Marco Pasi1, Lansing Sugita1, Li Xiong1, Andreas Charidimou1, Gregoire Boulouis1, Thanakit Pongpitakmetha1, Sanjula Singh1, Christina Kourkoulis1, Kristin Schwab1, Steven M Greenberg1, Christopher D Anderson1, M Edip Gurol1, Jonathan Rosand1, Anand Viswanathan1, Alessandro Biffi2. 1. From U 1172-LilNCog-Lille Neuroscience and Cognition (M.P.), Université de Lille, Inserm, CHU Lille, France; Department of Neurology (M.P., L.S., L.X., A.C., T.P., S.S., C.K., K.S., S.M.G., C.D.A., M.E.G., J.R., A.V., A.B.), Hemorrhagic Stroke Research Program (L.S., A.C., S.M.G., C.D.A., M.E.G., J.R., A.V., A.B.), and Henry and Allison McCance Center for Brain Health (C.K., C.D.A., J.R., A.B.), Massachusetts General Hospital, Boston; Department of Neuroradiology (G.B.), Centre Hospitalier Sainte-Anne, Université Paris-Descartes, INSERM UMR 894, Paris, France; Department of Pharmacology, Faculty of Medicine (T.P.), Chulalongkorn University; and Chulalongkorn Stroke Center (T.P.), King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand. 2. From U 1172-LilNCog-Lille Neuroscience and Cognition (M.P.), Université de Lille, Inserm, CHU Lille, France; Department of Neurology (M.P., L.S., L.X., A.C., T.P., S.S., C.K., K.S., S.M.G., C.D.A., M.E.G., J.R., A.V., A.B.), Hemorrhagic Stroke Research Program (L.S., A.C., S.M.G., C.D.A., M.E.G., J.R., A.V., A.B.), and Henry and Allison McCance Center for Brain Health (C.K., C.D.A., J.R., A.B.), Massachusetts General Hospital, Boston; Department of Neuroradiology (G.B.), Centre Hospitalier Sainte-Anne, Université Paris-Descartes, INSERM UMR 894, Paris, France; Department of Pharmacology, Faculty of Medicine (T.P.), Chulalongkorn University; and Chulalongkorn Stroke Center (T.P.), King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand. abiffi@partners.org.
Abstract
OBJECTIVE: To determine whether MRI-based cerebral small vessel disease (CSVD) burden assessment, in addition to clinical and CT data, improved prediction of cognitive impairment after spontaneous intracerebral hemorrhage (ICH). METHODS: We analyzed data from ICH survivors enrolled in a single-center prospective study. We employed 3 validated CSVD burden scores: global, cerebral amyloid angiopathy (CAA)-specific, and hypertensive arteriopathy (HTNA)-specific. We quantified cognitive performance by administering the modified Telephone Interview for Cognitive Status test. We utilized linear mixed models to model cognitive decline rates, and survival models for new-onset dementia. We calculated CSVD scores' cutoffs to maximize predictive performance for dementia diagnosis. RESULTS: We enrolled 612 ICH survivors, and followed them for a median of 46.3 months (interquartile range 35.5-58.7). A total of 214/612 (35%) participants developed dementia. Higher global CSVD scores at baseline were associated with faster cognitive decline (coefficient -0.25, standard error [SE] 0.02) and dementia risk (sub-hazard ratio 1.35, 95% confidence interval 1.10-1.65). The global score outperformed the CAA and HTNA scores in predicting post-ICH dementia (all p < 0.05). Compared to a model including readily available clinical and CT data, inclusion of the global CSVD score resulted in improved prediction of post-ICH dementia (area under the curve [AUC] 0.89, SE 0.02 vs AUC 0.81, SE 0.03, p = 0.008 for comparison). Global CSVD scores ≥2 had highest sensitivity (83%) and specificity (91%) for dementia diagnosis. CONCLUSIONS: A validated MRI-based CSVD score is associated with cognitive performance after ICH and improved diagnostic accuracy for predicting new onset of dementia.
OBJECTIVE: To determine whether MRI-based cerebral small vessel disease (CSVD) burden assessment, in addition to clinical and CT data, improved prediction of cognitive impairment after spontaneous intracerebral hemorrhage (ICH). METHODS: We analyzed data from ICH survivors enrolled in a single-center prospective study. We employed 3 validated CSVD burden scores: global, cerebral amyloid angiopathy (CAA)-specific, and hypertensive arteriopathy (HTNA)-specific. We quantified cognitive performance by administering the modified Telephone Interview for Cognitive Status test. We utilized linear mixed models to model cognitive decline rates, and survival models for new-onset dementia. We calculated CSVD scores' cutoffs to maximize predictive performance for dementia diagnosis. RESULTS: We enrolled 612 ICH survivors, and followed them for a median of 46.3 months (interquartile range 35.5-58.7). A total of 214/612 (35%) participants developed dementia. Higher global CSVD scores at baseline were associated with faster cognitive decline (coefficient -0.25, standard error [SE] 0.02) and dementia risk (sub-hazard ratio 1.35, 95% confidence interval 1.10-1.65). The global score outperformed the CAA and HTNA scores in predicting post-ICH dementia (all p < 0.05). Compared to a model including readily available clinical and CT data, inclusion of the global CSVD score resulted in improved prediction of post-ICH dementia (area under the curve [AUC] 0.89, SE 0.02 vs AUC 0.81, SE 0.03, p = 0.008 for comparison). Global CSVD scores ≥2 had highest sensitivity (83%) and specificity (91%) for dementia diagnosis. CONCLUSIONS: A validated MRI-based CSVD score is associated with cognitive performance after ICH and improved diagnostic accuracy for predicting new onset of dementia.
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