Poststroke Cognitive Decline is Independent of Longitudinal Changes in Cerebral Hemodynamics Parameters.
Poststroke vascular cognitive impairment is highly prevalent with significant functional consequences. However, reliable biomarkers for early prediction of cognitive decline after acute ischemic stroke (AIS) are not well established. Although parenchymal imaging in patients with AIS and transient ischemic attack (TIA) may predict the resultant cognitive impairment, it may not explain the progressive deterioration after the index event. We postulated that longitudinal changes in cerebral hemodynamic parameters may influence the cognitive performance after a cerebrovascular event.



One-hundred consecutive AIS/TIA patients were recruited within 2 weeks following a cerebrovascular event. At 3-6 months, 69 patients were followed up with transcranial Doppler (TCD) and brief cognitive tests (Mini-Mental State Examination [MMSE]/Montreal Cognitive Assessment [MoCA]). Basic demographics, vascular risk factors, clinical, cognitive, and neurological status were recorded.



Considerable proportion (12%) of patients showed cognitive decline and changes in the hemodynamic parameters over 3-6 months after the index event. We showed that right middle cerebral artery (MCA) stenosis and right internal carotid artery/MCA tandem lesions at 3-6 months are associated with the change in the MMSE scores. Additionally, there was a trend toward association between increased pulsatility index of the right MCA and a decline in the MMSE score. However, we did not observe any association between cognitive decline and longitudinal changes in hemodynamic parameters.



Although hemodynamic parameters deteriorate in a considerable proportion of patients during first 3-6 months after a cerebrovascular event, cognitive decline appears to be an independent phenomenon.
Department of Psychological Medicine, National University Health System, Singapore.
Ma Serrie Platero
MSP
Suministrado
Department of Pharmacology, National University of Singapore, Singapore.
Esther Wan Yee
EWY
Shuang
Department of Pharmacology, National University of Singapore, Singapore.|Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Jing
J
Xu
Division of Neurology, National University Health System, Singapore.
Hock Luen
HL
Teoh
Division of Neurology, National University Health System, Singapore.
Bernard Poon-Lap
BP
Chan
Department of Pharmacology, National University of Singapore, Singapore.|Neuroscience Centre, Raffles Hospital, Singapore.
Narayanaswamy
N
Venketasubramanian
Yong Loo Lin School of Medicine, National University of Singapore, Singapore.|Division of Neurology, National University Health System, Singapore.
Raymond Chee Seong
RCS
Seet
Department of Pharmacology, National University of Singapore, Singapore.|Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Christopher Li-Hsian
CL
Chen
Department of Physiology, National University of Singapore.
Boon Seng
BS
Wong
Yong Loo Lin School of Medicine, National University of Singapore, Singapore.|Division of Neurology, National University Health System, Singapore.
Vijay Kumar
VK
Sharma
Department of Pharmacology, National University of Singapore, Singapore.|Yong Loo Lin School of Medicine, National University of Singapore, Singapore.|Division of Neurology, National University Health System, Singapore.
YanHong
Y
Dong
D000368:Aged; D060825:Cognitive Dysfunction / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology*; D005260:Female; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D002546:Ischemic Attack, Transient / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging / Q000503:physiopathology*; D009483:Neuropsychological Tests; D012307:Risk Factors; D020521:Stroke / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology*; D017585:Ultrasonography, Doppler, Transcranial
Cerebral hemodynamics; cognitive decline; transcranial Doppler