| Objects:To observe the silent cerebral infarction (SCI) influence on cognition outcome of first ever acute ischemic stroke patients in the early stage (2 weeks) and long term (3 months).Methods:This was a prospective, observational, single center, cohort study. All patients were selected from the Department of Neurology, the First Affiliated Hospital of Ji Nan University. The main inclusion criterion was first-ever acute ischemic stroke within 14 days. A magnetic resonance imaging (MRI) brain scan was performed for each patient; MRI was reviewed blindly by two neurology physicians. The included patients were divided into 2 groups according to MRI, acute ischemic stroke with SCI and without SCI. Define of SCI on MRI was hyperintensity on T2-weighted images, hypo intensity on T1-weighted images, and 3 mm in size or larger. Severity of leukoaraiosis was evaluated by Fazekas scale. Patients were evaluated with Chinese version of Montreal Cognitive Assessment (MoCA) and Mini-mental State Examination (MMSE) at 2 weeks and 3 months later after the stoke.Results:From May 2008 to June 2009,87 patients with acute ischemic stroke were involved in this study, all these patients had finished MRI scan and first MoCA, MMSE test.73.6% patients completed 3 months follow-up (mean per person,113.46±23.89 days), The correlation between result of MoCA and MMSE was high.(r= 0.91).60.9% patients had SCI, those who were older, had higher incidence of diabetes and displayed more serious leukoaraiosis at base line. The most SCI lesions were located in basal ganglia (40.8%),79.2% of lesions less than 1 cm, majority of patients (64.2%) had multiple lesions.Rate of cognitive impairment at early stage (2 weeks) was 85.7% and 3 months was 71.6%. The rate of vascular cognitive impairment with no dementia (VCIND) and vascular dementia (VD) was not different between patients with SCI and without SCI at early stroke period and after 3 months, but patients with SCI showed higher incidence trends of VD, there was two times more than those without SCI. There was no statistically significant difference in scores of MMSE and MoCA.Domains of cognitive decline were variable, and not especially distinct after acute ischemic stoke. The predominant decline was in domains of visuopatial/executive function, memory and abstraction. The impairment of memory and visuopatial/executive function was rather equally. The impairment of attention, naming and orientation was not remarkable. No differences were observed in domains of cognitive decline between 2 groups.3 months after acute ischemic stroke, the rate of cognitive impairment and VD declined in both patients with SCI and without SCI. However patients with SCI, the scores of MMSE and MoCA did not improve. Patients without SCI memory scores significant increased as well as patients with SCI. The scores of visuopatial/executive function, attention, and abstraction also significant increased in patients without SCI, but not in patients with SCI. The scores of naming orientation and language were not significant increased between 2 groups.The number of SCI lesion was a risk factor for dementia three months after ischemic stroke, OR 1.22, P=0.03.Conclusions:There is a high possibility that the patients suffer cognitive impairment after first-ever acute ischemic stroke. Domains of cognitive decline are variable, in which visuopatial/executive function, memory and abstraction are most effected. Patients with SCI and without SCI is resemble in the rates of cognitive impairment and the domains that impaired. The cognitive impairment after acute ischemic stroke in the early stage is reversible, which will decline 3 month after stroke. The number of SCI lesion is a risk factors of further dementia. SCI have negative influence on the improvement of global cognitive function as well as the visuopatial/executive function, attention and abstraction ability after stroke.
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