Cerebral blood flow by arterial spin labeling in poststroke dementia
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Abstract
Objective: To investigate the relationship between cerebral blood flow and dementia in older stroke survivors and subjects with Alzheimer disease (AD).
Methods: This cohort study used arterial spin labeling MRI at 3 T to examine cerebral blood flow (CBF). We scanned 39 patients 6 years after stroke. They were older than 75 years at the time of stroke and free of dementia 3 months poststroke, with 8 subsequently developing dementia. We also scanned 17 subjects with AD and 29 healthy control subjects. We determined the perfusion in regions of interest (ROIs). Hippocampal volume was also measured using a previously validated automated procedure.
Results: The gray matter/white matter CBF ratio was reduced globally in the poststroke dementia (PSD) group (1.55 SD = 0.12) relative to control subjects (1.78 SD = 0.18; p = 0.03). The CBF ratio in a parietal ROI was reduced in the AD (1.34 SD = 0.31; p = 0.003), PSD (1.32 SD = 0.22; p = 0.041), and poststroke no-dementia (PSND) (1.44 SD = 0.34; p = 0.014) groups relative to that of control subjects (1.70 SD = 0.32). In subjects without stroke, the best predictor of dementia was hippocampus volume, whereas in the stroke group, it was the global CBF gray matter/white matter ratio. Hippocampus volume was not significantly different between the AD and PSD groups, and both had reduced hippocampi relative to those of control subjects and the PSND group.
Conclusions: We found evidence for both vascular and AD pathology in PSD, suggesting that both the direct impact of the stroke and subsequent development of AD-type changes play a role in the etiology of PSD.
Footnotes
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Study funding: Supported by the Medical Research Council (UK) (grant G0500247) and the Alzheimer's Research Trust (UK) and the UK National Institute for Health Research Biomedical Research Centre for Ageing and Age Related Diseases award to the Newcastle upon Tyne Hospitals NHS Foundation Trust.
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Supplemental data at www.neurology.org
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- AD
- Alzheimer disease
- CAMCOG-R
- Cambridge Cognitive Examination–Revised, Section B
- CBF
- cerebral blood flow
- DSM-III-R
- Diagnostic and Statistical Manual of Mental Disorders, 3rd edition, revised
- FLAIR
- fluid-attenuated inversion recovery
- GM
- gray matter
- ICV
- intracranial volume
- MMSE
- Mini-Mental State Examination
- MTA
- medial temporal lobe atrophy
- OCSP
- Oxfordshire Community Stroke Project
- PSD
- poststroke dementia
- PSND
- poststroke no dementia
- ROI
- region of interest
- SIVD
- subcortical ischemic vascular disease
- TBV
- total brain volume
- VaD
- vascular dementia
- WM
- white matter
- WMH
- white matter hyperintensity
- Received September 3, 2010.
- Accepted January 19, 2011.
- Copyright © 2011 by AAN Enterprises, Inc.
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