Abstract
INTRODUCTION: This study examines the relationship between white matter lesions (WML) and vascular cognitive impairment in patients with acute ischemic stroke (AIS). MATERIALS AND METHODS: We enrolled 120 AIS patients (79 males, 41 females; mean age 65.63 ± 10.12 years) admitted to the Department of Neurology, Mianyang Central Hospital, between February and November 2019. Demographic and clinical data were collected. All patients underwent cranial magnetic resonance imaging (MRI), and WML were graded using the Fazekas scale: mild WML (score 1-3, n = 67) and severe WML (score 4-6, n = 53). WML volume was quantified semi-automatically with 3D Slicer. Cognitive function was longitudinally assessed using the Clinical Dementia Rating (CDR) scale at two follow-up time points: 90 days and 1 year post-stroke. Statistical analyses included Chi-square tests, Spearman correlation, and linear regression. RESULTS: At 1 year post-stroke, the severe WML group had higher rates of mild cognitive impairment (MCI) (58.49% vs. 52.24%) and dementia (35.85% vs. 25.37%) compared to the mild WML group (all P < 0.05). Normal cognitive function was more frequent in the mild WML group (22.39% vs. 5.66%, P < 0.05). Correlation analyses showed that WML volume, total WML score, deep WML score, and age correlated with 1-year CDR scores (P < 0.05). Admission National Institutes of Health Stroke Scale (NIHSS) score, total WML score, and age were associated with 90-day CDR scores. Linear regression indicated that admission NIHSS score (P = 0.004, β = 0.26), total WML score (P = 0.047, β = 0.19), and age (P = 0.041, β = 0.19) independently influenced 90-day cognitive outcomes (R(2) = 0.13). CONCLUSION: Based on the assessment results of the CDR scale, WML severity, age and admission NIHSS score may demonstrate positive associations with cognitive function at 90 days post-stroke. While WML severity correlates with cognitive impairment at one year post-stroke, it does not appear to be the determining factor.