Frontal lobe atrophy is associated with small vessel disease in ischemic stroke patients

Chen, Yangkun; Chen, Xiangyan; Xiao, Weimin; Mok, Vincent C.T.; Wong, Ka Sing; Tang, Wai Kwong

doi:10.1016/j.clineuro.2009.08.019

« Previous Next »Clinical Neurology and Neurosurgery
Volume 111, Issue 10 , Pages 852-857, December 2009

Frontal lobe atrophy is associated with small vessel disease in ischemic stroke patients

Yangkun Chen
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong, China
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
- Corresponding author at: Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong, China. Tel.: +852 68719260; fax: +852 2648 3394.
Xiangyan Chen
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
Weimin Xiao
- Department of Neurology, Dongguan People's Hospital, Dongguan City, Guangdong Province, China
Vincent C.T. Mok
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
Ka Sing Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
Wai Kwong Tang
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong, China

Received 5 February 2009; received in revised form 17 August 2009; accepted 17 August 2009.

Abstract

Background

The pathogenesis of frontal lobe atrophy (FLA) in stroke patients is unclear. We aimed to ascertain whether subcortical ischemic changes were more associated with FLA than with parietal lobe atrophy (PLA) and temporal lobe atrophy (TLA).

Methods

Brain magnetic resonance images (MRIs) from 471 Chinese ischemic stroke patients were analyzed. Lobar atrophy was defined by a widely used visual rating scale. All patients were divided into non-severe, mild–moderate, and severe atrophy of the frontal, parietal, and temporal lobe groups. The severity of white matter lesions (WMLs) was rated with the Fazekas’ scale. Clinical and radiological features were compared among the groups. Subsequent logistic regressions were performed to determine the risk factors of atrophy and severe atrophy of the frontal, parietal and temporal lobes.

Results

The frequency of FLA in our cohort was 36.9% (174/471). Severe FLA occurred in 30 (6.4%) patients. Age, previous stroke, and periventricular hyperintensities (PVH) (odds ratio (OR)=1.640, p=0.039) were independent risk factors of FLA. Age and deep white matter hyperintensities (DWMH) (OR=3.634, p=0.002) were independent risk factors of severe FLA. PVH and DWMH were not independent risk factors of PLA and TLA.

Conclusion

Frontal lobe atrophy in ischemic stroke patients may be associated with small vessel disease. The association between WMLs and FLA was predominant over atrophy of the parietal and temporal lobes, which suggests that the frontal lobe may be vulnerable to subcortical ischemic changes.

Keywords: Frontal lobe, Atrophy, Stroke, Small vessel disease, MRI, White matter lesions