Jill Abrigo (Hong Kong PRC)
The Chinese University of Hong Kong Department of Imaging and InterventionalAuthor Of 2 Presentations
SEX DIFFERENCES IN OCCURRENCE AND TYPE OF POST-STROKE COGNITIVE IMPAIRMENT: A MULTICENTER STUDY IN 2950 PATIENTS WITH ACUTE ISCHEMIC STROKE
Abstract
Background And Aims
Post-stroke cognitive impairment (PSCI) occurs in about half of stroke survivors. It is unknown if occurrence and type of PSCI within a year after ischemic stroke differs by sex.
Methods
We harmonized individual patient data from twelve cohorts through the Meta-VCI-Map consortium. Patients with acute symptomatic infarcts on CT/MRI and cognitive assessment <1 year post-stroke were eligible. PSCI was defined as impairment in ≥1 cognitive domains on neuropsychological assessment or impairment on the Montreal Cognitive Assessment, both based on local norm-referenced data. Odds ratios (OR) for PSCI and the separate cognitive domains were calculated with logistic regression analyses.
Results
2950 patients (age 67±12 years, 39% female) were analyzed. Females were older (69 ±12 versus 65±11 years; p<.001) and lower educated (71% <high school versus 49%; p<.001) than males. The risk of PSCI was comparable between the sexes (males OR 0.94 (95%CI 0.81-1.09)), 45% of females and 43% of males. Females had a higher risk of impairment in the domains attention & executive functioning (males OR 0.75 (95%CI 0.60-0.94)), and language (males OR 0.67 (95%CI 0.53-0.83)), whereas males had a higher risk of verbal memory impairment (males OR 1.31 (95%CI1.08-1.59)). The risk of impairment in the other domains, information processing speed; visuospatial perception/construction; and visuospatial memory was comparable between the sexes.
Conclusions
PSCI is equally common in both females and males, but PSCI cognitive profiles differ by sex. This has implications for post-stroke clinical care, since both the diagnosis and rehabilitation are influenced by cognitive profile.
Trial Registration Number
Not applicable
RISK OF RUPTURE OF AN INTRACRANIAL ANEURYSM WITH GROWTH DETECTED DURING FOLLOW-UP: A MULTICENTRE COHORT STUDY
Abstract
Background And Aims
Unruptured intracranial aneurysms (UIAs) not undergoing preventive treatment are often followed radiologically to detect aneurysm growth, which is associated with an increased risk of rupture. We aimed to determine the absolute risk of aneurysm rupture after detection of growth.
Methods
In this observational study, we included patients ≥18 years from 15 international cohorts with ≥1 UIA with growth. Growth was defined as ≥1 mm increase in at least one direction. We calculated the absolute risk of rupture at six months, one year, and two years. Hazard ratios (HRs) with 95% CIs were generated. A prediction model was built to estimate an individualized risk of rupture after detection of growth.
Results
We screened 5166 patients who had follow-up imaging for 6928 UIAs, and included 312 patients with 329 aneurysms with growth during follow-up. During 864 aneurysm-years of follow-up after detection of growth, 25 (7.6%) aneurysms ruptured. The absolute risk of rupture after growth was 2.9% [95%CI:0.9-4.9%] at six months, 4.3% [95%CI:1.9-6.7%] at one year, and 6.0% [95%CI:2.9-9.1] at two years. In multivariable analyses, predictors of rupture were size (≥7 mm: HR 4.3 [95%CI:4.1-13.0]), shape (irregular: HR 2.9 [95%CI:1.3-6.4]) and site (middle cerebral artery: HR 3.6 [95%CI:0.7-16.3]; anterior cerebral artery/posterior communicating artery/posterior circulation: HR 2.8 [95%CI:0.6-13.0])). In the triple-S (size, site, shape) prediction model, the one-year risk of rupture ranged from 2.1% to 10.6%.
Conclusions
Our newly developed triple-S prediction model can be used by physicians to estimate absolute risks of rupture for the initial period after detection of aneurysm growth.