A Small Vessel Disease syndrome? Symptoms associated with cerebral SVD progression and incident infarcts after minor stroke

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U Clancy,¹ C Arteaga,¹ W Hewins,¹ D Jaime Garcia,¹ R Penman,¹ MC Valdés-Hernández,¹ S Wiseman,¹ M Stringer,¹ MJ Thrippleton,¹ FM Chappell,¹ ACC Jochems,¹ OKL Hamilton,¹ Cheng,2 X Liu,3 J Zhang,4 S Rudilosso,5 E Sakka,1 A Kampaite,1 R Brown,¹ ME Bastin,¹ S
¹ Centre for Clinical Brain Sciences, Edinburgh Imaging and the UK Dementia Research Institute at the University of Edinburgh, UK 2 Center of Cerebrovascular Diseases, 2 Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
Scientific Research
SP - Neurology & Neuroscience
Stroke
Cardiovascular

Abstract

Introduction

Small vessel disease (SVD) lesions may cause symptoms apart from stroke. We aimed to determine whether white matter hyperintensity (WMH) progression and incident infarcts associate with gait, mood, and cognitive symptoms.

 

Method

We recruited patients with non-disabling stroke (modified Rankin Scale <3), performed diagnostic MRI, and questioned participants/informants about gait, mood, cognitive, Center Epidemiologic Studies-Depression Scale (CES-D), Neuropsychiatric Inventory-Questionnaire (NPI-Q) symptoms and Informant Questionnaire for Cognitive Decline in the Elderly (IQCODE).

The baseline visit occurred < 3months post-stroke. We repeated MRI and symptoms assessments every 3-6 months for 12 months, assessing WMH change and incident infarcts (i.e. new since previous scan) on DWI or FLAIR. We analysed WMH using cubed root normalised for intracranial volume. We used linear mixed-effects models, adjusting for age, gait speed, modified Rankin Scale, and time for gait symptoms; age, anxiety, MoCA, stroke subtype, and time for cognitive/neuropsychiatric symptoms. 

 

Results

We recruited 230 participants (mean age=65.8 [SD=11.2] years; 34% female; 56.5% lacunar); median baseline WMH volumes = 8.26mL (IQR 3.65-19.0); one-year = 8.24mL (IQR = 4.15-20.1). Incident infarcts (n=110, 82/110 (74.5%) small subcortical subtype) occurred in 53/230 (23%) of patients.

WMH progression over one year was associated with falls (OR=4.13 [95% CI=1.6-10.1]); self-reported brain fog (OR=3.13 [95% CI=1.11-8.82]); and increasing NPI-Q scores (est=2.12 [95% CI=0.46-3.77] p=0.012). Baseline and one-year WMH volumes were cross-sectionally associated with apathy (baseline OR=8.78 [95% CI=2.56-31.88]; one-year OR=4.83 [95% CI=1.43-17.26]).

Higher CES-D depression scores were associated with incident infarcts (mean 15.2 [12.9] with vs 11.9 [SD10.6] without; est=2.26 (95% CI=0.12-4.4), p=0.038). WMH progression and infarcts were not associated with fatigue, anxiety, subjective memory complaints, confusion, dizziness, or IQCODE scores.

 

Conclusions

SVD progression following minor stroke co-associates with specific gait/cognitive/mood symptoms. WMH progression and incident infarcts may cause non-focal, non-stroke symptoms which characterise a potential ‘SVD syndrome’.

Presentation