OBJECTIVE This study investigated the association between small vessel disease (SVD) burden, a combination of multiple SVD markers and cognitive dysfunction after stroke. METHODS The study sample comprised 451 patients with first-ever acute ischemic stroke. Cognitive functions were assessed with the Mini-Mental State Examination (MMSE) at 3, 9, and 15 months after the index stroke. Cognitive impairment was defined as an MMSE score of ≤26. A total SVD score, indicating SVD burden, was constructed by summing the scores of the 4 SVD markers (white matter hyperintensities [WMHs], lacunes, cerebral microbleeds, and perivascular spaces) ascertained by magnetic resonance imaging (range: 0-4). The association between SVD burden and cognitive dysfunction was assessed with linear mixed models or generalized estimating equation models, as appropriate. RESULTS The majority of patients had mild-to-moderate stroke and at least one identifiable SVD marker. Cognitive impairment was found in about one-third of patients. After adjusting for confounding factors, the SVD burden was associated with MMSE scores (β = -0.37, P = .003) and cognitive impairment (odds ratio [OR] = 1.20, 95% confidence interval [CI] = 1.02-1.42). SVD burden was specifically associated with the performance of MMSE subscores including orientation to place and time, calculation, and word recall. Of the SVD markers, WMHs was the most robust predictor of decrease in MMSE scores (β = -0.25, P = .01) and cognitive impairment (OR = 1.14, 95% CI = 1.01-1.29). CONCLUSION Cerebral SVD burden is associated with decreased MMSE scores, suggesting cognitive dysfunction during the first year after mild-to-moderate acute ischemic stroke.

中文翻译：

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脑小血管疾病负担与中风后认知功能下降有关：一项为期1年的随访研究。

目的本研究调查了小血管疾病（SVD）负担，多种SVD标志物的组合与中风后认知功能障碍之间的关系。方法该研究样本包括451例首例急性缺血性中风。在指标性卒中后第3、9和15个月，通过迷你精神状态检查（MMSE）评估认知功能。认知障碍定义为MMSE分数≤26。通过对磁共振成像确定的4种SVD标记（白质高信号[WMH]，腔隙，脑微出血和血管周间隙）的分数求和，可以得出表示SVD负担的总SVD分数（范围：0-4）。适当地，使用线性混合模型或广义估计方程模型评估了SVD负担与认知功能障碍之间的关联。结果大多数患者患有轻度至中度卒中和至少一种可识别的SVD标记物。在约三分之一的患者中发现了认知障碍。调整混杂因素后，SVD负担与MMSE评分（β= -0.37，P = 0.003）和认知障碍（赔率[OR] = 1.20，95％置信区间[CI] = 1.02-1.42）相关。SVD负担与MMSE子成绩的表现特别相关，包括对时间和地点的定向，计算和单词回忆。在SVD标记中，WMH是MMSE得分（β= -0.25，P = 0.01）和认知障碍（OR = 1.14，95％CI = 1.01-1.29）下降的最强有力的预测因子。结论脑SVD负担与MMSE评分降低有关，提示轻度至中度急性缺血性卒中后第一年出现认知功能障碍。