Details

Autor(en) / Beteiligte

• Chaturvedi, Shruti
• Yu, Jia
• Brown, Jenna
• Wei, Aria
• Selvakumar, Sruthi
• Gerber, Gloria F.
• Moliterno, Alison R.
• Streiff, Michael B.
• Kraus, Peggy
• Logue, Claire M.
• Yui, Jennifer C.
• Naik, Rakhi P.
• Latif, Hira
• Lanzkron, Sophie M.
• Braunstein, Evan M.
• Brodsky, Robert A.
• Gottesman, Rebecca F.
• Lin, Doris D.

Titel

Silent cerebral infarction during immune TTP remission: prevalence, predictors, and impact on cognition

Ist Teil von

• Blood, 2023-07, Vol.142 (4), p.325-335

Ort / Verlag

United States: Elsevier Inc

Erscheinungsjahr

2023

Quelle

Elektronische Zeitschriftenbibliothek (Open access)

Beschreibungen/Notizen

• •SCI is common in iTTP in clinical remission.•SCI is associated with mild and major cognitive impairment independent of stroke history and depression. [Display omitted] Immune thrombotic thrombocytopenic purpura (iTTP) survivors have increased risk of cardiovascular disease, including strokes, and report persistent cognitive difficulties during remission. We conducted this prospective study involving iTTP survivors during clinical remission to determine the prevalence of silent cerebral infarction (SCI), defined as magnetic resonance imaging (MRI) evidence of brain infarction without corresponding overt neurodeficits. We also tested the hypothesis that SCI is associated with cognitive impairment, assessed using the National Institutes of Health ToolBox Cognition Battery. For cognitive assessments, we used fully corrected T scores adjusted for age, sex, race, and education. Based on the diagnostic and statistical manual 5 criteria, we defined mild and major cognitive impairment as T scores with a 1 or 2 standard deviation (SD) and >2 SD below the mean on at least 1 test, respectively. Forty-two patients were enrolled, with 36 completing MRIs. SCI was present in 50% of the patients (18), of which 8 (44.4%) had prior overt stroke including during acute iTTP. Patients with SCI had higher rates of cognitive impairment (66.7% vs 27.7%; P = .026), including major cognitive impairment (50% vs 5.6%; P = .010). In separate logistic regression models, SCI was associated with any (mild or major) cognitive impairment (odds ratio [OR] 10.5 [95% confidence interval (95% CI), 1.45-76.63]; P = .020) and major cognitive impairment (OR 7.98 [95% CI, 1.11-57.27]; P = .039) after adjusting for history of stroke and Beck depression inventory scores. MRI evidence of brain infarction is common in iTTP survivors; the strong association of SCI with impaired cognition suggests that these silent infarcts are neither silent nor innocuous. Immune thrombotic thrombocytopenic purpura (iTTP) can cause small vessel ischemic damage to any organ, including the brain. Chaturvedi and colleagues document silent cerebral infarction (SCI) in 50% of patients with iTTP in remission studied prospectively with MRIs and cognitive tests. SCI is strongly associated with major cognitive impairment, even in patients who had no overt neurological event during their acute episode.