WMH and long-term outcomes in ischemic stroke: a systematic review and meta-analysis

OBJECTIVE: To investigate the relationship between baseline white matter hyperintensities (WMH) in patients with ischemic stroke and long-term risk of dementia, functional impairment, recurrent stroke, and mortality. METHODS: Following the MOOSE and PRISMA guidelines (PROSPERO protocol: CRD42018092857), we systematically searched Medline and Scopus for cohort studies of ischemic stroke patients examining whether MRI- or CT-assessed WMH at baseline are associated with dementia, functional impairment, recurrent stroke, and mortality at 3 months or later post-stroke. We extracted data and evaluated study quality with the Newcastle-Ottawa scale. We pooled relative risks (RR) for the presence and severity of WMH using random-effects models. RESULTS: We included 104 studies with 71,298 ischemic stroke patients. Moderate/severe WMH at baseline were associated with increased risk of dementia (RR: 2.17, 95%CI: 1.72-2.73), cognitive impairment (RR: 2.29, 95%CI: 1.48-3.54), functional impairment (...