch Spectrum Twente, Enschede, The Netherlands (L.D.A.D.).
Hennie C
HC
Schoonderwaldt
From the Departments of Neurology (P.S., A.M.T., R.M.A., S.F., N.A.M.M., H.C.S., E.J.v.D., F.-E.d.L.) and Medical Psychology (R.P.C.K.), Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands; Department of Clinical Neurosciences, University of Cambridge, United Kingdom (L.C.A.R.-J.); and Department of Neurology, Medisch Spectrum Twente, Enschede, The Netherlands (L.D.A.D.).
Lucille D A
LD
Dorresteijn
From the Departments of Neurology (P.S., A.M.T., R.M.A., S.F., N.A.M.M., H.C.S., E.J.v.D., F.-E.d.L.) and Medical Psychology (R.P.C.K.), Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands; Department of Clinical Neurosciences, University of Cambridge, United Kingdom (L.C.A.R.-J.); and Department of Neurology, Medisch Spectrum Twente, Enschede, The Netherlands (L.D.A.D.).
Ewoud J
EJ
van Dijk
From the Departments of Neurology (P.S., A.M.T., R.M.A., S.F., N.A.M.M., H.C.S., E.J.v.D., F.-E.d.L.) and Medical Psychology (R.P.C.K.), Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands; Department of Clinical Neurosciences, University of Cambridge, United Kingdom (L.C.A.R.-J.); and Department of Neurology, Medisch Spectrum Twente, Enschede, The Netherlands (L.D.A.D.).
Roy P C
RP
Kessels
From the Departments of Neurology (P.S., A.M.T., R.M.A., S.F., N.A.M.M., H.C.S., E.J.v.D., F.-E.d.L.) and Medical Psychology (R.P.C.K.), Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands; Department of Clinical Neurosciences, University of Cambridge, United Kingdom (L.C.A.R.-J.); and Department of Neurology, Medisch Spectrum Twente, Enschede, The Netherlands (L.D.A.D.). FrankErik.deLeeuw@radboudumc.nl.
Frank-Erik
FE
de Leeuw
D000293:Adolescent; D000328:Adult; D002545:Brain Ischemia / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology; D003072:Cognition Disorders / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology; D060825:Cognitive Dysfunction / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology; D056324:Diffusion Tensor Imaging; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D011379:Prognosis; D020521:Stroke / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology; D066127:White Matter / Q000000981:diagnostic imaging / Q000473:pathology*; D055815:Young Adult
diffusion tensor imaging; neuropsychological tests; stroke; white matter