Temporal influence of infarct volume in the head of the caudate nucleus on post-stroke cognitive impairment_West China Medical Journal

Authors：

ZHANG Quanzeng ¹ , MA Yue ¹ , DI Zhengli ¹ , ZHANG Weiping ¹ , GU Naibing ¹ , XIONG Jing ¹ , LIU Hongsheng ² , YANG Xiangchun ² , GONG Ting ² ,  LIU Zhiqin ¹

1. Department of Neurology, Xi’an Central Hospital, Xi’an, Shaanxi 710004, P. R. China;
2. Department of Medical Imaging, Xi’an Central Hospital, Xi’an, Shaanxi 710004, P. R. China;

Corresponding?author：

LIU Zhiqin, Email: docterqing@163.com

Keywords：

Caudate head; ischemic stroke; post-stroke cognitive impairment; MRI; Montreal Cognitive Assessment

DOI：

10.7507/1002-0179.202505042

Video：

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Objective To explore the 2 year cognitive trajectory of patients with acute caudate head infarction and the impact of infarct volume on cognitive impairment. Methods We consecutively enrolled patients with acute caudate head infarction admitted to Xi’an Central Hospital between January 2014 and January 2022. Cognitive function was assessed with the Montreal Cognitive Assessment (MoCA) and Mini-Mental State Examination (MMSE) at 1 week, 6-months, 12-months, 18-months and 24-months after admission. Infarct volume was measured via diffusion-weighted imaging. Spearman rank correlation was used to analyze the correlation between infarct volume and cognitive score changes; Friedman test with Bonferroni correction was applied for cross-time-point score comparison. Results A total of 25 patients completed the 24-months follow-up. The average was (62.08±8.90) years, the average infarct volume was (1 165.05±850.07) mm³. The average MoCA scores at the 5 time points were 20.40±4.46, 24.64±5.34, 24.48±5.65, 24.04±6.01 and 23.20±6.58. The average MMSE scores were 23.68±4.14, 26.92±4.33, 26.88±4.82, 26.76±4.85 and 26.32±5.04. The cognitive trajectory showed an initial rise followed by a decline within 24 months. MoCA score changes were strongly correlated with infarct volume (no significant correlation for MMSE). The difference in MoCA scores over the first 6 months was negatively correlated with infarct volume (P<0.001). 24-months MoCA changes were mainly attributed to visuospatial/executive function, language and delayed recall subdomains. Conclusion Caudate head infarct volume is associated with early-onset post-stroke cognitive impairment, with cognitive changes mainly driven by alterations in visuospatial/executive, language and delayed recall subdomains.

Citation： ZHANG Quanzeng, MA Yue, DI Zhengli, ZHANG Weiping, GU Naibing, XIONG Jing, LIU Hongsheng, YANG Xiangchun, GONG Ting, LIU Zhiqin. Temporal influence of infarct volume in the head of the caudate nucleus on post-stroke cognitive impairment. West China Medical Journal, 2026, 41(4): 599-604. doi: 10.7507/1002-0179.202505042 Copy

1.	Grahn JA, Parkinson JA, Owen AM. The cognitive functions of the caudate nucleus. Prog Neurobiol, 2008, 86(3): 141-155.
2.	Middleton FA, Strick PL. Basal ganglia output and cognition: evidence from anatomical, behavioral, and clinical studies. Brain Cogn, 2000, 42(2): 183-200.
3.	Gorelick PB, Scuteri A, Black SE, et al. Vascular contributions to cognitive impairment and dementia: a statement for healthcare professionals from the American heart association/American stroke association. Stroke, 2011, 42(9): 2672-2713.
4.	Grahn JA, Parkinson JA, Owen AM. The role of the basal ganglia in learning and memory: neuropsychological studies. Behav Brain Res, 2009, 199(1): 53-60.
5.	Rinne JO, Portin R, Ruottinen H, et al. Cognitive impairment and the brain dopaminergic system in Parkinson disease: [18F]fluorodopa positron emission tomographic study. Arch Neurol, 2000, 57(4): 470-475.
6.	保羅·W. 布拉扎斯, 約瑟夫·C·馬斯德烏, 何塞·比勒. 臨床神經病學定位. 7 版. 北京: 人民衛生出版社, 2018.
7.	??rak M, Ya?murlu K, Kearns KN, et al. The caudate nucleus: its connections, surgical implications, and related complications. World Neurosurg, 2020, 139: e428-e438.
8.	Gross BA, Batjer HH, Awad IA, et al. Cavernous malformations of the basal ganglia and thalamus. Neurosurgery, 2009, 65(1): 7-18.
9.	Kumral E, Evyapan D, Balkir K. Acute caudate vascular lesions. Stroke, 1999, 30(1): 100-108.
10.	Caplan LR, Schmahmann JD, Kase CS, et al. Caudate infarcts. Arch Neurol, 1990, 47(2): 133-143.
11.	中華醫學會神經病學分會, 中華醫學會神經病學分會腦血管病學組. 中國急性缺血性腦卒中診治指南 2014. 中華神經科雜志, 2015, 48(4): 246-257.
12.	中華醫學會神經病學分會腦血管病學組“卒中一級預防指南”撰寫組. 中國卒中一級預防指南 2010. 中華神經科雜志, 2011, 44(4): 282-288.
13.	Nasreddine ZS, Phillips NA, Bedirian V, et al. The montreal cognitive assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc, 2005, 53(4): 695-699.
14.	Folstein MF, Folstein SE, McHugh PR, et al. “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res, 1975, 12(3): 189-198.
15.	陳佳, 葉子容, 袁滿瓊, 等. 蒙特利爾認知評估量表在輕度認知功能障礙篩查中的應用與進展. 中華精神科雜志, 2017, 50(5):386-389.
16.	Yushkevich PA, Piven J, Hazlett HC, et al. User-guided 3D active contour segmentation of anatomical structures: significantly improved efficiency and reliability. Neuroimage, 2006, 31(3):1116-1128.
17.	Dharmasaroja PA. Temporal changes in cognitive function in early recovery phase of the strok. J Stroke Cerebrovasc Dis, 2021, 30(10): 106027.
18.	Obaid M, Flach C, Marshall I, et al. Long-term outcomes in stroke patients with cognitive impairment: a population-based study. Geriatrics (Basel), 2020, 5(2): 32.
19.	Turunen KEA, Laari SPK, Kauranen TV, et al. Domain-specific cognitive recovery after first-ever stroke: a 2-year follow-up. J Int Neuropsychol Soc, 2018, 24(2): 117-127.
20.	Patel M, Coshall C, Rudd AG, et al. Natural history of cognitive impairment after stroke and factors associated with its recovery. Clin Rehabil, 2003, 17(2): 158-166.
21.	Mijajlovi? MD, Pavlovi? A, Brainin M, et al. Post-stroke dementia – a comprehensive review. BMC Med, 2017, 15(1): 11.
22.	El Husseini N, Katzan IL, Rost NS, et al. Cognitive impairment after ischemic and hemorrhagic stroke: a scientific statement from the American Heart Association/American Stroke Association. Stroke, 2023, 54(6): e272-e291.
23.	Bokura H, Robinson R G. Long-term cognitive impairment associated with caudate stroke. Stroke, 1997, 28(5): 970-975.
24.	Qu J, Chen Y, Luo G, et al. Delirium in the acute phase of ischemic stroke: incidence, risk factors, and effects on functional outcome.J Stroke Cerebrovasc Dis, 2018, 27(10): 2641-2647.
25.	Pendlebury ST, Wadling S, Silver LE, et al. Transient cognitive impairment in TIA and minor stroke. Stroke, 2011, 42(11):3116-3121.
26.	汪凱, 董強, 郁金泰, 等. 卒中后認知障礙管理專家共識 2021. 中國卒中雜志, 2021, 16(4): 376-389.
27.	王俊. 中國卒中后認知障礙防治研究專家共識. 中國卒中雜志, 2020, 15(2): 158-166.
28.	蔡遠貴, 曾進勝. 重視卒中后遠隔腦區繼發性損害與認知障礙. 中華神經科雜志, 2021, 54(5): 429-433.
29.	Rossini PM, Dal Forno G. Neuronal post-stroke plasticity in the adult. Restor Neurol Neurosci, 2004, 22(3/4/5): 193-206.
30.	Salvadori E, Pasi M, Poggesi A, et al. Predictive value of MoCA in the acute phase of stroke on the diagnosis of mid-term cognitive impairment. J Neurol, 2013, 260(9): 2220-2227.
31.	Blackburn DJ, Bafadhel L, Randall M, et al. Cognitive screening in the acute stroke setting. Age Ageing, 2013, 42(1): 113-116.
32.	Alexander GE, DeLong MR, Strick PL. Parallel organization of functionally segregated circuits linking basal ganglia and cortex. Annu Rev Neurosci, 1986, 9: 357-381.
33.	Alexander GE, Crutcher MD, DeLong MR. Basal ganglia-thalamocortical circuits: parallel substrates for motor, oculomotor, “prefrontal” and “limbic” functions. Prog Brain Res, 1990, 85:119-146.
34.	Constantinidis C, Klingberg T. The neuroscience of working memory capacity and training. Nat Rev Neurosci, 2016, 17(7):438-449.
35.	Miyake A, Friedman NP, Emerson MJ, et al. The unity and diversity of executive functions and their contributions to complex “frontal lobe” tasks: a latent variable analysis. Cogn Psychol, 2000, 41(1): 49-100.
36.	Battig K, Rosvold HE, Mishkin M. Comparison of the effects of frontal and caudate lesions on delayed response and alternation in monkeys. J Comp Physiol Psychol, 1960, 53: 400-404.
37.	Mendez MF, Adams NL, Lewandowski KS. Neurobehavioral changes associated with caudate lesions. Neurology, 1989, 39(3): 349-354.
38.	Nomura EM, Reber PJ. A review of medial temporal lobe and caudate contributions to visual category learning. Neurosci Biobehav Rev, 2007, 32(2): 279-291.
39.	Frisch S, Kotz SA, von Cramon DY, et al. Why the P600 is not just a P300: the role of the basal ganglia. Clin Neurophysiol, 2003, 114(2): 336-340.
40.	Mega MS, Alexander MP. Subcortical aphasia: the core profile of capsulostriatal infarction. Neurology, 1994, 44(10): 1824-1829.
41.	Duffau H, Moritz-Gasser S, Mandonnet E. A re-examination of neural basis of language processing: proposal of a dynamic hodotopical model from data provided by brain stimulation mapping during picture naming. Brain Lang, 2014, 131: 1-10.
42.	Urban PP, Hopf HC, Zorowka PG, et al. Dysarthria and lacunar stroke: pathophysiologic aspects. Neurology, 1996, 47(5):1135-1141.
43.	Jing C, Jing C, Zheng L, et al. Disruption of cigarette smoking addiction after dorsal striatum damage. Front Behav Neurosci, 2021, 15: 646337.

1. Grahn JA, Parkinson JA, Owen AM. The cognitive functions of the caudate nucleus. Prog Neurobiol, 2008, 86(3): 141-155.
2. Middleton FA, Strick PL. Basal ganglia output and cognition: evidence from anatomical, behavioral, and clinical studies. Brain Cogn, 2000, 42(2): 183-200.
3. Gorelick PB, Scuteri A, Black SE, et al. Vascular contributions to cognitive impairment and dementia: a statement for healthcare professionals from the American heart association/American stroke association. Stroke, 2011, 42(9): 2672-2713.
4. Grahn JA, Parkinson JA, Owen AM. The role of the basal ganglia in learning and memory: neuropsychological studies. Behav Brain Res, 2009, 199(1): 53-60.
5. Rinne JO, Portin R, Ruottinen H, et al. Cognitive impairment and the brain dopaminergic system in Parkinson disease: [18F]fluorodopa positron emission tomographic study. Arch Neurol, 2000, 57(4): 470-475.
6. 保羅·W. 布拉扎斯, 約瑟夫·C·馬斯德烏, 何塞·比勒. 臨床神經病學定位. 7 版. 北京: 人民衛生出版社, 2018.
7. ??rak M, Ya?murlu K, Kearns KN, et al. The caudate nucleus: its connections, surgical implications, and related complications. World Neurosurg, 2020, 139: e428-e438.
8. Gross BA, Batjer HH, Awad IA, et al. Cavernous malformations of the basal ganglia and thalamus. Neurosurgery, 2009, 65(1): 7-18.
9. Kumral E, Evyapan D, Balkir K. Acute caudate vascular lesions. Stroke, 1999, 30(1): 100-108.
10. Caplan LR, Schmahmann JD, Kase CS, et al. Caudate infarcts. Arch Neurol, 1990, 47(2): 133-143.
11. 中華醫學會神經病學分會, 中華醫學會神經病學分會腦血管病學組. 中國急性缺血性腦卒中診治指南 2014. 中華神經科雜志, 2015, 48(4): 246-257.
12. 中華醫學會神經病學分會腦血管病學組“卒中一級預防指南”撰寫組. 中國卒中一級預防指南 2010. 中華神經科雜志, 2011, 44(4): 282-288.
13. Nasreddine ZS, Phillips NA, Bedirian V, et al. The montreal cognitive assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc, 2005, 53(4): 695-699.
14. Folstein MF, Folstein SE, McHugh PR, et al. “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res, 1975, 12(3): 189-198.
15. 陳佳, 葉子容, 袁滿瓊, 等. 蒙特利爾認知評估量表在輕度認知功能障礙篩查中的應用與進展. 中華精神科雜志, 2017, 50(5):386-389.
16. Yushkevich PA, Piven J, Hazlett HC, et al. User-guided 3D active contour segmentation of anatomical structures: significantly improved efficiency and reliability. Neuroimage, 2006, 31(3):1116-1128.
17. Dharmasaroja PA. Temporal changes in cognitive function in early recovery phase of the strok. J Stroke Cerebrovasc Dis, 2021, 30(10): 106027.
18. Obaid M, Flach C, Marshall I, et al. Long-term outcomes in stroke patients with cognitive impairment: a population-based study. Geriatrics (Basel), 2020, 5(2): 32.
19. Turunen KEA, Laari SPK, Kauranen TV, et al. Domain-specific cognitive recovery after first-ever stroke: a 2-year follow-up. J Int Neuropsychol Soc, 2018, 24(2): 117-127.
20. Patel M, Coshall C, Rudd AG, et al. Natural history of cognitive impairment after stroke and factors associated with its recovery. Clin Rehabil, 2003, 17(2): 158-166.
21. Mijajlovi? MD, Pavlovi? A, Brainin M, et al. Post-stroke dementia – a comprehensive review. BMC Med, 2017, 15(1): 11.
22. El Husseini N, Katzan IL, Rost NS, et al. Cognitive impairment after ischemic and hemorrhagic stroke: a scientific statement from the American Heart Association/American Stroke Association. Stroke, 2023, 54(6): e272-e291.
23. Bokura H, Robinson R G. Long-term cognitive impairment associated with caudate stroke. Stroke, 1997, 28(5): 970-975.
24. Qu J, Chen Y, Luo G, et al. Delirium in the acute phase of ischemic stroke: incidence, risk factors, and effects on functional outcome.J Stroke Cerebrovasc Dis, 2018, 27(10): 2641-2647.
25. Pendlebury ST, Wadling S, Silver LE, et al. Transient cognitive impairment in TIA and minor stroke. Stroke, 2011, 42(11):3116-3121.
26. 汪凱, 董強, 郁金泰, 等. 卒中后認知障礙管理專家共識 2021. 中國卒中雜志, 2021, 16(4): 376-389.
27. 王俊. 中國卒中后認知障礙防治研究專家共識. 中國卒中雜志, 2020, 15(2): 158-166.
28. 蔡遠貴, 曾進勝. 重視卒中后遠隔腦區繼發性損害與認知障礙. 中華神經科雜志, 2021, 54(5): 429-433.
29. Rossini PM, Dal Forno G. Neuronal post-stroke plasticity in the adult. Restor Neurol Neurosci, 2004, 22(3/4/5): 193-206.
30. Salvadori E, Pasi M, Poggesi A, et al. Predictive value of MoCA in the acute phase of stroke on the diagnosis of mid-term cognitive impairment. J Neurol, 2013, 260(9): 2220-2227.
31. Blackburn DJ, Bafadhel L, Randall M, et al. Cognitive screening in the acute stroke setting. Age Ageing, 2013, 42(1): 113-116.
32. Alexander GE, DeLong MR, Strick PL. Parallel organization of functionally segregated circuits linking basal ganglia and cortex. Annu Rev Neurosci, 1986, 9: 357-381.
33. Alexander GE, Crutcher MD, DeLong MR. Basal ganglia-thalamocortical circuits: parallel substrates for motor, oculomotor, “prefrontal” and “limbic” functions. Prog Brain Res, 1990, 85:119-146.
34. Constantinidis C, Klingberg T. The neuroscience of working memory capacity and training. Nat Rev Neurosci, 2016, 17(7):438-449.
35. Miyake A, Friedman NP, Emerson MJ, et al. The unity and diversity of executive functions and their contributions to complex “frontal lobe” tasks: a latent variable analysis. Cogn Psychol, 2000, 41(1): 49-100.
36. Battig K, Rosvold HE, Mishkin M. Comparison of the effects of frontal and caudate lesions on delayed response and alternation in monkeys. J Comp Physiol Psychol, 1960, 53: 400-404.
37. Mendez MF, Adams NL, Lewandowski KS. Neurobehavioral changes associated with caudate lesions. Neurology, 1989, 39(3): 349-354.
38. Nomura EM, Reber PJ. A review of medial temporal lobe and caudate contributions to visual category learning. Neurosci Biobehav Rev, 2007, 32(2): 279-291.
39. Frisch S, Kotz SA, von Cramon DY, et al. Why the P600 is not just a P300: the role of the basal ganglia. Clin Neurophysiol, 2003, 114(2): 336-340.
40. Mega MS, Alexander MP. Subcortical aphasia: the core profile of capsulostriatal infarction. Neurology, 1994, 44(10): 1824-1829.
41. Duffau H, Moritz-Gasser S, Mandonnet E. A re-examination of neural basis of language processing: proposal of a dynamic hodotopical model from data provided by brain stimulation mapping during picture naming. Brain Lang, 2014, 131: 1-10.
42. Urban PP, Hopf HC, Zorowka PG, et al. Dysarthria and lacunar stroke: pathophysiologic aspects. Neurology, 1996, 47(5):1135-1141.
43. Jing C, Jing C, Zheng L, et al. Disruption of cigarette smoking addiction after dorsal striatum damage. Front Behav Neurosci, 2021, 15: 646337.

West China Medical Journal

Temporal influence of infarct volume in the head of the caudate nucleus on post-stroke cognitive impairment

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