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Normal-Appearing White Matter Deteriorates over the Year After an Ischemic Stroke and Is Associated with Global Cognition

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Abstract

Normal-appearing white matter (NAWM) is a hub of plasticity, but data relating to its influence on post-ischemic stroke (IS) outcome remain scarce. The aim of this study was to evaluate the relationship between NAWM integrity and cognitive outcome after an IS. A longitudinal study was conducted including supra-tentorial IS patients. A 3-Tesla brain MRI was performed at baseline and 1 year, allowing the analyses of mean fractional anisotropy (FA) and mean diffusivity (MD) in NAWM masks, along with the volume of white matter hyperintensities (WMH) and IS. A Montreal Cognitive Assessment (MoCA), an Isaacs set test, and a Zazzo’s cancellation task were performed at baseline, 3 months and 1 year. Mixed models were built, followed by Tract-based Spatial Statistics (TBSS) analyses. Ninety-five patients were included in the analyses (38% women, median age 69 ± 20). FA significantly decreased, and MD significantly increased between baseline and 1 year, while cognitive scores improved. Patients who decreased their NAWM FA more over the year had a slower cognitive improvement on MoCA (β =  − 0.11, p = 0.05). The TBSS analyses showed that patients who presented the highest decrease of FA in various tracts of white matter less improved their MoCA performances, regardless of WMH and IS volumes, demographic confounders, and clinical severity. NAWM integrity deteriorates over the year after an IS, and is associated with a cognitive recovery slowdown. The diffusion changes recorded here in patients starting with an early preserved white matter structure could have long term impact on cognition.

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Abbreviations

DTI:

Diffusion tensor imaging

DWI:

Diffusion weighted imaging

ET:

Echo time

FA:

Fractional anisotropy

FLAIR:

Fluid attenuated inversion recovery

FOV:

Field of view

FSL:

FMRIB software library

GM:

Grey matter

HAD:

Hospital Anxiety and Depression Scale

IQCODE:

Informant Questionnaire in Cognitive Decline in the Elderly

IS:

Ischemic stroke

IST:

Isaacs set test

MD:

Mean diffusivity

MoCA:

Montreal Cognitive Assessment

NAWM:

Normal-appearing white matter

NIHSS:

National Institute of Health Stroke Score

Ns:

Not significant

RT:

Repetition time

TBSS:

Tract-based spatial statistics

TFCE:

Threshold free cluster enhancement

WMH:

White matter hyperintensities

ZCT:

Zazzo’s cancellation task

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Funding

The study was supported by public grants (PHRCI-2012 and ANR-10-LABX-57 from the Translational Research and Advanced Imaging Laboratory).

Author information

Authors and Affiliations

  1. UMR-5287, CNRS, Université de Bordeaux, EPHE PSL Research University, Bordeaux, France

    Sharmila Sagnier, Gwenaëlle Catheline, Bixente Dilharreguy & Igor Sibon

  2. CHU de Bordeaux, Unité Neuro-Vasculaire, Bordeaux, France

    Sharmila Sagnier, Mathilde Poli, Sabrina Debruxelles, Pauline Renou, Stéphane Olindo, François Rouanet & Igor Sibon

  3. INCIA Université Bordeaux 2, 146 rue Léo Saignat Zone Nord, Bâtiment 2A, 2e étage, 33076, Bordeaux, France

    Sharmila Sagnier

  4. CHU de Bordeaux, Neuroradiologie, Bordeaux, France

    Pierre-Antoine Linck, Antoine Bigourdan, Vincent Dousset & Thomas Tourdias

  5. UMR-5800, CNRS, Université de Bordeaux, LaBRI, Talence, France

    Pierrick Coupé

  6. Beth Israel Deaconess Medical Center, Harvard University, Boston, USA

    Fanny Munsch

  7. INSERM-U1215, Neurocentre Magendie, Bordeaux, France

    Vincent Dousset & Thomas Tourdias

Authors
  1. Sharmila Sagnier
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  2. Gwenaëlle Catheline
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  15. Igor Sibon
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Corresponding author

Correspondence to Sharmila Sagnier.

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Ethics Approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the regional French Human Protection Committee (CPP 2012/19 2012-A00190-43).

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The authors declare no competing interests.

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Sagnier, S., Catheline, G., Dilharreguy, B. et al. Normal-Appearing White Matter Deteriorates over the Year After an Ischemic Stroke and Is Associated with Global Cognition. Transl. Stroke Res. 13, 716–724 (2022). https://doi.org/10.1007/s12975-022-00988-8

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  • DOI: https://doi.org/10.1007/s12975-022-00988-8

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