Prediction of cognitive decline after stroke using proton magnetic resonance spectroscopy

Structural MRI measures have been used to predict cognitive decline in elderly subjects, but few studies have used proton magnetic resonance spectroscopy (1H-MRS) for this purpose, particularly after stroke. We studied the potential of 1H-MRS to predict cognitive decline in patients with stroke or TIA and healthy ageing controls over 12 months and 3 years. Structural MRI and single-voxel 1H-MRS in the frontal white matter and the occipito-parietal gray matter were performed at the index assessment (3–6 months post-stroke) in 49 stroke/TIA patients and 60 controls. Neuropsychological testing was performed at the index assessment and repeated at 12 months in 30 stroke/TIA patients and 49 controls, and at 3 years in 25 patients and 48 controls. In stroke/TIA patients, frontal NAA/Cr predicted cognitive decline over 12 months and 3 years, and in elderly control subjects frontal NAA predicted cognitive decline over 12 months only. In stroke/TIA patients, the 1H-MRS measures were better predictors of cognitive decline than structural measures. 1H-MRS may be useful in assessing early cognitive impairment after stroke/TIA and in normal ageing.