Prevalence and factors associated with cognitive impairment in symptomatic intracranial atherosclerotic disease: A prospective observational study.

Background

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Objectives

Symptomatic intracranial atherosclerotic disease (ICAD) carries a high risk of cognitive impairment despite optimal medical management. This study aimed to evaluate the prevalence of cognitive impairment and identify clinical and imaging factors associated with it in symptomatic ICAD.

Methods

In this prospective observational study, patients with the first-ever transient ischemic attack (TIA) or ischemic stroke attributed to ICAD were enrolled within one month of symptom onset. Baseline clinical and imaging characteristics, as well as recurrent cerebrovascular events during follow-up, were documented. The primary outcome was cognitive function, assessed using the Montreal Cognitive Assessment (MoCA) at 3 months and 15 months after symptom onset. Multinomial logistic regression analysis was performed to identify the independent factors associated with cognitive impairment.

Results

A total of 120 patients were enrolled (mean age, 60.27 ± 9.29 years; 76.7% men). Cognitive impairment was present in 98/114 (85.9%) patients at 3 months and 96/112 (85.7%) at 15 months; moderate-to-severe cognitive impairment was present in 45/114 (39.5%) and 42/112 (37.5%), respectively. There was no significant change in MoCA scores between 3 and 15 months. A subgroup of patients (36.6%) experienced a decrease in MoCA score (≥1 point), which was more frequent in patients with recurrent cerebrovascular events than those without (51.52% vs 30.38%, p = 0.034). Of the clinical and imaging factors, advanced age (OR, 1.12; 95% CI, 1.04-1.22; p = 0.003), stroke as the index event than TIA (OR, 8.85; 95% CI, 1.28-62.5; p = 0.027), and post-stroke depression (OR, 1.42; 95% CI, 1.03-1.95; p = 0.035) were independently associated with long-term moderate to severe cognitive impairment. None of the imaging factors was independently associated with cognitive impairment.

Conclusions

Cognitive impairment was highly prevalent in symptomatic ICAD, affecting approximately 86% of patients at both 3 and 15 months. There was no significant change in MoCA scores over time. Elderly patients presenting with stroke as the index event and those with depressive symptoms represent the high-risk group. These findings underscore the importance of early cognitive screening and rehabilitation in high-risk patients.