Visual MR-scales in patients with cognitive impairment in acute ischemic stroke of lacunar and cardioembolic subtypes

Background. Cognitive impairment in acute ischemic stroke has a negative impact on patients’ adaptability and quality life. They can result from acute ischemic brain damage affecting areas responsible for cognitive functions, or they can precede stroke. In the latter case, chronic cerebrovascular pathology and neurodegenerative process are the most common clinical variants. Their combination is considered within the concept of mixed cognitive impairment. In routine practice, magnetic resonance imaging (MRI) plays an important role, and visual semi-quantitative MR scales have been developed for the assessment of brain damage. Objective. To assess changes in white and gray matter in patients with lacunar and cardioembolic stroke using visual MR scales and to compare these data with the results of neuropsychological examination. Design and methods. We included 42 patients with cardioembolic and 52 patients with lacunar stroke and assessed changes in white and gray matter using 6 visual MR scales. A comprehensive neuropsychological examination was also performed. A correlation analysis was applied to assess the associations between the results of MR scales and impaired cognitive functions. Results. Patients with both lacunar and cardioembolic stroke subtypes, were characterized by a moderate degree of white matter damage. At the same time, patients with cardioembolic stroke tend to have more severe changes. In lacunar stroke, minor and moderate changes in gray predominate, while cardioembolic stroke is characterized by moderate and severe atrophy, which is reflected by the Koedam scales (0,000004) and atrophy of medial temporal lobe (0,000002). However, the results of the global cortical atrophy scale did not differ in these groups (0,902). Neuropsychological examination demonstrated that mild (44,2 % and 16,7 %, respectively) and moderate (46,2 % and 59,5 %, respectively) cognitive impairment predominates in both lacunar and cardioembolic stroke, and dementia is less common. Correlation analysis showed reliable links between structural brain damage and clinical features of cognitive impairment. Conclusion. Cardioembolic and lacunar strokes are characterized by moderate diffuse damage of white matter. The Wahlund and Scheltens scales are the most efficient for their detection. The greatest of degree gray matter damage was recorded in frontal lobes, in mediobasal regions of temporal lobes and parietal lobes in cardioembolic stroke and infratentorially and in basal ganglia in lacunar stroke. Both stroke subtypes are characterized by mild and moderate cognitive disorders, and dementia is registered only in isolated cases. The development of cognitive impairment correlates with topography and degree of white and gray matter damage.

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