Abstract DP354: Imaging Markers of Vascular Brain Health in Patients with Minor Stroke

Background: Several MR imaging markers of vascular brain health have been associated with cognitive impairment, dementia, and recurrent stroke. Patients with minor stroke (NIHSS<6) usually have good functional outcomes, but it is unclear whether poor brain health impacts cognitive and functional outcomes. We investigated the association between MRI markers of vascular brain health and functional outcome in patients with minor stroke. Methods: Patients were selected from an NIH study (NCT00009243) of patients who were enrolled at two stroke centers with minor stroke (NIHSS<6) and received an MRI within 24h of stroke onset. Baseline MRI scans were evaluated by two independent raters (blinded to outcomes) for the following imaging markers: lacunar stroke, cortical microinfarct, enlarged perivascular spaces, cerebral microbleed, superficial siderosis, and intracranial stenosis; white matter hyperintensity volumes were measured quantitatively using semiautomated methods. The presence of each imaging marker was scored one point and a white matter hyperintensity volume > 0.44% of intracranial volume was scored one point for a composite score of 0-7. Final scores were stratified as mild (0-1) or moderate/severe (≥ 2). We evaluated associations between composite scores and 30- and 90-day post-stroke outcomes of cognitive impairment (MoCA <18), and poor functional outcome (mRS ≥2). Multivariable logistic regression analyses were conducted to estimate OR for post-stroke outcomes. Results: 127 patients were included in the study (Table 1). Overall, 32% of patients had scores of mild and 68% moderate/severe. Compared to patients with a mild score, cognitive impairment was more common among those with moderate/severe scores at 30-days (57% vs. 32%, p=0.01), and 90-days (63% vs. 46%, p=0.118); and poor functional outcome (mRS ≥ 2) was more common among those with moderate/severe scores at 30-days (35% vs. 20%, p=0.09), and 90 days (21% vs. 5%, p=0.01). In logistic regression analysis, a moderate/severe score was independently associated with poor functional outcome (mRS ≥2) at 90-days (aOR = 8.17; 95% CI, 1.12 – 59.6). Conclusions: MR imaging markers of vascular brain health are common among patients with minor stroke. Patients with a higher rate of imaging markers were more likely to have cognitive impairment and poor functional outcome after minor stroke. Further studies are needed to confirm these findings.