Cognitive Impairment in Ischaemic Lacunar Stroke
European Neurological Review
Ischaemic cerebral small-vessel disease (SVD) can be visualised on brain magnetic resonance imaging (MRI) scans as lacunar infarcts, white matter hyperintensities and cerebral microbleeds, and has been recognised as the most frequent cause of cognitive impairment of vascular origin. Lacunar infarction is the most common manifestation of SVD and accounts for approximately 25 % of all brain infarctions. In patients with first-ever lacunar infarction, more than half of cases show impairment of the
... executive functions and meet criteria of mild vascular cognitive impairment. Lacunar stroke is an important predictor of post-stroke cognitive decline and vascular dementia. In the wellcharacterised cohort of 1,636 lacunar stroke patients of the Secondary Prevention of Small Subcortical Strokes (SPS3) trial, mild cognitive impairment was present in nearly half of participants and was an important complication of lacunar stroke more prevalent than physical disability. The cognitive profile identified to be associated with ischaemic cerebral SVD includes preserved memory with attention deficits and executive functioning impairment. However, in a recent systematic review of cognitive impairment in lacunar ischaemic stroke, impaired cognition appears less selective than previously thought, involving episodic memory and all major cognitive domains. Brain atrophy is also a feature of ischaemic cerebral SVD. Cognitive dysfunction in lacunar stroke sufferers is frequently overlooked in routine clinical practice and may be as common and clinically relevant as motor and sensory sequelae. Keywords Lacunar infarct, brain atrophy, prognosis, cognitive impairment, neuropsychology, cerebral small-vessel disease, brain atrophy Disclosure: The authors have no conflicts of interest to declare. Acknowledgements: The authors thank Marta Grau-Olivares for her contribution in searching the literature and helpful constructive comments and Marta Pulido for editing the manuscript and editorial assistance.