Korelasi Perfusi Regional Area Frontal MRI Arterial Spin Labeling dengan Fungsi Kognitif Demensia Vaskular Pasca StrokeFungsi Kognitif

Diba Anindhita Nandawardhani, dr. Amelia Nur Vidyanti, Ph.D., Sp.N., Subsp.NGD(K); dr. Yudiyanta, Sp.N., Subsp.NN(K)

2026 | Tesis-Spesialis | S2 Ilmu Penyakit Saraf

Latar Belakang: Demensia vaskular merupakan gangguan kognitif akibat lesi vaskular otak, merupakan tipe demensia kedua terbanyak setelah Alzheimer, dengan prevalensi tinggi di Asia termasuk Indonesia. Pasca-stroke, insiden demensia vaskular meningkat hingga 34%, disebabkan oleh hipoperfusi kronis pada regio frontal yang memengaruhi fungsi eksekutif. MRI dengan Arterial Spin Labeling (ASL) memungkinkan pengukuran non-invasif perfusi serebral tanpa bahan kontras, mulai banyak digunakan pada kasus demensia, namun korelasi dengan fungsi kognitif pasien demensia vascular pasca stroke masih inkonsisten.

Tujuan: Mengetahui korelasi perfusi regional area frontal berdasarkan MRI ASL dengan fungsi kognitif pada pasien demensia vaskular pasca-stroke.

Metode: Studi potong lintang pada 32 pasien demensia vaskular pasca-stroke yang memenuhi kriteria probable NINDS-AIREN. Dilakukan MRI ASL menggunakan PASL semikuantitatif dengan ROI 6 area dibandingkan hemisfer kontralateral untuk menghitung relative Cerebral Blood Flow (rCBF) pada fase pasca-akut stroke. Asesmen fungsi kognitif dengan Montreal Cognitive Assessment Indonesia (MoCA-Ina). Analisis statistik mencakup korelasi Pearson dan regresi linier multivariat.

Hasil: Median dilakukan MRI yaitu 54 (14-116) hari dari onset stroke. Tidak terdapat korelasi signifikan antara rCBF frontal (r=-0.12, p=0.52) atau global dengan skor total MoCA-Ina. Prediktor independen penurunan fungsi kognitif meliputi derajat Fazekas tinggi (?=-3.2, p=0.01), lesi di regio temporal dan ganglia basalis (?=-4.1, p=0.003), gula darah sewaktu tinggi (?=-2.8, p=0.02), obesitas (?=-3.5, p=0.008), serta pendidikan rendah (?=-2.9, p=0.015).

Kesimpulan: Perfusi regional area frontal berdasar MRI ASL tidak berkorelasi dengan fungsi kognitif pada demensia vaskular pasca-stroke. Faktor struktural seperti derajat Fazekas, lesi temporal dan ganglia basal, hiperglikemia, obesitas, serta tingkat pendidikan rendah berperan dominan sebagai prediktor independen.

Background: Vascular dementia, a cognitive impairment from cerebrovascular lesions, is the second most common dementia type after Alzheimer's, with high prevalence in Asia, including Indonesia. After a stroke, its incidence rises to 34%, driven by chronic frontal hypoperfusion affecting executive function. MRI with Arterial Spin Labeling (ASL) enables non-invasive cerebral perfusion measurement without contrast and is increasingly used in dementia; however, correlation with cognitive function in post-stroke vascular dementia remains inconsistent

Objective: To determine the correlation between regional frontal perfusion on MRI ASL and cognitive function in patients with post-stroke vascular dementia.

Methods: Cross-sectional study of 32 post-stroke vascular dementia patients meeting probable NINDS-AIREN criteria. MRI ASL was performed using semiquantitative PASL with ROI in 6 areas compared to the contralateral hemisphere to calculate relative Cerebral Blood Flow (rCBF) in the post-acute stroke phase. Cognitive function was assessed using the Montreal Cognitive Assessment Indonesia (MoCA-Ina). Pearson correlation and multivariate linear regression were used.

Results: Median MRI timing was 54 (14-116) days from stroke onset. No significant correlation was found between frontal rCBF (r=-0.12, p=0.52) or global rCBF and total MoCA-Ina scores. Independent predictors of cognitive decline included high Fazekas grade (?=-3.2, p=0.01), temporal and basal ganglia lesions (?=-4.1, p=0.003), high random blood glucose (?=-2.8, p=0.02), obesity (?=-3.5, p=0.008), and low education (?=-2.9, p=0.015).

Conclusion: Regional frontal perfusion on MRI ASL does not correlate with cognitive function in post-stroke vascular dementia. Structural factors (Fazekas grade, temporal and basal ganglia lesions), hyperglycemia, obesity, and low education level act as dominant independent predictors.

Kata Kunci : Demensia vaskular, MRI ASL, Stroke, MoCA-Ina, Perfusi serebral