title: Cerebral small vessel disease, medial temporal lobe atrophy and cognitive status in patients with ischaemic stroke and transient ischaemic attack.
abstract: Small vessel disease (SVD) and Alzheimer's disease (AD) are two common causes of cognitive impairment and dementia, traditionally considered as distinct processes. The relationship between radiological features suggestive of AD and SVD was explored, and the association of each of these features with cognitive status at 1 year was investigated in patients with stroke or transient ischaemic attack.
  
  
  
  Anonymized data were accessed from the Virtual International Stroke Trials Archive (VISTA). Medial temporal lobe atrophy (MTA; a marker of AD) and markers of SVD were rated using validated ordinal visual scales. Cognitive status was evaluated with the Mini Mental State Examination (MMSE) 1 year after the index stroke. Logistic regression models were used to investigate independent associations between (i) baseline SVD features and MTA and (ii) all baseline neuroimaging features and cognitive status 1 year post-stroke.
  
  
  
  In all, 234 patients were included, mean (±SD) age 65.7 ± 13.1 years, 145 (62%) male. Moderate to severe MTA was present in 104 (44%) patients. SVD features were independently associated with MTA (P < 0.001). After adjusting for age, sex, disability after stroke, hypertension and diabetes mellitus, MTA was the only radiological feature independently associated with cognitive impairment, defined using thresholds of MMSE ≤ 26 (odds ratio 1.94; 95% confidence interval 1.28-2.94) and MMSE ≤ 23 (odds ratio 2.31; 95% confidence interval 1.48-3.62).
  
  
  
  In patients with ischaemic cerebrovascular disease, SVD features are associated with MTA, which is a common finding in stroke survivors. SVD and AD type neurodegeneration coexist, but the AD marker MTA, rather than SVD markers, is associated with post-stroke cognitive impairment.
authors.affiliation: NEUROFARBA Department, University of Florence, Florence, Italy.|Institute of Cardiovascular and Medical Sciences, Queen Elizabeth University Hospital Glasgow, Glasgow, UK.
authors.forename: F
authors.initials: F
authors.lastname: Arba
authors.affiliation: Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow Royal Infirmary, Glasgow, UK.
authors.forename: T
authors.initials: T
authors.lastname: Quinn
authors.affiliation: School of Medicine and Pharmacology, University of Western Australia, Harry Perkins Institute of Medical Research, QEII Medical Centre, Perth, Australia.
authors.forename: G J
authors.initials: GJ
authors.lastname: Hankey
authors.affiliation: Institute of Cardiovascular and Medical Sciences, Queen Elizabeth University Hospital Glasgow, Glasgow, UK.
authors.forename: M
authors.initials: M
authors.lastname: Ali
authors.affiliation: Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.
authors.forename: K R
authors.initials: KR
authors.lastname: Lees
authors.affiliation: NEUROFARBA Department, University of Florence, Florence, Italy.
authors.forename: D
authors.initials: D
authors.lastname: Inzitari
mesh_terms: D000368:Aged; D001284:Atrophy / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology* / Q000523:psychology; D059345:Cerebral Small Vessel Diseases / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology* / Q000523:psychology; D003071:Cognition / Q000502:physiology; D060825:Cognitive Dysfunction / Q000150:complications / Q000175:diagnosis* / Q000473:pathology / Q000523:psychology; D005260:Female; D006801:Humans; D002546:Ischemic Attack, Transient / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology* / Q000523:psychology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D020521:Stroke / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology* / Q000523:psychology; D013702:Temporal Lobe / Q000000981:diagnostic imaging / Q000473:pathology*
keywords: Alzheimer's disease; cognitive disorders and dementia; medial temporal lobe atrophy; small vessel disease; stroke