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Vol. 20, No. 1, 2005
Issue release date: July 2005

Lacunar Infarcts: Functional and Cognitive Outcomes at Five Years in Relation to MRI Findings

Appelros P. · Samuelsson M. · Lindell D.
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Abstract

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.



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References

  1. Norrving B: Long-term prognosis after lacunar infarction. Lancet Neurol 2003;2:238–245.
  2. Samuelsson M, Söderfeldt B, Olsson GB: Functional outcome in patients with lacunar infarction. Stroke 1996;27:842–846.
  3. Yamamoto Y, Akiguchi I, Oiwa K, Hayashi M, Kasai T, Ozasa K: Twenty-four-hour blood pressure and MRI as predictive factors for different outcomes in patients with lacunar infarct. Stroke 2002;33:297–305.
  4. Zhu L, Fratiglioni L, Guo Z, Winblad B, Viitanen M: Incidence of stroke in relation to cognitive function and dementia in the Kungsholmen Project. Neurology 2000;54:2103–2107.
  5. Ferro JM, Kertesz A, Black SE: Subcortical neglect: Quantitation, anatomy, and recovery. Neurology 1987;37:1487–1492.
  6. Tatemichi TK, Desmond DW, Prohovnik I, Cross DT, Gropen TI, Mohr JP, Stern Y: Confusion and memory loss from capsular genu infarction: A thalamocortical disconnection syndrome? Neurology 1992;42:1966–1979.
  7. Samuelsson M, Lindell D, Olsson GB: Lacunar infarcts: A 1-year clinical and MRI follow-up study. Cerebrovasc Dis 1994;4:265–272.

    External Resources

  8. Wahlund LO, Barkhof F, Fazekas F, Bronge L, Augustin M, Sjögren M, Wallin A, Ader H, Leys D, Pantoni L, Pasquier F, Erkinjuntti T, Scheltens P: A new rating scale for age-related white matter changes applicable to MRI and CT. Stroke 2001;32:1318–1322.
  9. Aho K, Harmsen P, Hatano S, Marquardsen J, Smirnov VE, Strasser T: Cerebrovascular disease in the community: Results of a WHO collaborative study. Bull WHO 1980;58:113–130.
  10. Bamford J, Sandercock P, Jones L, Warlow C: The natural history of lacunar infarction: The Oxfordshire Community Stroke Project. Stroke 1987;18:545–551.
  11. Scandinavian Stroke Study Group: Multicenter trial of hemodilution in ischemic stroke – Background and study protocol. Stroke 1985;16:885–890.

    External Resources

  12. Katz S, Ford AB, Moskowitz RW, Jackson BA, Jaffe MW: Studies of illness in the aged. The Index of ADL: A standardized measure of biological and psychological function. JAMA 1963;185:914–919.
  13. Hulter Åsberg K, Sonn U: The cumulative structure of personal and instrumental ADL. A study of elderly people in a health service district. Scand J Rehabil Med 1989;21:171–177.

    External Resources

  14. Van Swieten JC, Koudstaal PJ, Visser MC, Schouten HJ, van Gijn J: Interobserver agreement for the assessment of handicap in stroke patients. Stroke 1988;19:604–607.
  15. Bamford JM, Sandercock PA, Warlow CP, Slattery J: Interobserver agreement for the assessment of handicap in stroke patients. Stroke 1989;20:828.
  16. Folstein MF, Folstein SE, McHugh PR: ‘Mini-Mental State’. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12:189–198.
  17. Asplund K, Tuomilehto J, Stegmayr B, Wester PO, Tunstall-Pedoe H: Diagnostic criteria and quality control of the registration of stroke events in the MONICA project. Acta Med Scand 1988;728(suppl):26–39.
  18. Newcombe RG, Altman DG: Proportions and their differences; in Altman DG, Machin D, Bryant TN, Gardner MJ (eds): Statistics with Confidence, ed 2. London, BMJ Books, 2000, pp 45–56.
  19. Eriksson SE, Olsson JE: Survival and recurrent strokes in patients with different subtypes of stroke: A fourteen-year follow-up study. Cerebrovasc Dis 2001;12:171–180.
  20. Staaf G, Lindgren A, Norrving B: Pure motor stroke from presumed lacunar infarct: Long-term prognosis for survival and risk of recurrent stroke. Stroke 2001;32:2592–2596.
  21. Salgado AV, Ferro JM, Gouveia-Oliveira A: Long-term prognosis of first-ever lacunar strokes. A hospital-based study. Stroke 1996;27:661–666.
  22. Appelros P, Nydevik I, Seiger Å, Terént A: High incidence rates of stroke in Örebro, Sweden: Further support for regional incidence differences within Scandinavia. Cerebrovasc Dis 2002;14:161–168.
  23. Sacco RL, Shi T, Zamanillo MC, Kargman DE: Predictors of mortality and recurrence after hospitalized cerebral infarction in an urban community: The Northern Manhattan Stroke Study. Neurology 1994;44:626–634.
  24. Hénon H, Vroylandt P, Durieu I, Pasquier F, Leys D: Leukoaraiosis more than dementia is a predictor of stroke recurrence. Stroke 2003;34:2935–2940.
  25. Dombovy ML, Basford JR, Whisnant JP, Bergstralh EJ: Disability and use of rehabilitation services following stroke in Rochester, Minnesota, 1975–1979. Stroke 1987;18:830–836.
  26. Wilkinson PR, Wolfe CD, Warburton FG, Rudd AG, Howard RS, Ross-Russell RW, Beech RR: A long-term follow-up of stroke patients. Stroke 1997;28:507–512.
  27. Tombaugh TN, McIntyre NJ: The Mini-Mental State Examination: A comprehensive review. J Am Geriatr Soc 1992;40:922–935.
  28. Crum RM, Anthony JC, Bassett SS, Folstein MF: Population-based norms for the Mini-Mental State Examination by age and educational level. JAMA 1993;269:2386–2391.
  29. Miyao S, Takano A, Teramoto J, Takahashi A: Leukoaraiosis in relation to prognosis for patients with lacunar infarction. Stroke 1992;23:1434–1438.
  30. Van Swieten JC, Staal S, Kappelle LJ, Derix MM, van Gijn J: Are white matter lesions directly associated with cognitive impairment in patients with lacunar infarcts? J Neurol 1996;243:196–200.
  31. Loeb C, Gandolfo C, Croce R, Conti M: Dementia associated with lacunar infarction. Stroke 1992;23:1225–1229.
  32. Ivan CS, Seshadri S, Beiser A, Au R, Kase CS, Kelly-Hayes M, Wolf PA: Dementia after stroke: The Framingham Study. Stroke 2004;35:1264–1269.
  33. Aharon-Peretz J, Daskovski E, Mashiach T, Kliot D, Tomer R: Progression of dementia associated with lacunar infarctions. Dement Geriatr Cogn Disord 2003;16:71–77.
  34. Galasko DR, Gould RL, Abramson IS, Salmon DP: Measuring cognitive change in a cohort of patients with Alzheimer’s disease. Stat Med 2000;19:1421–1432.
  35. Longstreth WT Jr, Arnold AM, Beauchamp NJ Jr, Manolio TA, Lefkowitz D, Jungreis C, Hirsch CH, O’Leary DH, Furberg CD: Incidence, manifestations, and predictors of worsening white matter on serial cranial magnetic resonance imaging in the elderly: The Cardiovascular Health Study. Stroke 2005;36:56–61.
  36. Leys D, Pruvo JP, Scheltens P, Rondepierre P, Godefroy O, Leclerc X, De Reuck J: Leukoaraiosis: Relationship with the types of focal lesions occurring in acute cerebrovascular disorders. Cerebrovasc Dis 1992;2:169–176.

    External Resources



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