Whispers Before the Stroke: Evaluating Cognitive Decline as a Predictor of Silent Cerebral Infarcts in Elderly Populations
Anna Fischer¹, Hugo Moreau², Sophie Turner³
Keywords:
Silent Cerebral Infarct, Cognitive Decline, Elderly, Neurology, Stroke RiskAbstract
Background: Silent cerebral infarcts (SCIs) are common among older adults and significantly increase the risk of dementia and stroke. Subtle cognitive decline may precede radiological detection, yet it is underutilized in clinical practice.
Objective: To investigate whether early cognitive decline is a predictor of SCIs in elderly patients.
Methods: A prospective cohort of 842 adults aged ≥65 years was followed at two neurology clinics in Germany between 2020–2024. Baseline cognitive testing (MMSE and MoCA) and MRI scans were performed. Participants were re-evaluated every 18 months for four years. Logistic regression models identified predictors of SCIs.
Results: SCIs were detected in 29.4% of participants. Those with ≥2-point MMSE decline at baseline had 2.5 times higher odds of SCIs (OR: 2.5, 95% CI: 1.7–3.7, p < 0.001). MoCA decline of ≥3 points predicted SCIs with sensitivity 81% and specificity 74%. Hypertension (OR: 1.8, 95% CI: 1.3–2.6) and diabetes (OR: 1.5, 95% CI: 1.1–2.2) further increased risk.
Conclusion: Subtle early cognitive decline is a strong predictor of SCIs in elderly patients. Combining cognitive screening with routine MRI may allow earlier detection and intervention to prevent dementia and overt stroke.
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