Neuropsychiatric Symptom Clusters in Stroke and Transient Ischemic Attack by Cognitive Status and Stroke Subtype: Frequency and Relationships with Vascular Lesions, Brain Atrophy and Amyloid

Adrian Wong; Alexander Y L Lau; Jie Yang; Zhaolu Wang; Wenyan Liu; Bonnie Y K Lam; Lisa Au; Lin Shi; Defeng Wang; Winnie C W Chu; Yun-Yun Xiong; Eugene S K Lo; Lorraine S N Law; Thomas W H Leung; Linda C W Lam; Anne Y Y Chan; Yannie O Y Soo; Eric Y L Leung; Lawrence K S Wong; Vincent C T Mok

doi:10.1371/journal.pone.0162846

Neuropsychiatric Symptom Clusters in Stroke and Transient Ischemic Attack by Cognitive Status and Stroke Subtype: Frequency and Relationships with Vascular Lesions, Brain Atrophy and Amyloid

PLoS One. 2016 Sep 15;11(9):e0162846. doi: 10.1371/journal.pone.0162846. eCollection 2016.

Authors

Adrian Wong^{1

2}, Alexander Y L Lau^{1

2}, Jie Yang³, Zhaolu Wang¹, Wenyan Liu¹, Bonnie Y K Lam^{1

2}, Lisa Au^{1

2}, Lin Shi¹, Defeng Wang⁴, Winnie C W Chu⁴, Yun-Yun Xiong⁵, Eugene S K Lo¹, Lorraine S N Law¹, Thomas W H Leung¹, Linda C W Lam⁶, Anne Y Y Chan¹, Yannie O Y Soo¹, Eric Y L Leung⁷, Lawrence K S Wong¹, Vincent C T Mok^{1

2}

Affiliations

¹ Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China.
² Therese Pei Fong Chow Research Centre for Prevention of Dementia, The Chinese University of Hong Kong, Hong Kong, China.
³ Institute of Neuroscience and the Second Affiliated Hospital of Guangzhou Medical University and Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and Ministry of Education of China, Guangzhou, 510260, China.
⁴ Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Hong Kong, China.
⁵ Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China.
⁶ Department of Psychiatry, Lui Che Woo Institute of Innovative Medicine, The Chinese University of Hong Kong, Hong Kong, China.
⁷ Department of Nuclear Medicine, Hong Kong Sanatorium and Hospital, Hong Kong, China.

Abstract

Background: The objectives of this study are 1) to examine the frequencies of neuropsychiatric symptom clusters in patients with stroke or transient ischemic attack (TIA) by cognitive level and stroke subtype; and 2) to evaluate effect of demographic, clinical, and neuroimaging measures of chronic brain changes and amyloid upon neuropsychiatric symptom clusters.

Methods: Hospital-based, cross-sectional study. 518 patients were administered the Neuropsychiatric Inventory (NPI) 3-6 months post index admission. NPI symptoms were classified into four symptom clusters (Behavioral Problems, Psychosis, Mood Disturbance & Euphoria) derived from a confirmatory factor analysis of the 12 NPI items. Multivariable logistic regression was used to determine independent associations between demographic, clinical and neuroimaging measures of chronic brain changes (white matter changes, old infarcts, whole brain atrophy, medial temporal lobe atrophy [MTLA] and frontal lobe atrophy [FLA]) with the presence of NPI symptoms and all symptom clusters except euphoria. 11C-Pittsburg Compound B Positron Emission Tomography (11C-PiB PET) was performed in 24 patients to measure amyloid retention for Alzheimer's Disease (AD) pathology.

Results: 50.6% of the whole sample, including 28.7% cognitively normal and 66.7% of patients with mild cognitive symptoms, had ≥1 NPI symptoms. Frequencies of symptom clusters were largely similar between stroke subtypes. Compared to patients with cardioembolic stroke and intracranial haemorrhage, those with TIA had less frequent mood disturbance. Stroke severity at admission and MTLA were the most robust correlates of symptoms. FLA was associated with behavioral problems cluster only. Frequency of symptom clusters did not differ between patients with and without significant amyloid retention.

Conclusion: Frequency of neuropsychiatric symptoms increased with level of cognitive impairment but was largely similar between stroke subtypes. Stroke severity and MTLA were associated with neuropsychiatric symptoms. AD pathology appeared to be unrelated to neuropsychiatric manifestations but further studies with larger sample size are required to substantiate this finding.

MeSH terms

Amyloid / metabolism*
Blood Vessels / pathology*
Brain / blood supply
Brain / pathology*
Brain Ischemia / physiopathology*
Brain Ischemia / psychology
Cognition*
Cross-Sectional Studies
Humans
Stroke / classification
Stroke / physiopathology*
Stroke / psychology

Substances

Amyloid

Grants and funding

This work was supported by Health and Health Services Research Fund (HHSRF 0708041) of the Food and Health Bureau, Hong Kong Special Administrative Region, The Therese Pei Fong Chow Research Centre for Prevention of Dementia and the Neurology Research Fund of the Chinese University of Hong Kong. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.