Pulsatility index is a prognostic marker of cognitive outcome in patients with transient ischemic attack and mild acute stroke.

BACKGROUND: Pulsatility Index (PI) has been linked to cognitive impairment in patients with lacunar infarcts, but its role in other stroke subtypes remains unclear. We investigated whether PI predicts cognitive outcomes in acute stroke/TIA patients across etiologies. METHODS: Patients with TIA or mild ischemic stroke were followed for 12 months, with assessments at T1 (baseline; 48-72 hours from onset), T2 (1 month), T3 (6 months), and T4 (12 months). Cognitive tests were performed at all visits, whereas Middle Cerebral Artery (MCA) and Posterior Cerebral Artery (PCA) PI in the unaffected and affected hemispheres, respectively, was measured at T1 and T3. RESULTS: A total of 124 patients (71% men; median age 66) were enrolled; 69.4% had stroke. MCA/PCA PI remained stable from T1-T3 (p=0.630; p=0.086). MoCA increased significantly from T1-T4 (p<0.001), while MMSE showed a trend (p=0.055). MoCA improvement (T1-T4) was independently associated with MCA PI≤1.1 (p=0.014), MoCA at T1 (p<0.001), and NIHSS at T1 (p=0.037). MMSE change (T1-T4) was associated with MMSE at T1 (p<0.001) and NIHSS at T1 (p=0.042), with a trend for MCA PI≤1.1 at T1 (p=0.073). From T3-T4, MMSE improvement was associated with MCA PI≤1.1 (p=0.004) and MMSE at T3 (p<0.001); MoCA improvement was associated only with MoCA at T3 (p<0.001), with a trend for MCA PI≤1.1 at T3 (p=0.082). Age and diabetes were the main determinants of MCA PI at T1 (p<0.0001), while PCA PI was influenced only by age (p<0.0001). CONCLUSION: PI is a prognostic marker of cognitive outcome in patients with TIA and mild ischemic stroke.