Background:Stroke survivors are at an increased risk of developing post-stroke cognitive
impairment and post-stroke dementia; those at risk could be identified by
brain imaging routinely performed at stroke onset.Aim:This systematic review aimed to identify features which are associated with
post-stroke cognitive impairment (including dementia) on magnetic resonance
imaging (MRI) performed at stroke diagnosis.Summary of review:We searched the literature from inception to January 2022 and identified
10,284 records. We included studies that performed MRI at the time of stroke
(0–30 days after a stroke) and assessed cognitive outcome at least 3 months
after stroke. We synthesized findings from 26 papers, comprising 27
stroke-populations (N = 13,114, average age range = 40–80 years, 19–62%
female). When data were available, we pooled unadjusted (ORu) and
adjusted (ORa) odds ratios.We found associations between cognitive outcomes and presence of cerebral
atrophy (three studies, N = 453, ORu= 2.48, 95% CI = 1.15–4.62),
presence of microbleeds (two studies, N = 9151, ORa= 1.36, 95%
CI = 1.08–1.70), and increasing severity of white matter hyperintensities
(three studies, N = 704, ORa= 1.26, 95% CI = 1.06–1.49).
Increasing cerebral small vessel disease score was associated with cognitive
outcome following unadjusted analysis only (two studies, N = 499,
ORu= 1.34, 95%CI = 1.12–1.61; three studies, N = 950,
ORa= 1.23, 95% CI = 0.96–1.57). Associations remained after
controlling for pre-stroke cognitive impairment. We did not find
associations between other stroke features and cognitive outcome, or there
were insufficient data.Conclusion:Acute stroke MRI features may enable healthcare professionals to identify
patients at risk of post-stroke cognitive problems. However, there is still
substantial uncertainty about the prognostic utility of acute MRI for
this.