AUTHOR=Seyman Estelle Emanuelle , Sadeh-Gonik Udi , Berman Phillip , Blum Itay , Shendler Genady , Nathan Bornstein , Rothschild Ofer , Molad Jeremy , Ben Assayag Einor , Hallevi Hen ,  the TABASCO prospective cohort study group 

TITLE=Association between intracranial vessel calcifications, structural brain damage, and cognitive impairment after minor strokes: a prospective study

JOURNAL=Frontiers in Neurology

VOLUME=14

YEAR=2023

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2023.1218077

DOI=10.3389/fneur.2023.1218077

ISSN=1664-2295

ABSTRACT=<sec id="sec1"><title>Background</title><p>Vascular calcifications are a hallmark of atherosclerosis, and in the coronary arteries are routinely used as a prognostic marker. Calcifications of intracranial vessels (ICC) are frequently observed on non-contrast CT (NCCT) and their effect on post-stroke cognitive impairment (PSCI) remains unclear. Our aim was to explore the association of ICC with prospective long-term cognitive function and advanced MRI-measures in a large prospective cohort of cognitively intact mild stroke survivors.</p></sec><sec id="sec2"><title>Methods</title><p>Data from the Tel-Aviv brain acute stroke cohort (TABASCO) study [<uri xlink:href="http://ClinicalTrials.gov" xmlns:xlink="http://www.w3.org/1999/xlink">ClinicalTrials.gov</uri> #NCT01926691] were analyzed. This prospective cohort study (<italic>n</italic> = 575) aimed to identify predictors of PSCI, in cognitively intact mild stroke survivors. A quantitative assessment of the intracranial calcium content – The ICC score (ICCS) was calculated semi-automatically on NCCT using a validated calcium quantification application. Participants underwent a 3 T-MRI and prospective comprehensive cognitive clinical and laboratory assessments at enrollment, 6, 12, and 24-months.</p></sec><sec id="sec3"><title>Results</title><p>Data were available for 531 participants (67.4 years, 59.5% males). The incidence of PSCI at two-years doubled in the high ICCS group (26% vs. 13.7%, <italic>p</italic> &lt; 0.001). The high ICCS group had significantly greater small-vessel-disease (SVD) tissue changes and reduced microstructural-integrity assessed by Diffusion-Tensor-Imaging (DTI) maps (<italic>p</italic> &lt; 0.05 for all). In multivariate analysis, a higher ICCS was independently associated with brain atrophy manifested by lower normalized white and gray matter, hippocampal and thalamic volumes (<italic>β</italic> = −0.178, <italic>β</italic> = −0.2, <italic>β</italic> = −0.137, <italic>β</italic> = −0.157; <italic>p</italic> &lt; 0.05) and independently predicted PSCI (OR 1.83, 95%CI 1.01–3.35).</p></sec><sec id="sec4"><title>Conclusion</title><p>Our findings suggest that the ICCS, which is a simple and readily available imaging marker on NCCT, is associated with brain atrophy, microstructural damage, the extent of SVD, and may predict PSCI. This finding has implications for identifying individuals at risk for PSCI and implementing targeted interventions to mitigate this risk.</p></sec>