2023 American Academy of Neurology Abstract Website

Objective:

To determine the annual rate of WMD progression and cognition by stroke types in a cohort of real-world patients hospitalized for cerebrovascular diseases.

Background:

White matter disease (WMD) of presumed vascular origin is a type of cerebral small vessel disease associated with cognitive impairment. Studies have suggested that stroke may accelerate the progression of WMD, yet little is known on the potential differential effect of stroke types on WMD progression and cognition.

Design/Methods:

Consecutive patients with two brain MRI scans at least one year apart from a single-center cerebrovascular registry were included. Stroke types were categorized as ischemic stroke, non-traumatic intracranial hemorrhage (ICH) and aneurysmal subarachnoid hemorrhage (aSAH). Non-stroke served as control. SPM-lesion predictive algorithm was used to quantify WMD volume with primary outcome measured as annual change in WMD volume (cm³/year). Rate of WMD progression were compared across stroke types.

Results:

Of the 207 patients, mean age was 60±16 years, 54.6% were women, and median time between MRI brain scans was 4.3 (1.3-11.8) years. Of the stroke types, 65.8% had AIS, 11.1% had ICH, 3.4% had aSAH and 19.8% were non-stroke control. The rate of WMD progression was fastest in patients with ICH (1.63 cc/yr, IQR 0.0-4.14 cc/yr), followed by ischemic stroke (1.43 cc/yr, IQR 0.24-3.51 cc/yr), aSAH (0.53 cc/yr, IQR 0.13-0.79 cc/yr) and non-stroke control (0.32 cc/yr, IQR -0.01-1.35 cc/yr). In terms of cognition, median MMSE was lowest in ICH (22.5), followed by aSAH (23.2), ischemic stroke (24.8) and non-stroke control (28.7) (trend-p=0.002).

Conclusions:

Our study showed differential effects of stroke types on the rate of WMD progression and post-stroke cognition. Patients with ICH had greater risk for WMD progression and cognitive impairment compared to other stroke types. Larger longitudinal study is needed to better test this observation.