White Matter Hyperintensity Volume and Poststroke Cognition: An Individual Patient Data Pooled Analysis of 9 Ischemic Stroke Cohort Studies

Floor A.S. De Kort, Mirthe Coenen, Nick A. Weaver, Hugo J. Kuijf, Hugo P. Aben, Hee Joon Bae, Régis Bordet, Guido Cammà, Christopher P.L.H. Chen, Anna Dewenter, Marco Duering, Rong Fang, Ruben S. Van Der Giessen, Olivia K.L. Hamilton, Saima Hilal, Irene M.C. Huenges Wajer, Cheuk Ni Kan, Jonguk Kim, Beom Joon Kim, Sebastian KöhlerPaul L.M. De Kort, Peter J. Koudstaal, Jae Sung Lim, Renaud Lopes, Vincent C.T. Mok, Julie Staals, Narayanaswamy Venketasubramanian, Charlotte M. Verhagen, Frans R.J. Verhey, Joanna M. Wardlaw, Xin Xu, Kyung Ho Yu, J. Matthijs Biesbroek, Geert Jan Biessels*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

5 Citations (Scopus)
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White matter hyperintensities (WMH) are associated with cognitive dysfunction after ischemic stroke. Yet, uncertainty remains about affected domains, the role of other preexisting brain injury, and infarct types in the relation between WMH burden and poststroke cognition. We aimed to disentangle these factors in a large sample of patients with ischemic stroke from different cohorts. 


We pooled and harmonized individual patient data (n=1568) from 9 cohorts, through the Meta VCI Map consortium (www.metavcimap.org). Included cohorts comprised patients with available magnetic resonance imaging and multidomain cognitive assessment <15 months poststroke. In this individual patient data meta-analysis, linear mixed models were used to determine the association between WMH volume and domain-specific cognitive functioning (Z scores; attention and executive functioning, processing speed, language and verbal memory) for the total sample and stratified by infarct type. Preexisting brain injury was accounted for in the multivariable models and all analyses were corrected for the study site as a random effect. 


In the total sample (67 years [SD, 11.5], 40% female), we found a dose-dependent inverse relationship between WMH volume and poststroke cognitive functioning across all 4 cognitive domains (coefficients ranging from -0.09 [SE, 0.04, P=0.01] for verbal memory to -0.19 [SE, 0.03, P<0.001] for attention and executive functioning). This relation was independent of acute infarct volume and the presence of lacunes and old infarcts. In stratified analyses, the relation between WMH volume and domain-specific functioning was also largely independent of infarct type.


In patients with ischemic stroke, increasing WMH volume is independently associated with worse cognitive functioning across all major domains, regardless of old ischemic lesions and infarct type.

Original languageEnglish
Pages (from-to)3021-3029
Number of pages9
Issue number12
Publication statusPublished - Dec 2023

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