Individual markers of cerebral small vessel disease and domain-specific quality of life deficits.
cerebral small vessel disease
executive function
functional disability
lacunar infarcts
quality of life
stroke
Journal
Brain and behavior
ISSN: 2162-3279
Titre abrégé: Brain Behav
Pays: United States
ID NLM: 101570837
Informations de publication
Date de publication:
05 2021
05 2021
Historique:
revised:
23
02
2021
received:
22
06
2020
accepted:
24
02
2021
pubmed:
23
3
2021
medline:
1
7
2021
entrez:
22
3
2021
Statut:
ppublish
Résumé
Cerebral small vessel disease (SVD) leads to reduced quality of life (QOL), but the mechanisms underlying this relationship remain unknown. This study investigated multivariate relationships between radiological markers of SVD and domain-specific QOL deficits, as well as potential mediators, in patients with SVD. Clinical and neuroimaging measures were obtained from a pooled sample of 174 SVD patients from the St. George's Cognition and Neuroimaging in Stroke and PRESsure in established cERebral small VEssel disease studies. Lacunes, white matter hyperintensities, and microbleeds were defined as radiological markers of SVD and delineated using MRI. QOL was assessed using the Stroke-Specific Quality of Life Scale. Multivariate linear regression was used to determine whether SVD markers were associated with domain-specific QOL deficits. Significant associations were further investigated using mediation analysis to examine whether functional disability or cognition was potential mediators. Multivariate regression analyses revealed that lacunes were associated with total QOL score (β = -8.22, p = .02), as well as reductions in mobility (β = -1.41, p = .008) and language-related subdomains (β = -0.69, p = .033). White matter hyperintensities and microbleeds showed univariate correlations with QOL, but these became nonsignificant during multivariate analyses. Mediation analyses revealed that functional disability, defined as reduced activities of daily living, and executive function, partially mediated the relationship between lacunes and total QOL, as well as mobility-related QOL, but not language-related QOL. Lacunar infarcts have the most detrimental effect on QOL in SVD patients, particularly in the mobility and language-related subdomains. These effects may be partially explained by a reduction in activities of daily living. These results may inform targeted interventions to improve QOL in patients with SVD.
Sections du résumé
BACKGROUND
Cerebral small vessel disease (SVD) leads to reduced quality of life (QOL), but the mechanisms underlying this relationship remain unknown. This study investigated multivariate relationships between radiological markers of SVD and domain-specific QOL deficits, as well as potential mediators, in patients with SVD.
METHODS
Clinical and neuroimaging measures were obtained from a pooled sample of 174 SVD patients from the St. George's Cognition and Neuroimaging in Stroke and PRESsure in established cERebral small VEssel disease studies. Lacunes, white matter hyperintensities, and microbleeds were defined as radiological markers of SVD and delineated using MRI. QOL was assessed using the Stroke-Specific Quality of Life Scale. Multivariate linear regression was used to determine whether SVD markers were associated with domain-specific QOL deficits. Significant associations were further investigated using mediation analysis to examine whether functional disability or cognition was potential mediators.
RESULTS
Multivariate regression analyses revealed that lacunes were associated with total QOL score (β = -8.22, p = .02), as well as reductions in mobility (β = -1.41, p = .008) and language-related subdomains (β = -0.69, p = .033). White matter hyperintensities and microbleeds showed univariate correlations with QOL, but these became nonsignificant during multivariate analyses. Mediation analyses revealed that functional disability, defined as reduced activities of daily living, and executive function, partially mediated the relationship between lacunes and total QOL, as well as mobility-related QOL, but not language-related QOL.
CONCLUSIONS
Lacunar infarcts have the most detrimental effect on QOL in SVD patients, particularly in the mobility and language-related subdomains. These effects may be partially explained by a reduction in activities of daily living. These results may inform targeted interventions to improve QOL in patients with SVD.
Identifiants
pubmed: 33751852
doi: 10.1002/brb3.2106
pmc: PMC8119866
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
e02106Subventions
Organisme : Department of Health
Pays : United Kingdom
Organisme : British Heart Foundation
Pays : United Kingdom
Organisme : Biotechnology and Biological Sciences Research Council
Pays : United Kingdom
Organisme : Wellcome Trust
ID : 081589
Pays : United Kingdom
Informations de copyright
© 2021 The Authors. Brain and Behavior published by Wiley Periodicals LLC.
Références
Lancet Neurol. 2013 Aug;12(8):822-38
pubmed: 23867200
JAMA. 1995 Jan 4;273(1):59-65
pubmed: 7996652
Int J Stroke. 2021 Jul;16(5):510-518
pubmed: 33527880
J Neurol Neurosurg Psychiatry. 2020 Feb;91(2):196-203
pubmed: 31744851
Neurology. 2014 Oct 14;83(16):1417-23
pubmed: 25230999
Stroke. 1999 Jul;30(7):1362-9
pubmed: 10390308
PLoS One. 2013 Apr 22;8(4):e61014
pubmed: 23613774
Brain Behav. 2021 May;11(5):e02106
pubmed: 33751852
Prog Neurobiol. 2020 May;188:101785
pubmed: 32151533
Med Care. 1997 Dec;35(12):1212-9
pubmed: 9413309
Am J Occup Ther. 1999 Sep-Oct;53(5):471-81
pubmed: 10500855
Lancet. 1991 Jun 22;337(8756):1521-6
pubmed: 1675378
Md State Med J. 1965 Feb;14:61-5
pubmed: 14258950
Gerontologist. 1969 Autumn;9(3):179-86
pubmed: 5349366
AJR Am J Roentgenol. 1987 Aug;149(2):351-6
pubmed: 3496763
Lancet Neurol. 2010 Jul;9(7):689-701
pubmed: 20610345
Neurology. 2019 Mar 12;92(11):e1157-e1167
pubmed: 30737341
J Neurol Neurosurg Psychiatry. 2020 Sep;91(9):953-959
pubmed: 32651249
JAMA Neurol. 2018 Jun 1;75(6):720-727
pubmed: 29507944
Hippocampus. 2019 Jun;29(6):500-510
pubmed: 30307080
Brain. 2016 Apr;139(Pt 4):1136-51
pubmed: 26936939