期刊
INTERNATIONAL JOURNAL OF STROKE
卷 17, 期 4, 页码 415-424出版社
SAGE PUBLICATIONS LTD
DOI: 10.1177/17474930211012837
关键词
Brain microbleeds; cognition; Lacunar stroke; leukoaraiosis; small vessel disease; stroke
资金
- British Heart Foundation [RG/4/32218]
- NIHR Clinical Research Network
- MRC [MR/N026896/1]
- ABN Clinical Research Training Fellowship - Guarantors of Brain
- NIHR
- MRC [MR/N026896/1] Funding Source: UKRI
In patients with symptomatic cerebral small vessel disease, cerebral microbleeds are significantly associated with cognitive dysfunction, especially affecting executive function and processing speed. The presence and number of microbleeds also independently predict vascular cognitive impairment.
Background and aim Whether cerebral microbleeds cause cognitive impairment remains uncertain. We analyzed whether cerebral microbleeds are associated with cognitive dysfunction in patients with symptomatic cerebral small vessel disease, and whether this association is independent of other neuroimaging markers of cerebral small vessel disease. Methods We analyzed consecutive patients with MRI-confirmed lacunar stroke included in DNA-Lacunar-2 multicenter study. Cerebral microbleeds were graded using the Brain Observer Microbleed Rating Scale (BOMBS). Neuropsychological assessment was performed using the Brief Memory and Executive Test (BMET). We analyzed the association between cerebral microbleeds, BMET, and the following subdomains: executive function/processing speed and orientation/memory. We also searched for an independent association between cerebral microbleeds and vascular cognitive impairment, defined as BMET <= 13. Results Out of 688 included patients, cerebral microbleeds were detected in 192 (27.9%). After adjusting for white matter hyperintensities severity, lacune count, and other confounders, both the presence and the number of cerebral microbleeds were significantly associated with impaired cognitive performance [beta = -13.0; 95% CI = (-25.3, -0.6) and beta = -13.1; 95% CI = (-19.8, -6.4), respectively]. On analysis of specific cognitive domains, associations were present for executive function/processing speed [beta = -5.8; 95% CI = (-9.3, -2.2) and beta = -4.3; 95% CI = (-6.2, -2.4), respectively] but not for orientation/memory [beta = -0.4; 95% CI = (-4.0, 3.2) and beta = -2.1; 95% CI = (-4.0, 0.1), respectively]. We also found an independent association between the presence and the number of cerebral microbleeds and vascular cognitive impairment [adjusted OR = 1.48; 95% CI = (1.01, 2.18) and OR = 1.43; 95% CI = (1.15, 1.79), respectively]. Conclusion In a large cohort of symptomatic cerebral small vessel disease patients, after controlling for other neuroimaging markers of cerebral small vessel disease severity, cerebral microbleeds were associated with cognitive dysfunction. Executive function and processing speed were predominantly impaired. This might suggest a causal role of cerebral microbleeds in determining vascular cognitive impairment.
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