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How Complex Interactions of Ischemic Brain Infarcts, White Matter Lesions, and Atrophy Relate to Poststroke Dementia
Tarja Pohjasvaara, MD, PhD;
Riitta Mäntylä, MD;
Oili Salonen, MD, PhD;
Hannu J. Aronen, MD, PhD;
Raija Ylikoski, PhD;
Marja Hietanen, PhD;
Markku Kaste, MD, PhD;
Timo Erkinjuntti, MD, PhD
Arch Neurol. 2000;57:1295-1300.
Background Cerebrovascular disease is a major factor related to cognitive impairment. However, behavioral correlates of ischemic brain lesions are insufficiently characterized.
Objective To examine magnetic resonance imaging correlates of dementia in a large, well-defined series of patients with ischemic stroke.
Methods Detailed medical, neurological, and neuropsychological examinations were conducted 3 months after ischemic stroke for 337 of 486 consecutive patients aged 55 to 85 years. Infarcts (type, site, side, number, and volume), extent of white matter lesions (WMLs), and degree of atrophy were categorized according to magnetic resonance images of the head. The definition for dementia of the Diagnostic and Statistical Manual of Mental Disorders, Third Edition (DSM-III) was used.
Results Dementia was diagnosed in 107 (31.8%) of the patients and stroke-related dementia in 87 (25.8%). Volumes, numbers, distinct sites of infarcts, extent of WMLs, and degree of atrophy were different for the demented and nondemented subjects. Particularly, volumes of infarcts in any (right- or left-sided) superior middle cerebral artery territory (27.3 vs 13.7 cm3, P = .002) and left thalamocortical connection (14.8 vs 4.0 cm3, P = .002) differentiated the 2 groups. Logistic regression analysis showed that the correlates of any dementia included the combination of infarct features (volume of infarcts in any superior middle cerebral artery: odds ratio [OR], 1.11; frequency of left-sided infarcts: OR, 1.21), extent of WMLs (OR, 1.3), medial temporal lobe atrophy (OR, 2.1), and host factors (education; OR, 0.91). In the patients with stroke-related dementia, the main correlate was volume of infarcts in the left anterior corona radiata (OR, 1.68).
Conclusion Correlates of poststroke dementia do not include merely 1 feature but a combination of infarct features, extent of WMLs, medial temporal lobe atrophy, and host features.
From the Department of Clinical Neurosciences, Memory Research Unit (Drs Pohjasvaara, Ylikoski, Hietanen, and Erkinjuntti), Stroke Unit (Dr Kaste), and Department of Radiology (Drs Mäntylä, Salonen, and Aronen), Helsinki University Central Hospital, Helsinki, Finland.
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