A case-controlled study of cognitive progression in Chinese lacunar stroke patients
Introduction
Lacunar infarcts (LI) are small, deep cerebral infarcts commonly found in the basal ganglia, thalamus and subcortical white matter [1]. Small vessel disease (SVD), manifested as LI and white matter changes (WMC) [2], accounts for the most frequent subtype of vascular dementia (VaD) [3]. Compared to Caucasians, lacunar stokes are more prevalent among Asians, including Chinese [4]. Although mortality in lacunar stroke in the short term is generally lower than that of other ischemic stroke subtypes [5], clinical and epidemiological studies have demonstrated close relationships between LI and cognitive impairment. First, lacunar strokes are commonly associated with cognitive decline in the early post-stroke period [6], [7]. Second, LI conferred increased risk for long-term cognitive decline and development of dementia, even in the absence of clinical strokes [8]. Third, LI may interact with [9], or add to [10], the effects of concomitant neurodegenerative pathology to enhance the clinical expression of dementia. Given these observations, longitudinal data on cognitive outcome are particular relevant to the management and healthcare planning for patients with lacunar stroke because of their relatively better survival at least in the first 2–3 years after stroke [5]. A number of studies examined the long-term cognitive progression among lacunar stroke patients and all of these studies were done on Caucasian subjects [11], [12], [13], [14]. To the best of our knowledge, such data is not yet available from Chinese lacunar stroke patients.
In our previous study we showed that 52% of our cohort of lacunar stroke patients experienced cognitive decline 3 months post-stroke [7]. We prospectively followed this cohort with repeated neuropsychological assessments. The objectives of this longitudinal study are to (1) determine the rate of cognitive change using commonly used general and executive cognitive measures and compare these changes with that of demographically matched controls; and (2) to identify the features associated with these changes among this cohort of lacunar stroke patients.
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Materials and methods
We recruited a consecutive cohort of 75 Chinese lacunar stroke patients admitted to the acute stroke unit of the Prince of Wales Hospital in Hong Kong between January and July 2002. We included only patients with lacunar stroke due to pure SVD. Patients with lacunar stroke due to extracranial or intracranial large artery disease or cardioembolic disease were excluded. Intracranial large artery disease was considered to be relevant if the stenosis was at least moderate (≥50%) in severity and if
Results
There were no significant changes between baseline and follow-up assessments in any cognitive test or in the global composite score within both groups. Controls performed significantly better than patients in all cognitive measures at both time points. Controls and patients had similar rates of change in MMSE, MDRS I/P and the global composite score. On the ADAS-cog, there was a trend for lacunar stroke patients to improve relative to controls (p = 0.084). Details of ANCOVA for the 3 psychometric
Discussion
This is the first case-controlled longitudinal stroke registry study that examined the cognitive progression among Chinese lacunar stroke patients utilizing both general and executive psychometric measures. This study differs from previous studies [8], [28] that it involved consecutive patients admitted for clinical lacunar strokes, and prior case-controlled studies that examined the long-term cognitive progression in stroke patients with detailed breakdown of cognitive domains did not provide
Conflict of interest
The authors have reported no conflicts of interest.
Acknowledgements
Supported by Earmarked Research Grant CUHK 4069/02M and CUHK 4317/04 from the Hong Kong Research Grants Council and the research fund from the Department of Medicine and Therapeutics, The Chinese University of Hong Kong.
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