Objectives Vascular cognitive impairment and Alzheimer's disease (AD) may interact and co-exist. We investigated the prevalence and impact of mesial temporal lobe atrophy (MTA), a radiological marker for AD, in a population of stroke patients.

Methods Patients referred to a stroke service underwent detailed neuropsychological testing and standardised imaging, including GRE T2* MRI and FLAIR. We assessed MTA on FLAIR images using a newly developed and validated visual rating scale based on the Scheltens scale (scores 0 to 4; mild MTA <2 and severe ≥2). Microbleeds and white matter changes (WMC) were rated using validated scales. The effect of MTA on cognitive functions was tested using multivariate regression analyses.

Findings 396 patients with full neuropsychological testing and complete MRI sequences were included (358 mild and 38 severe MTA). 171 patients (43%) showed some degree (score ≥1) of MTA. Patients with severe MTA were older (76 vs 64, p=0.000), more hypertensive (97% vs 66%, p=0.000), and had more severe WMC (median 9 vs 5.5, p=0.000) than patients with mild or no MTA. In adjusted multivariate analyses, MTA was a predictor of verbal memory impairment (OR 1.81, p=0.004) and frontal executive dysfunction (OR 1.48, p=0.023).

Conclusions MTA is common in stroke patients and is independently associated with verbal memory and frontal executive deficits. Alzheimer pathology may play an important role in cognitive impairment in patients with cerebrovascular disease.