Marios K Georgakis1, Marco Duering1, Joanna M Wardlaw1, Martin Dichgans2. 1. From the Institute for Stroke and Dementia Research, University Hospital (M.K.G., M. Duering, M. Dichgans), and Graduate School for Systemic Neurosciences (M.K.G.), Ludwig-Maximilians-Universität LMU, Munich, Germany; Division of Neuroimaging Science (J.M.W.), Centre for Clinical Brain Science, Edinburgh Imaging and UK Dementia Research Institute, University of Edinburgh, UK; Munich Cluster for Systems Neurology (SyNergy) (M. Dichgans); and German Centre for Neurodegenerative Diseases (M. Dichgans), Munich, Germany. 2. From the Institute for Stroke and Dementia Research, University Hospital (M.K.G., M. Duering, M. Dichgans), and Graduate School for Systemic Neurosciences (M.K.G.), Ludwig-Maximilians-Universität LMU, Munich, Germany; Division of Neuroimaging Science (J.M.W.), Centre for Clinical Brain Science, Edinburgh Imaging and UK Dementia Research Institute, University of Edinburgh, UK; Munich Cluster for Systems Neurology (SyNergy) (M. Dichgans); and German Centre for Neurodegenerative Diseases (M. Dichgans), Munich, Germany. martin.dichgans@med.uni-muenchen.de.
Abstract
OBJECTIVE: To investigate the relationship between baseline white matter hyperintensities (WMH) in patients with ischemic stroke and long-term risk of dementia, functional impairment, recurrent stroke, and mortality. METHODS: Following the Meta-analysis of Observational Studies in Epidemiology and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PROSPERO protocol: CRD42018092857), we systematically searched Medline and Scopus for cohort studies of ischemic stroke patients examining whether MRI- or CT-assessed WMH at baseline are associated with dementia, functional impairment, recurrent stroke, and mortality at 3 months or later poststroke. We extracted data and evaluated study quality with the Newcastle-Ottawa scale. We pooled relative risks (RR) for the presence and severity of WMH using random-effects models. RESULTS: We included 104 studies with 71,298 ischemic stroke patients. Moderate/severe WMH at baseline were associated with increased risk of dementia (RR 2.17, 95% confidence interval [CI] 1.72-2.73), cognitive impairment (RR 2.29, 95% CI 1.48-3.54), functional impairment (RR 2.21, 95% CI 1.83-2.67), any recurrent stroke (RR 1.65, 95% CI 1.36-2.01), recurrent ischemic stroke (RR 1.90, 95% CI 1.26-2.88), all-cause mortality (RR 1.72, 95% CI 1.47-2.01), and cardiovascular mortality (RR 2.02, 95% CI 1.44-2.83). The associations followed dose-response patterns for WMH severity and were consistent for both MRI- and CT-defined WMH. The results remained stable in sensitivity analyses adjusting for age, stroke severity, and cardiovascular risk factors, in analyses of studies scoring high in quality, and in analyses adjusted for publication bias. CONCLUSIONS: Presence and severity of WMH are associated with substantially increased risk of dementia, functional impairment, stroke recurrence, and mortality after ischemic stroke. WMH may aid clinical prognostication and the planning of future clinical trials.
OBJECTIVE: To investigate the relationship between baseline white matter hyperintensities (WMH) in patients with ischemic stroke and long-term risk of dementia, functional impairment, recurrent stroke, and mortality. METHODS: Following the Meta-analysis of Observational Studies in Epidemiology and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PROSPERO protocol: CRD42018092857), we systematically searched Medline and Scopus for cohort studies of ischemic stroke patients examining whether MRI- or CT-assessed WMH at baseline are associated with dementia, functional impairment, recurrent stroke, and mortality at 3 months or later poststroke. We extracted data and evaluated study quality with the Newcastle-Ottawa scale. We pooled relative risks (RR) for the presence and severity of WMH using random-effects models. RESULTS: We included 104 studies with 71,298 ischemic stroke patients. Moderate/severe WMH at baseline were associated with increased risk of dementia (RR 2.17, 95% confidence interval [CI] 1.72-2.73), cognitive impairment (RR 2.29, 95% CI 1.48-3.54), functional impairment (RR 2.21, 95% CI 1.83-2.67), any recurrent stroke (RR 1.65, 95% CI 1.36-2.01), recurrent ischemic stroke (RR 1.90, 95% CI 1.26-2.88), all-cause mortality (RR 1.72, 95% CI 1.47-2.01), and cardiovascular mortality (RR 2.02, 95% CI 1.44-2.83). The associations followed dose-response patterns for WMH severity and were consistent for both MRI- and CT-defined WMH. The results remained stable in sensitivity analyses adjusting for age, stroke severity, and cardiovascular risk factors, in analyses of studies scoring high in quality, and in analyses adjusted for publication bias. CONCLUSIONS: Presence and severity of WMH are associated with substantially increased risk of dementia, functional impairment, stroke recurrence, and mortality after ischemic stroke. WMH may aid clinical prognostication and the planning of future clinical trials.
Authors: A Mahammedi; L L Wang; B J Williamson; P Khatri; B Kissela; R P Sawyer; R Shatz; V Khandwala; A Vagal Journal: AJNR Am J Neuroradiol Date: 2021-10-07 Impact factor: 3.825
Authors: Anna K Bonkhoff; Sungmin Hong; Martin Bretzner; Markus D Schirmer; Robert W Regenhardt; E Murat Arsava; Kathleen Donahue; Marco Nardin; Adrian Dalca; Anne-Katrin Giese; Mark R Etherton; Brandon L Hancock; Steven J T Mocking; Elissa McIntosh; John Attia; Oscar Benavente; John W Cole; Amanda Donatti; Christoph Griessenauer; Laura Heitsch; Lukas Holmegaard; Katarina Jood; Jordi Jimenez-Conde; Steven Kittner; Robin Lemmens; Christopher Levi; Caitrin W McDonough; James Meschia; Chia-Ling Phuah; Arndt Rolfs; Stefan Ropele; Jonathan Rosand; Jaume Roquer; Tatjana Rundek; Ralph L Sacco; Reinhold Schmidt; Pankaj Sharma; Agnieszka Slowik; Martin Soederholm; Alessandro Sousa; Tara M Stanne; Daniel Strbian; Turgut Tatlisumak; Vincent Thijs; Achala Vagal; Johan Wasselius; Daniel Woo; Ramin Zand; Patrick McArdle; Bradford B Worrall; Christina Jern; Arne G Lindgren; Jane Maguire; Polina Golland; Danilo Bzdok; Ona Wu; Natalia S Rost Journal: Neurology Date: 2022-07-08 Impact factor: 11.800
Authors: Marios K Georgakis; Rainer Malik; Christopher D Anderson; Klaus G Parhofer; Jemma C Hopewell; Martin Dichgans Journal: Brain Date: 2020-02-01 Impact factor: 13.501
Authors: Una Clancy; Daniela Jaime Garcia; Michael S Stringer; Michael J Thrippleton; Maria C Valdés-Hernández; Stewart Wiseman; Olivia Kl Hamilton; Francesca M Chappell; Rosalind Brown; Gordon W Blair; Will Hewins; Emilie Sleight; Lucia Ballerini; Mark E Bastin; Susana Munoz Maniega; Tom MacGillivray; Kirstie Hetherington; Charlene Hamid; Carmen Arteaga; Alasdair G Morgan; Cameron Manning; Ellen Backhouse; Iona Hamilton; Dominic Job; Ian Marshall; Fergus N Doubal; Joanna M Wardlaw Journal: Eur Stroke J Date: 2020-06-05