Fax +41 61 306 12 34 E-Mail karger@karger.ch www.karger.com Original Research Article Dement Geriatr Cogn Disord 2005;20:225–230 DOI: 10.1159/000087310 Determinants of Prestroke Cognitive Impairment in Stroke Associated with Small Vessel Disease V. Mok a A. Wong a Wai Kwong Tang b W.W.M. Lam c Yu Hua Fan a Polly S. Richards c K.T. Wong c A.T. Ahuja c Ka Sing Wong a Departments of a Medicine and Therapeutics, b Psychiatry and c Radiology and Organ Imaging, the Chinese University of Hong Kong, Shatin, Hong Kong, SAR, China Introduction Small vessel disease (SVD) commonly manifests as la- cune and/or white matter changes (WMC) and is a com- mon geriatric disease. Stroke associated with SVD ac- counts for a quarter of patients with ischemic stroke [1]. Silent lacunes occur in about 20% of healthy elderly and the prevalence of WMC reaches as high as 95% among elderly people [2, 3]. Interest in SVD has increased re- cently due to its association with cognitive impairment [4] and Alzheimer’s disease (AD) [5, 6]. We have recent- ly observed that varying severity levels of prestroke cog- nitive impairment (PCI) are common among patients with SVD, and PCI predicts dementia 3 months after stroke [7]. Since cognitive impairment in SVD common- ly progresses [8, 9], the same risk factors that have been affecting patient’s cognition before stroke may continue to affect it after stroke. Identifying patients with PCI in SVD and examining its determinants are important steps for devising preventive measures that can be initiated soon after stroke. Previous studies on PCI have grouped all stroke sub- types together [10–14]. Risk factors for PCI include age, education, female sex, family history of dementia, previ- ous stroke, atrial fibrillation, cerebral atrophy, medial temporal lobe atrophy and WMC [10–14] . However, Key Words Prestroke cognitive impairment  Stroke  Small vessel disease Abstract Understanding the determinants of prestroke cognitive impairment (PCI) in stroke associated with small vessel disease (SVD) may shed light on how to prevent further cognitive deterioration after stroke. We administered the Informant Questionnaire on Cognitive Decline (IQCODE) to close informants of 78 consecutive stroke patients who had SVD. PCI, as defined by an average score of IQ- CODE 6 3.4 was found in 19 (24%) patients. Regression analyses were performed on the following risk factors for PCI: age, years of education, gender, previous stroke, volume of white matter changes, measures of silent la- cunes, cerebral atrophy index, medial temporal lobe at- rophy and frontal lobe atrophy. Multivariate regression analyses revealed that only cerebral atrophy index (OR 1.5, CI 1.2–1.9, p ! 0.001) predicted PCI among patients with SVD. Copyright © 2005 S. Karger AG, Basel Accepted: January 29, 2005 Published online: August 4,2005 Dr. Vincent C.T. Mok Department of Medicine and Therapeutics The Chinese University of Hong Kong Shatin, Hong Kong, SAR (China) Tel. +852 2632 3131, Fax +852 2649 3761, E-Mail vctmok@cuhk.edu.hk © 2005 S. Karger AG, Basel 1420–8008/05/0204–0225$22.00/0 Accessible online at: www.karger.com/dem