Impact of white matter hyperintensities on cognitive, motor and functional recovery in veterans following acute/subacute stroke: a prospective study
Meheroz H Rabadi, Chao XuObjective
To evaluate how the presence and severity of white matter hyperintensities (WMHs) affect cognitive, motor and functional recovery in veterans during the acute to subacute phase post-stroke.
Methods
A total of 125 veterans were consecutively and prospectively admitted to a designated stroke inpatient rehabilitation unit. All participants were originally enrolled in the recently published Motivation Study, forming a well-characterised cohort for evaluating post-stroke recovery outcomes. The WMH were assessed using brain MRI and graded according to the Fazekas scale, which evaluates periventricular hyperintensity, microbleeds and deep white matter hyperintensity. Assessments were conducted at admission and 3 months post-discharge. Linear and logistic regression models adjusted for potential confounders.
Results
Baseline demographic characteristics were similar between veterans with and without WMH, except for age (66.5±8.43 vs 60±9.88 years) and hypertension (n=82, 91.1% vs n=22, 62.9%) (p<0.001). At the 3-month follow-up, changes in Mini-Mental State Examination, National Institute of Health Stroke Scale and Functional Independence Measure (FIM)-Activities of Daily Living scores were similar between groups. However, clinically meaningful improvements in the FIM-Mobility and Total Functional Independence Measure scores favoured the non-WMH group, even after controlling for potential confounders (p<0.05).
Conclusion
Maintaining hypertension control in the presence of WMH in veterans undergoing inpatient rehabilitation after an ischaemic stroke is associated with a reduction in functional motor disability and future stroke risk.