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Stroke. 2014 Apr;45(4):1069-76. doi: 10.1161/STROKEAHA.113.004156. Epub 2014 Mar 6.

Cortical hubs and subcortical cholinergic pathways as neural substrates of poststroke dementia.

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From the Department of Neurology, Seoul National University Boramae Hospital, Seoul, Korea (J.-S.L.); Department of Neurology and Clinical Neuroscience Center, Seoul National University Bundang Hospital, Seongnam, Korea (N.K., M.U.J., M.-K.H., S.Y.K., M.J.B., M.S.J., B.B., H.-J.B.); Department of Psychology, Hallym University, Chuncheon, Korea (Y.K.); Department of Neurology, Dongguk University Ilsan Hospital, Ilsan, Korea (D.-E.K.); Biostatistical Consulting Unit, Soonchunhyang University Medical Center, Seoul, Korea (J.S.L.); Department of Biostatistics, Korea University College of Medicine, Seoul, Korea (J.L.); Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Korea (B.-C.L., K.-H.Y.); and Department of Medicine (Neurology), Brain Sciences Research Program, Heart and Stroke Foundation Centre for Stroke Recovery at Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada (S.E.B.).



A role of neural networks in the development of poststroke dementia has not been clearly established. We hypothesized that stroke-mediated disruption of subcortical cholinergic pathway or large-scale neural networks contributes to poststroke dementia.


A matched case-control study was conducted in a predetermined cohort with acute ischemic stroke. Cases were defined as newly developed dementia diagnosed >3 months after stroke using the Korean Vascular Cognitive Impairment Harmonization Standards. Each case was matched to 2 controls for age, education, and initial stroke severity. The Cholinergic Pathways HyperIntensities Scale was applied with some modifications to characterize disruption of cholinergic pathways by acute stroke lesions. Involvement of major cortical hub locations of the default mode network, central executive network, and salience network was also investigated.


After matching, 38 cases and 66 matched controls were included. Cholinergic Pathways HyperIntensities Scale scores were significantly higher in cases than in controls (2.2±2.9 versus 0.9±1.4). Acute ischemic lesions affecting the default mode and central executive networks were more frequently observed in cases compared with controls (36.8% versus 7.6% and 26.3% versus 6.1%, respectively). These findings remained significant in the multiple logistic regression models adjusted for various sets of potential confounders. Lesion location analysis revealed that cases were more likely to have acute lesions in the left corona radiata, hippocampal formation, and posterior parietal cortex.


Disruption of cholinergic pathways and major hubs of large-scale neural networks might contribute to newly developed dementia after acute ischemic stroke.


cholinergic fibers; dementia; neural networks; neural pathways; stroke

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