Background: White matter hyperintensities (WMH) have been shown to impact functional outcomes after ischemic stroke. However, their role in cognitive recovery after ischemic stroke is unclear. Therefore, it is important to evaluate if WMH can predict the degree of cognitive recovery after inpatient rehabilitation.
Methods: We retrospectively studied 162 patients admitted to inpatient rehabilitation after an acute ischemic stroke. We reviewed patient demographics, presence of co-morbidities, infarct volume, pre-admission Modified Rankin Scale, TOAST criteria, acute interventions for their stroke, rehabilitation length of stay, and Functional Independence Measure (FIM) scores (motor and cognitive) at admission and discharge from rehab. WMH were graded according to the Fazekas scale on the basis of visual assessment in both periventricular and subcortical areas.
Results: 162 patient charts reviewed, 53 were excluded due to primary intracerebral hemorrhage and insufficient imaging. 109 patients were included in the final analysis. Multiple linear regression analysis revealed that, when adjusted for infarct volume, NIHSS stroke scale and age; severity of WMH as graded on Fazekas scale independently predicted Functional Independence Measure (FIM) cognitive scores at discharge (p < 0.0084). WMH severity did not predict Functional Independence (FIM) motor scores.
Conclusions: In this retrospective analysis, we found that severity of WMH hyperintensities as graded by Fazekas scale is an independent predictor of cognitive FIM scores after inpatient rehabilitation for acute ischemic stroke.