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Secondary thalamic atrophy related to brain infarction may contribute to post-stroke cognitive impairment

  • Jieli Geng
    Affiliations
    Department of Neurology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
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  • Fuqiang Gao
    Affiliations
    LC Campbell Cognitive Neurology, Dr. Sandra Black Centre for Brain Resilience & Recovery, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, University of Toronto, Ontario, Canada
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  • Joel Ramirez
    Affiliations
    LC Campbell Cognitive Neurology, Dr. Sandra Black Centre for Brain Resilience & Recovery, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, University of Toronto, Ontario, Canada

    Heart and Stroke Foundation Canadian Partnership for Stroke Recovery (Sunnybrook site), Toronto, Ontario, Canada
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  • Kie Honjo
    Affiliations
    LC Campbell Cognitive Neurology, Dr. Sandra Black Centre for Brain Resilience & Recovery, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, University of Toronto, Ontario, Canada

    Heart and Stroke Foundation Canadian Partnership for Stroke Recovery (Sunnybrook site), Toronto, Ontario, Canada
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  • Melissa F. Holmes
    Affiliations
    LC Campbell Cognitive Neurology, Dr. Sandra Black Centre for Brain Resilience & Recovery, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, University of Toronto, Ontario, Canada
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  • Sabrina Adamo
    Affiliations
    LC Campbell Cognitive Neurology, Dr. Sandra Black Centre for Brain Resilience & Recovery, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, University of Toronto, Ontario, Canada
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  • Miracle Ozzoude
    Affiliations
    LC Campbell Cognitive Neurology, Dr. Sandra Black Centre for Brain Resilience & Recovery, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, University of Toronto, Ontario, Canada
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  • Gregory M. Szilagyi
    Affiliations
    LC Campbell Cognitive Neurology, Dr. Sandra Black Centre for Brain Resilience & Recovery, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, University of Toronto, Ontario, Canada
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  • Christopher J.M. Scott
    Affiliations
    LC Campbell Cognitive Neurology, Dr. Sandra Black Centre for Brain Resilience & Recovery, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, University of Toronto, Ontario, Canada
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  • Glen T. Stebbins
    Affiliations
    Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
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  • David L. Nyenhuis
    Affiliations
    Hauenstein Neuroscience Center, Saint Mary's Health Care, Grand Rapids, MI, USA

    LCC International University
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  • Maged Goubran
    Affiliations
    LC Campbell Cognitive Neurology, Dr. Sandra Black Centre for Brain Resilience & Recovery, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, University of Toronto, Ontario, Canada

    Heart and Stroke Foundation Canadian Partnership for Stroke Recovery (Sunnybrook site), Toronto, Ontario, Canada

    Department of Medical Biophysics, University of Toronto, Ontario, Canada
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  • Sandra E. Black
    Correspondence
    Corresponding author at: Cognitive Neurology, Sunnybrook Research Institute, A421-2075 Bayview Ave., Toronto, ON, Canada M4N 3M5.
    Affiliations
    LC Campbell Cognitive Neurology, Dr. Sandra Black Centre for Brain Resilience & Recovery, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, University of Toronto, Ontario, Canada

    Heart and Stroke Foundation Canadian Partnership for Stroke Recovery (Sunnybrook site), Toronto, Ontario, Canada

    Department of Medicine (Neurology), Sunnybrook Health Sciences Centre and University of Toronto, Ontario, Canada
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      Abstract

      Background and purpose

      The thalamus is a key brain hub that is globally connected to many cortical regions. Previous work highlights thalamic contributions to multiple cognitive functions, but few studies have measured thalamic volume changes or cognitive correlates. This study investigates associations between thalamic volumes and post-stroke cognitive function.

      Methods

      Participants with non-thalamic brain infarcts (3-42 months) underwent MRI and cognitive testing. Focal infarcts and thalami were traced manually. In cases with bilateral infarcts, the side of the primary infarct volume defined the hemisphere involved. Brain parcellation and volumetrics were extracted using a standardized and previously validated neuroimaging pipeline. Age and gender-matched healthy controls provided normal comparative thalamic volumes. Thalamic atrophy was considered when the volume exceeded 2 standard deviations greater than the controls.

      Results

      Thalamic volumes ipsilateral to the infarct in stroke patients (n=55) were smaller than left (4.4 ± 1.4 vs. 5.4 ± 0.5 cc, p < 0.001) and right (4.4 ± 1.4 vs. 5.5 ± 0.6 cc, p < 0.001) thalamic volumes in the controls. After controlling for head-size and global brain atrophy, infarct volume independently correlated with ipsilateral thalamic volume (β= -0.069, p=0.024). Left thalamic atrophy correlated significantly with poorer cognitive performance (β = 4.177, p = 0.008), after controlling for demographics and infarct volumes.

      Conclusions

      Our results suggest that the remote effect of infarction on ipsilateral thalamic volume is associated with global post-stroke cognitive impairment

      Key Words

      Abbreviations:

      SABRE (semi-automatic brain region extraction), PSCI (post-stroke cognitive impairment), AD (Alzheimer's Disease), MCI (mild cognitive impairment), WMH (white matter hyperintensities), MoCA (Montreal Cognitive Assessment), VCI-60min (60-Minute Protocol (Vascular Cognitive Impairment)), VCI-30min (30-Minute Protocol), VCI-5min (5-Minute Protocol)
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