Supplementary Material for: Cerebral Microbleeds Are Not Associated with Long-Term Cognitive Outcome in Patients with Transient Ischemic Attack or Minor Stroke

Background: Cerebral microbleeds have been related to cerebrovascular disease and dementia. They occur more frequently in patients with ischemic stroke than in the general population, but their relation to cognition in these patients is uncertain, particularly in the long run. We examined the relationship between microbleeds in patients with a transient ischemic attack (TIA) or minor ischemic stroke, and cognitive performance 4 years later. Methods: Participants were recruited from a prospective multicenter cohort of patients with a TIA or minor ischemic stroke (n = 397). They underwent magnetic resonance imaging (MRI), including a T2*-weighted sequence, within 3 months after their ischemic event. Microbleeds, atrophy, lacunae and white matter hyperintensities (WMH) were rated visually. Cognitive status was examined in 94% of all patients who were still alive after a mean interval of 3.8 years by the Dutch version of the Telephone Interview for Cognitive Status (TICS; n = 280) or by an Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) obtained from a close relative if a TICS could not be obtained (n = 48). The relationship between presence of microbleeds and TICS or IQCODE score was assessed with linear regression analyses adjusted for age, sex, educational level and time interval between MRI and cognitive evaluation. Results: The mean age was 65 ± 12 years at inclusion. The vascular event at inclusion was a TIA in 170 patients (52%) and a minor ischemic stroke in 155 patients (47%). Microbleeds were present in 11.6% of the patients. Patients with microbleeds were significantly older than patients without microbleeds (70 ± 9 vs. 64 ± 12 years), more often had hypertension, and had more cerebral atrophy, WMH and lacunae on MRI (all p Conclusions: In this sample of patients with a recent TIA or minor ischemic stroke, microbleeds were not associated with cognitive performance 4 years later. Apparently, this association is different from other markers of small vessel disease.背景：脑微出血（cerebral microbleeds）与脑血管疾病及痴呆存在关联。相较于普通人群，缺血性卒中患者中脑微出血的发生率更高，但二者与这类患者认知功能的相关性尚不明确，尤其是在长期随访场景下。本研究旨在探讨短暂性脑缺血发作（transient ischemic attack, TIA）或轻度缺血性卒中患者的脑微出血与4年后认知表现的关联。 方法：研究对象招募自一项针对TIA或轻度缺血性卒中患者的前瞻性多中心队列研究，共纳入397例患者。所有患者在缺血事件发生后3个月内接受磁共振成像（magnetic resonance imaging, MRI）检查，其中包含T2*加权序列。由研究者通过视觉评分法对脑微出血、脑萎缩、腔隙性梗死灶及白质高信号（white matter hyperintensities, WMH）进行评级。在平均随访3.8年后仍存活的患者中，94%接受了认知状态评估：其中280例采用荷兰版认知状态电话访谈量表（Telephone Interview for Cognitive Status, TICS）进行评估，剩余48例因无法完成TICS评估，则通过其近亲属填写的老年认知下降知情者问卷（Informant Questionnaire on Cognitive Decline in the Elderly, IQCODE）完成评估。采用校正了年龄、性别、受教育程度及MRI检查与认知评估间隔时间的线性回归分析，评估脑微出血存在与否与TICS或IQCODE评分之间的关联。 结果：入组时受试者的平均年龄为65±12岁。入组时的血管事件为TIA者170例（52%），轻度缺血性卒中者155例（47%）。11.6%的患者存在脑微出血。合并脑微出血的患者年龄显著高于无脑微出血者（70±9岁 vs. 64±12岁），高血压患病率更高，且MRI显示脑萎缩、白质高信号及腔隙性梗死灶的程度更严重（all p 结论：在本次纳入的近期TIA或轻度缺血性卒中患者队列中，脑微出血与4年后的认知表现无显著关联。这一结果提示，脑微出血与其他小血管疾病标志物的认知关联模式存在差异。