Aims Cortical cerebral microinfarcts (CMIs) are small but could induce tissue injury extending beyond the lesion core. The thalamus, as a central cortico-subcortical hub, may be particularly vulnerable to CMI-related remote injury, potentially linking focal cortical lesions to cognitive impairment in cerebral small vessel disease (SVD). We examined associations of CMI burden with thalamic atrophy and cognitive impairment in SVD patients. Methods This cross-sectional study included 133 patients with SVD. CMI burden was visually rated for presence and count. Thalamic volumes were derived from T1 images, and cognition was measured via the Mini-Mental State Examination (MMSE). Linear regression analyses were performed to examine the associations of CMI count with conventional SVD imaging markers, thalamic volumes, and MMSE scores. Exploratory statistical mediation analysis examined the indirect association of CMI count with MMSE via intralaminar thalamic volume. Results Among 133 participants, 65 had CMIs. Higher CMI count was associated with lower MMSE scores after adjustment for age, sex, educational level, vascular risk factors, and conventional SVD MRI markers (p<0.001). Higher CMI count was not associated with total thalamic volume, but was selectively associated with lower intralaminar thalamic volume (FDR-adjusted p=0.045). The indirect association was statistically significant in the full sample but not after excluding thalamic lacunes. Conclusions CMIs were associated with cognitive impairment and lower intralaminar thalamic volume. The indirect association should be considered preliminary and hypothesis-generating. These findings highlight the role of the thalamus, as a key cortico-subcortical connectivity hub, in CMI-related remote tissue injury and cognitive dysfunction in SVD.
Background Post-stroke cognitive impairment drives long-term disability, yet cognitive deficits are rarely systematically screened in clinical practice or trials. The Oxford Cognitive Screen (OCS) is an established, brief, stroke-specific bedside tool. We present the Hungarian version (OCS-HU) to establish normative data and characterise performance in acute stroke survivors, to enable routine screening. Methods In a prospective, multicenter cross-sectional study, 106 healthy controls and 124 acute stroke survivors completed the OCS-HU within three weeks post-stroke. Normative 5th/95th percentile cut-offs derived from controls were compared with UK normative data. OCS-HU performance was subsequently compared between Hungarian controls and acute stroke survivors. Results The stroke cohort (68.21 ± 12.41 years) presented with a predominantly mild clinical profile (mean NIHSS: 5.15 ± 3.96; mRS: 2.47 ± 1.49). Hungarian controls (59.61 ± 12.30 years) were younger (p = 0.013) and had lower educational attainment (p < 0.001). Controlling for demographic differences, subtests demonstrated comparable normative performance, allowing retention of original UK cut-offs across most domains with minor linguistic adaptations. Minor control performance differences reflected demographic variations in age and education rather than recruitment bias. Stroke patients performed significantly worse than controls on 10 of 14 assessed measures (p < 0.001). Nonsignificant differences in the broken hearts test, semantics, and praxis reflect the mild cohortseverity and control error variance. Conclusions We establishes local normative reference data and characterised OCS-HU performance in acute stroke survivors, providing a foundation for its clinical and research application to improve deficit recognition, highlight unmet rehabilitation needs, and complement standard functional outcome measures.
Background We investigated if ambient air pollution and neighbourhood walkability associate with presence and progression of cerebral small vessel disease (CSVD) in patients with cardiovascular disorders along the heart-brain axis. Methods Data from patients with heart failure, carotid occlusive disease, or vascular cognitive impairment (30% women; mean age 69.0 years) of the Heart-Brain Connection study were used. Brain parenchymal fraction (BPF), white matter hyperintensity fraction (WMH), cerebral blood flow (CBF), and incident vascular lesions were assessed with 3T brain MRI at baseline (n = 300) and at two years follow-up (n = 181). Incident clinical cerebrovascular events were assessed with questionnaires and telephone interviews up to five years. Annual residential nitrogen dioxide (NO2; µg/m3) concentration was linked to participants at baseline. Neighbourhood walkability was measured using the Dutch walkability index within a 500-m Euclidean buffer around each residential-area centroid (range 0–100). Associations were analyzed using age- and sex-adjusted logistic regression and repeated-measures linear mixed models. Results At baseline, no association was found between NO2 or walkability and BPF, WMH, CBF, infarcts or microbleeds. Walkability (per 10 units) was associated with lower odds for having infarcts at baseline (OR 0.82, 95%CI 0.96–0.99) and attenuated age-related WMH increases by 0.01 SD (95%CI 0.00–0.02) per year. In longitudinal analyses, no associations between NO2 or walkability and progression of vascular brain lesions, cerebrovascular events, or mortality were found. Conclusion Although air pollution and neighbourhood walkability were not strongly associated with CSVD progression, stroke, or mortality, higher walkability appeared to modestly attenuate age-related increases in WMH.
Introduction Clinical impression of WMH commonly relies on visual rating scales (VRS), yet may improve through volumetric segmentation. Comparative studies, particularly considering clinical outcomes, are scarce. Methods We conducted a retrospective, cross-sectional study among 246 memory clinic patients. We compared WMH assessed through VRS (Fazekas) to automated volumetric segmentation (Quantib), through correlation and explained variance in neuropsychological assessment across six cognitive domains, above and beyond age, sex, and educational attainment in linear regression models. Results were contextualised through systematic literature review until 30 September 2022. Results Fazekas scores and WMH volumes were strongly correlated in the memory clinic population (ρ=0.83, p < 0.001), with little overlap in volumes between Fazekas categories. This was supported by similar correlations observed in 24 studies included in the systematic review and 13 in meta-analysis. Jointly with demographics, VRS and segmentation explained 6–19% of variance in cognitive domains in the memory clinic population. Volumetrics explained at most 2% more variance than visual rating, most substantial in MMSE (2%), in contrast to executive function (-1%). The systematic review identified three other comparative studies on cognitive outcome, each reporting similar correlations with volumetrics and visual rating scales. Previously proposed cut-offs in WMH volume that approximate Fazekas categories (3.4, 9.6 and 17.1 mL) showed classification accuracies of 59%, 70% and 78% in our cohort, with optimal thresholds in our sample at 1.6, 6.0 and 19.8 mL. Discussion VRS and volumetric segmentation of WMH are highly correlated. Small improvements in explained variance in cognition with volumetrics were inconsistent across cognitive domains
