Biological and imaging predictors of cognitive impairment after stroke: a systematic review

Abstract

Background: Cognitive impairment is frequent after stroke, and several studies have suggested that biological and imaging characteristics present before stroke are associated with the development of post-stroke cognitive impairment.

Objective: The aim of our study was to systematically review biological and imaging predictors of cognitive impairment after stroke.

Method: Studies were identified from bibliographic databases and reference lists, and were included if conducted in patients with acute stroke, with at least 30 patients, and a follow-up of at least 3 months. We included articles on potential biomarkers of cognitive impairment that pre-existed to stroke.

Results: We identified 22,169 articles, including 20,349 with abstract. After analysis, 66 studies conducted in 42 cohorts met selection criteria. They included 30-9522 patients [median 170; interquartile range (IQR) 104-251] with a median follow-up of 12 months (IQR 3-36). All studies met quality criteria for description of the study population and standardization of biomarkers. Twenty-nine studies met all quality criteria. There was no convincing evidence that any biological marker may predict cognitive impairment. The most consistent predictors of cognitive impairment after stroke were global atrophy and medial temporal lobe atrophy.

Conclusion: Pre-existing cerebral atrophy is the most consistent predictor of cognitive impairment that can be identified in patients with an acute stroke.

Keywords: Brain infarction; Cognitive disorders; Dementia; Intracerebral haemorrhage; Vascular dementia.