Lacunar Infarcts: Functional and Cognitive Outcomes at Five Years in Relation to MRI FindingsAppelros P. · Samuelsson M. · Lindell D.
Departments of aNeurology and bRadiology, Örebro University Hospital, Örebro, and cNeurotec, Karolinska Institutet, Stockholm, Sweden
Background: There are few long-term follow-up studies of patients with lacunar infarcts (LIs). The purpose of this 5-year follow-up study was to assess functional and cognitive outcome in relation to MRI findings. Methods: 81 patients with a first-ever LI were followed for 5 years with respect to mortality, stroke recurrence, functional and cognitive outcome. T2-weighted MRI was performed at baseline and at 5 years. The presence of basal ganglia lesions and white matter lesions was scored according to the European Task Force rating scale. Functional outcome was assessed with the Oxford Handicap Scale (OHP). Cognition was assessed with the Mini Mental State Examination (MMSE). Results: The 5-year mortality was 19%. Predictors for death were age (OR = 1.07, 95% CI 1.03–1.11), ischemic heart disease (OR = 2.1, 95% CI 1.1–4.1) and impairment score (OR = 1.16, 95% CI 1.02–1.32). 30% of the patients had a recurrent stroke. Predictors for recurrent stroke were diabetes mellitus (OR = 1.7, 95% CI 1.2–7.4) and amount of white matter lesions (OR = 1.7, 95% CI 1.2–2.7). 36% of the patients were functionally dependent (defined as OHP >2). Predictors for functional dependency were impairment score (OR = 1.71, 95% CI 1.12–2.59), MMSE (OR = 0.55, 95% CI 0.33–0.91) and stroke recurrence (OR = 84, 95% CI 9.4–745). 16% of the patients had cognitive impairment (defined as MMSE <24). Stroke recurrence and white matter score, but not basal ganglia score, were correlated to cognitive impairment. Conclusions: Many LI patients have a good functional outcome at 5 years. For older patients, for patients with an initial severe stroke, and with additional vascular risk factors, however, the prognosis is more severe, with an increased risk for mortality, stroke recurrence, and physical and cognitive decline.
Dr. Peter Appelros
Department of Neurology, Örebro University Hospital
SE–701 85 Örebro (Sweden)
Tel. +46 19 6022641, Fax +46 19 6116970
Received: October 29, 2004
Accepted: March 9, 2005
Published online: June 2, 2005
Number of Print Pages : 7
Number of Figures : 0, Number of Tables : 4, Number of References : 36
Vol. 20, No. 1, Year 2005 (Cover Date: Released July 2005)
Journal Editor: Bogousslavsky, J. (Lausanne)
ISSN: 1015–9770 (print), 1421–9786 (Online)
For additional information: http://www.karger.com/ced