06 Oct 21. Featured Paper

Predicting post-stroke cognitive impairment using acute CT neuroimaging: A systematic review & meta-analysis

Link to paper on International Journal of Stroke

Authors

Emily L Ball, Rachel Sutherland, Charlotte Squires, Gillian E Mead, Dorota Religa, Erik Lundström, Joshua Cheyne, Joanna M Wardlaw, Terence J Quinn, Susan D Shenkin

Abstract

Background: Identifying whether acute stroke patients are at risk of cognitive decline could improve prognostic discussions & management.

Structural computed tomography neuroimaging is routine in acute stroke, & may identify those at risk of post-stroke dementia or post-stroke cognitive impairment (PSCI).

Aim: To systematically review the literature to identify which stroke or pre-stroke features on brain computed tomography scans, performed at the time of stroke, are associated with post-stroke dementia or PSCI.

Summary of review: We searched electronic databases to December 2020.

We included studies reporting acute stroke brain computed tomography, & later diagnosis of a cognitive syndrome.

We created summary estimates of size of unadjusted association between computed tomography features & cognition.

Of 9536 citations, 28 studies (41 papers) were eligible (N = 7078, mean age 59.8–78.6 years).

Cognitive outcomes were post-stroke dementia (10 studies), PSCI (17 studies), & one study analyzed both.

Fifteen studies (N = 2952) reported data suitable for meta-analyses.

White matter lesions (WML) (six studies, N = 1054, OR = 2.46, 95% CI = 1.25–4.84), cerebral atrophy (four studies, N = 558, OR = 2.80, 95% CI = 1.21–6.51), & pre-existing stroke lesions (three studies, N = 352, OR = 2.38, 95% CI = 1.06–5.32) were associated with post-stroke dementia.

WML (four studies, N = 473, OR = 3.46, 95% CI = 2.17–5.52) were associated with PSCI. Other computed tomography features were either not associated with cognitive outcome, or there were insufficient data.

Conclusions: Cognitive impairment following stroke is of great concern to patients & carers.

Features seen on visual assessment of acute stroke computed tomography brain scans are strongly associated with cognitive outcomes.

Clinicians should consider when & how this information should be discussed with stroke survivors.

Keywords

• Cognitive impairment
• Computed tomography
• Dementia
• Neuroimaging
• Stroke