Abstract 425: The Impact of White Matter Lesions and Medial Temporal Lobe Atrophy on Prestroke Cognitive Function: A Multicenter Study

Introduction The predictive value of neuroimaging findings, specifically white matter lesions and medial temporal lobe atrophy, in assessing cognitive impairment before a stroke has been insufficiently explored. This study aims to clarify the relationship between these imaging markers and prestroke cognitive function across multiple clinical environments. Methods We conducted a retrospective analysis of 271 stroke patients who had undergone magnetic resonance imaging (MRI). Cognitive function was evaluated using the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE). MRI scans were systematically assessed for the presence and severity of white matter lesions and medial temporal lobe atrophy. Multivariate logistic regression was employed to determine the associations between these neuroimaging findings and prestroke cognitive impairment. Results Our analysis demonstrated a significant association between cognitive impairment and the presence of both white matter lesions (OR: 1.34, 95% CI: 1.04‐1.72) and medial temporal lobe atrophy (OR: 3.56, 95% CI: 1.38‐9.19). Notably, the impact of white matter lesions on cognitive decline was more pronounced in patients aged under 75, whereas a higher prevalence of medial temporal lobe atrophy was observed in younger cohorts. These findings suggest distinct age‐related patterns in the influence of neuroimaging markers on cognitive impairment. Conclusion This study highlights the critical role of white matter lesions and medial temporal lobe atrophy as early indicators of cognitive impairment prior to stroke. By integrating these neuroimaging assessments into routine clinical practice, healthcare providers can better identify patients at risk of cognitive decline, thereby enhancing preventative strategies to mitigate the risk of future strokes. Early identification and targeted interventions could significantly improve patient outcomes, underscoring the importance of incorporating neuroimaging markers into comprehensive stroke care protocols.