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Bayliss L, Sandoval AM, Nava A, Diaz-Victoria AR, Espinola-Nadurille M, Ramírez-Bermúdez J, Galvez V. Cognitive follow-up in anti-N-methyl-D-aspartate receptor encephalitis: Hospital discharge, 4, 8, and 12 months. Clin Neurol Neurosurg 2023; 228:107701. [PMID: 36996670 DOI: 10.1016/j.clineuro.2023.107701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/24/2023] [Accepted: 03/26/2023] [Indexed: 03/29/2023]
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Marsh EB, Girgenti S, Llinas EJ, Brunson AO. Outcomes in Patients with Minor Stroke: Diagnosis and Management in the Post-thrombectomy Era. Neurotherapeutics 2023; 20:732-743. [PMID: 36752947 PMCID: PMC10275835 DOI: 10.1007/s13311-023-01349-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2023] [Indexed: 02/09/2023] Open
Abstract
In the era of mechanical thrombectomy and better preventative strategies, a higher number of patients are being discharged home from the hospital with the so-called minor strokes. This has significantly changed the landscape of stroke recovery. Unfortunately, while symptoms may be categorized as mild compared to individuals with higher NIH Stroke Scale scores, the physical, cognitive, and emotional sequelae can be disabling and result in failure to return to work and poor quality of life in a population with significant potential to recover fully. In this review, we discuss the current state of minor stroke, the most common pattern of resulting deficits, what is known about the underlying pathophysiology that leads to a relatively global pattern of impaired cognition following an infarct in any location, and special considerations for treatment based on this population's unique needs. Raising awareness of the current morbidity associated with minor stroke, the need for a uniform definition that allows for comparisons of individuals across studies, and further research focused on this population to optimize outcomes, has the potential to significantly improve recovery.
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Affiliation(s)
- Elisabeth B Marsh
- Department of Neurology, Johns Hopkins Hospital, The Johns Hopkins University School of Medicine, 600 North Wolfe St, Baltimore, MD 21287, USA.
| | - Sophia Girgenti
- Department of Neurology, Johns Hopkins Hospital, The Johns Hopkins University School of Medicine, 600 North Wolfe St, Baltimore, MD 21287, USA
| | - Edward J Llinas
- Department of Neurology, Johns Hopkins Hospital, The Johns Hopkins University School of Medicine, 600 North Wolfe St, Baltimore, MD 21287, USA
| | - Autumn O Brunson
- Department of Neurology, Johns Hopkins Hospital, The Johns Hopkins University School of Medicine, 600 North Wolfe St, Baltimore, MD 21287, USA
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Tziaka E, Christidi F, Tsiptsios D, Sousanidou A, Karatzetzou S, Tsiakiri A, Doskas TK, Tsamakis K, Retzepis N, Konstantinidis C, Kokkotis C, Serdari A, Aggelousis N, Vadikolias K. Leukoaraiosis as a Predictor of Depression and Cognitive Impairment among Stroke Survivors: A Systematic Review. Neurol Int 2023; 15:238-272. [PMID: 36810471 PMCID: PMC9944578 DOI: 10.3390/neurolint15010016] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 02/02/2023] [Accepted: 02/06/2023] [Indexed: 02/15/2023] Open
Abstract
Stroke survivors are at increased risk of developing depression and cognitive decline. Thus, it is crucial for both clinicians and stroke survivors to be provided with timely and accurate prognostication of post-stroke depression (PSD) and post-stroke dementia (PSDem). Several biomarkers regarding stroke patients' propensity to develop PSD and PSDem have been implemented so far, leukoaraiosis (LA) being among them. The purpose of the present study was to review all available work published within the last decade dealing with pre-existing LA as a predictor of depression (PSD) and cognitive dysfunction (cognitive impairment or PSDem) in stroke patients. A literature search of two databases (MEDLINE and Scopus) was conducted to identify all relevant studies published between 1 January 2012 and 25 June 2022 that dealt with the clinical utility of preexisting LA as a prognostic indicator of PSD and PSDem/cognitive impairment. Only full-text articles published in the English language were included. Thirty-four articles were traced and are included in the present review. LA burden, serving as a surrogate marker of "brain frailty" among stroke patients, appears to be able to offer significant information about the possibility of developing PSD or cognitive dysfunction. Determining the extent of pre-existing white matter abnormalities can properly guide decision making in acute stroke settings, as a greater degree of such lesioning is usually coupled with neuropsychiatric aftermaths, such as PSD and PSDem.
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Affiliation(s)
- Eftychia Tziaka
- Neurology Department, Democritus University of Thrace, 68100 Alexandroupolis, Greece
| | - Foteini Christidi
- Neurology Department, Democritus University of Thrace, 68100 Alexandroupolis, Greece
| | - Dimitrios Tsiptsios
- Neurology Department, Democritus University of Thrace, 68100 Alexandroupolis, Greece
- Correspondence: ; Tel.: +30-6944320016
| | - Anastasia Sousanidou
- Neurology Department, Democritus University of Thrace, 68100 Alexandroupolis, Greece
| | - Stella Karatzetzou
- Neurology Department, Democritus University of Thrace, 68100 Alexandroupolis, Greece
| | - Anna Tsiakiri
- Neurology Department, Democritus University of Thrace, 68100 Alexandroupolis, Greece
| | | | - Konstantinos Tsamakis
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King’s College London, London SE5 8AB, UK
| | - Nikolaos Retzepis
- Department of Physical Education and Sport Science, Democritus University of Thrace, 69100 Komotini, Greece
| | - Christos Konstantinidis
- Department of Physical Education and Sport Science, Democritus University of Thrace, 69100 Komotini, Greece
| | - Christos Kokkotis
- Department of Physical Education and Sport Science, Democritus University of Thrace, 69100 Komotini, Greece
| | - Aspasia Serdari
- Department of Child and Adolescent Psychiatry, Medical School, Democritus University of Thrace, 68100 Alexandroupolis, Greece
| | - Nikolaos Aggelousis
- Department of Physical Education and Sport Science, Democritus University of Thrace, 69100 Komotini, Greece
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Liao X, Zuo L, Dong Y, Pan Y, Yan H, Meng X, Li H, Zhao X, Wang Y, Shi J, Wang Y. Persisting cognitive impairment predicts functional dependence at 1 year after stroke and transient ischemic attack: a longitudinal, cohort study. BMC Geriatr 2022; 22:1009. [PMID: 36585624 PMCID: PMC9805269 DOI: 10.1186/s12877-022-03609-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 11/11/2022] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE Minor stroke or transient ischemic attack (TIA) usually have mild and nondisabling symptoms, and these functional deficits may recover fully e.g., TIA, however, part of them still suffer from cognitive impairment and poor outcomes. We conducted a study to determine the relationship between cognition evaluated by Montreal Cognitive Assessment (MoCA) and poor functional outcomes assessed by the Modified Rankin Scale (mRS) (mRS ≥ 2) and Stroke Impact Scale (SIS)-16(SIS-16<25%). METHODS The data of this study come from the impairment of cognition and Sleep (ICONS) after acute ischemic stroke or transient ischemic attack in Chinese patients study. A total of 1675 minor stroke patients and TIA patients were finally recruited. Patients' cognition were evaluated by Montreal Cognitive Assessment (MoCA) scale at 2-week (2w), 3 months (3 m) and 1 year(1y). Cognitive impairment (CI) was defined as MoCA score ≤ 22. According to MoCA score, patients were divided into 4 groups: no PSCI group: with MoCA-2w>22 and MoCA-3 m>22; improved PSCI group: with MoCA-2w ≤ 2 and MoCA-3 m>22;delayed PSCI group: MoCA-2w>22 and MoCA-3 m ≤ 22; persisting PSCI group: with MoCA-2w ≤ 22 and MoCA-3 m ≤ 22. RESULTS A total of 1675 stroke patients were recruited in this study. There were 818 patients (48.84%) who had PSCI at baseline. Of these, 123 patients (15%) had mRS ≥2 at 3 months. The persisting PSCI group was a significant predictor of functional dependence at 3 months and 1 year after stroke and when adjusted for covariates such as gender, age, history of stroke, depression and intracranial atherosclerotic stenosis, stroke subtype and acute infarction type. CONCLUSION Persisting PSCI increased the risk of poor functional outcome after 3 months and 1 year follow-up. These high-risk individuals should be identified for targeted rehabilitation and counseling to improve longer-term post-stroke outcome.
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Affiliation(s)
- Xiaoling Liao
- grid.24696.3f0000 0004 0369 153XDepartment of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119, South Fourth Ring West Road, Fengtai District, Beijing, 100070 China
| | - Lijun Zuo
- grid.24696.3f0000 0004 0369 153XDepartment of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119, South Fourth Ring West Road, Fengtai District, Beijing, 100070 China
| | - Yanhong Dong
- grid.4280.e0000 0001 2180 6431Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Clinical Research Centre, Block MD11, Level 2, 10 Medical Dr., Singapore, 117597 Singapore
| | - Yuesong Pan
- grid.24696.3f0000 0004 0369 153XNational Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hongyi Yan
- grid.24696.3f0000 0004 0369 153XNational Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xia Meng
- grid.24696.3f0000 0004 0369 153XNational Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hao Li
- grid.24696.3f0000 0004 0369 153XNational Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xingquan Zhao
- grid.24696.3f0000 0004 0369 153XDepartment of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119, South Fourth Ring West Road, Fengtai District, Beijing, 100070 China
| | - Yilong Wang
- grid.24696.3f0000 0004 0369 153XDepartment of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119, South Fourth Ring West Road, Fengtai District, Beijing, 100070 China
| | - Jiong Shi
- grid.24696.3f0000 0004 0369 153XDepartment of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119, South Fourth Ring West Road, Fengtai District, Beijing, 100070 China
| | - Yongjun Wang
- grid.24696.3f0000 0004 0369 153XDepartment of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119, South Fourth Ring West Road, Fengtai District, Beijing, 100070 China ,grid.24696.3f0000 0004 0369 153XNational Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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Min Y, Liu C, Zuo L, Wang Y, Li Z. The Relationship between Altered Degree Centrality and Cognitive Function in Mild Subcortical Stroke: A Resting-State fMRI Study. Brain Res 2022; 1798:148125. [DOI: 10.1016/j.brainres.2022.148125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 09/28/2022] [Accepted: 10/10/2022] [Indexed: 11/02/2022]
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Zuo L, Dong Y, Liao X, Pan Y, Xiang X, Meng X, Li H, Zhao X, Wang Y, Shi J, Wang Y. Risk factors for decline in Montreal Cognitive Assessment (MoCA) scores in patients with acute transient ischemic attack and minor stroke. J Clin Hypertens (Greenwich) 2022; 24:851-857. [PMID: 35672957 PMCID: PMC9278567 DOI: 10.1111/jch.14453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 01/25/2022] [Accepted: 01/27/2022] [Indexed: 11/29/2022]
Abstract
Cognitive impairment after stroke/transient ischemic attack (TIA) has a high prevalence. The authors aimed to explore the risk factors for declined cognitive function with Montreal Cognitive Assessment (MoCA)‐Beijing in patients with stroke/TIA at acute phase. Total 2283 patients with acute stroke/TIA without a history of dementia were assessed at 2 weeks of onset. Patients were assessed by MoCA‐Beijing on day 14 and at 3 months follow‐ups. Cognitive impairment was defined as MoCA‐Beijing ≤22. Patients’ cognitive status was considered as declined if there were a reduction of ≥2 points in MoCA‐Beijing score and patients were considered to have improved if there were an increase of ≥2 points. The score of MoCA‐Beijing was considered to be stable if there were an increase or decrease of 1 point. Most patients were in 60 s (60.96 ± 10.75 years old) with a median (interquartile range) National Institute of Health Stroke Scale score of 3.00 (4.00) and greater than primary school level of education, and 1657 participants (72.58%) were male. Cognitive evaluation was conducted in 2283 of 2625 patients (82.70%) with MoCA‐Beijing at baseline. Total 292 (12.79%) patients have a cognitive decline at 3 months, 786 (34.42%) patients were stable and 1205 (52.78%) patients were improved. In the logistic regression, a history of hypertension was associated with cognitive deterioration from baseline to 3‐month. Patients with a history of hypertension have a higher risk for cognitive deterioration from baseline to 3‐month after stroke/TIA.
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Affiliation(s)
- Lijun Zuo
- Department of Neurology Beijing Tiantan Hospital Capital Medical University Beijing China
| | - YanHong Dong
- Alice Lee Centre for Nursing Studies Yong Loo Lin School of Medicine Clinical Research Centre National University of Singapore Singapore
| | - Xiaoling Liao
- Department of Neurology Beijing Tiantan Hospital Capital Medical University Beijing China
| | - Yuesong Pan
- National Clinical Research Center for Neurological Diseases Beijing Tiantan Hospital Capital Medical University Beijing China
| | - Xianglong Xiang
- National Clinical Research Center for Neurological Diseases Beijing Tiantan Hospital Capital Medical University Beijing China
| | - Xia Meng
- National Clinical Research Center for Neurological Diseases Beijing Tiantan Hospital Capital Medical University Beijing China
| | - Hao Li
- National Clinical Research Center for Neurological Diseases Beijing Tiantan Hospital Capital Medical University Beijing China
| | - Xingquan Zhao
- Department of Neurology Beijing Tiantan Hospital Capital Medical University Beijing China
| | - Yilong Wang
- Department of Neurology Beijing Tiantan Hospital Capital Medical University Beijing China
| | - Jiong Shi
- Department of Neurology Beijing Tiantan Hospital Capital Medical University Beijing China
| | - Yongjun Wang
- Department of Neurology Beijing Tiantan Hospital Capital Medical University Beijing China
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Ganesh A, Barber PA. The Cognitive Sequelae of Transient Ischemic Attacks-Recent Insights and Future Directions. J Clin Med 2022; 11:2637. [PMID: 35566762 PMCID: PMC9104376 DOI: 10.3390/jcm11092637] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 05/02/2022] [Accepted: 05/05/2022] [Indexed: 02/05/2023] Open
Abstract
There is now considerable evidence that Transient Ischemic Attack (TIA) carries important sequelae beyond the risk of recurrent stroke, particularly with respect to peri-event and post-event cognitive dysfunction and subsequent cognitive decline. The occurrence of a TIA could provide an important window in understanding the relationship of early mixed vascular-neurodegenerative cognitive decline, and by virtue of their clinical relevance as a "warning" event, TIAs could also furnish the opportunity to act preventatively not only for stroke prevention but also for dementia prevention. In this review, we discuss the current state of the literature regarding the cognitive sequelae associated with TIA, reviewing important challenges in the field. In particular, we discuss definitional and methodological challenges in the study of TIA-related cognitive impairment, confounding factors in the cognitive evaluation of these patients, and provide an overview of the evidence on both transient and long-term cognitive impairment after TIA. We compile recent insights from clinical studies regarding the predictors and mediators of cognitive decline in these patients and highlight important future directions for work in this area.
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Affiliation(s)
- Aravind Ganesh
- Calgary Stroke Program, Departments of Clinical Neurosciences, University of Calgary Cumming School of Medicine, Calgary, AB T2N 4N1, Canada;
- Department of Community Health Sciences, University of Calgary Cumming School of Medicine, Calgary, AB T2N 4N1, Canada
- Hotchkiss Brain Institute, University of Calgary Cumming School of Medicine, Calgary, AB T2N 4N1, Canada
| | - Philip A. Barber
- Calgary Stroke Program, Departments of Clinical Neurosciences, University of Calgary Cumming School of Medicine, Calgary, AB T2N 4N1, Canada;
- Department of Community Health Sciences, University of Calgary Cumming School of Medicine, Calgary, AB T2N 4N1, Canada
- Hotchkiss Brain Institute, University of Calgary Cumming School of Medicine, Calgary, AB T2N 4N1, Canada
- Department of Radiology, University of Calgary Cumming School of Medicine, Calgary, AB T2N 4N1, Canada
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Zhang C, Wang Y, Li S, Pan Y, Wang M, Liao X, Shi J, Wang Y. Infarct location and cognitive change in patients after acute ischemic stroke: The ICONS study. J Neurol Sci 2022; 438:120276. [DOI: 10.1016/j.jns.2022.120276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 05/04/2022] [Accepted: 05/05/2022] [Indexed: 11/27/2022]
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Ramirez-Garcia G, Galvez V, Diaz R, Campos-Romo A, Fernandez-Ruiz J. Montreal Cognitive Assessment (MoCA) performance in Huntington's disease patients correlates with cortical and caudate atrophy. PeerJ 2022; 10:e12917. [PMID: 35402100 PMCID: PMC8988933 DOI: 10.7717/peerj.12917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 01/20/2022] [Indexed: 01/11/2023] Open
Abstract
Huntington's Disease (HD) is an autosomal neurodegenerative disease characterized by motor, cognitive, and psychiatric symptoms. Cognitive impairment develops gradually in HD patients, progressing later into a severe cognitive dysfunction. The Montreal Cognitive Assessment (MoCA) is a brief screening test commonly employed to detect mild cognitive impairment, which has also been useful to assess cognitive decline in HD patients. However, the relationship between MoCA performance and brain structural integrity in HD patients remains unclear. Therefore, to explore this relationship we analyzed if cortical thinning and subcortical nuclei volume differences correlated with HD patients' MoCA performance. Twenty-two HD patients and twenty-two healthy subjects participated in this study. T1-weighted images were acquired to analyze cortical thickness and subcortical nuclei volumes. Group comparison analysis showed a significantly lower score in the MoCA global performance of HD patients. Also, the MoCA total score correlated with cortical thinning of fronto-parietal and temporo-occipital cortices, as well as with bilateral caudate volume differences in HD patients. These results provide new insights into the effectiveness of using the MoCA test to detect cognitive impairment and the brain atrophy pattern associated with the cognitive status of prodromal/early HD patients.
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Affiliation(s)
- Gabriel Ramirez-Garcia
- Departamento de Fisiología, Universidad Nacional Autónoma de Mexico, Ciudad de Mexico, Mexico
| | - Victor Galvez
- Escuela de Psicología, Universidad Panamericana, Ciudad de Mexico, Mexico
| | - Rosalinda Diaz
- Departamento de Fisiología, Universidad Nacional Autónoma de Mexico, Ciudad de Mexico, Mexico
| | - Aurelio Campos-Romo
- Facultad de Medicina, Unidad Periférica de Neurociencias, Universidad Nacional Autónoma de México/Instituto Nacional de Neurologia y Neurocirugia, Ciudad de Mexico, Mexico
| | - Juan Fernandez-Ruiz
- Departamento de Fisiología, Universidad Nacional Autónoma de Mexico, Ciudad de Mexico, Mexico
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Ramírez-Moreno J, Bartolomé Alberca S, Muñoz Vega P, Guerrero Barona E. Screening for cognitive impairment with the Montreal Cognitive Assessment in Spanish patients with minor stroke or transient ischaemic attack. NEUROLOGÍA (ENGLISH EDITION) 2022; 37:38-44. [DOI: 10.1016/j.nrleng.2018.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Accepted: 11/17/2018] [Indexed: 10/23/2022] Open
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Raghunath S, Glikmann-Johnston Y, Morand E, Stout JC, Hoi A. Evaluation of the Montreal Cognitive Assessment as a screening tool for cognitive dysfunction in SLE. Lupus Sci Med 2021; 8:8/1/e000580. [PMID: 34911821 PMCID: PMC8679063 DOI: 10.1136/lupus-2021-000580] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 11/19/2021] [Indexed: 12/19/2022]
Abstract
Objectives Cognitive dysfunction in SLE is common and associated with significant morbidity but is currently underdetected. Early detection requires the use of screening tests, as formal diagnostic cognitive testing is time-consuming. This study aims to evaluate the Montreal Cognitive Assessment (MoCA) as a screening tool for cognitive dysfunction in SLE. Methods Patients with SLE (n=95) and demographically matched healthy control participants (n=48) underwent cognitive testing using the 1-hour neuropsychiatric test battery recommended by the American College of Rheumatology for use in SLE and the MoCA. We used regression analyses to determine associations between MoCA and cognitive test scores. We assessed several MoCA cut-offs for predicting cognitive impairment in terms of sensitivity, specificity, positive predictive value and negative predictive value. Receiver operating curve analyses were used to determine the diagnostic accuracy of the MoCA cut-off thresholds. Results We found a significant correlation between MoCA score and 9 of the 10 cognitive endpoints studied (all p<0.001). Receiver operating curve analysis suggested that a MoCA cut-off of <27 had highest diagnostic accuracy across the cognitive impairment definitions (area under the curve 0.76–0.78). Using a screening cut-off of <28, the MoCA had sensitivity of 83%–94% and specificity of 46%–59%, depending on the impairment definition used. Conclusions The MoCA correlates strongly with cognitive test results in SLE and has sufficient sensitivity for use as a screening tool with a cut-off of <28 as the optimal threshold. This tool can be incorporated into clinical practice for screening for cognitive dysfunction in SLE.
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Affiliation(s)
- Sudha Raghunath
- Centre for Inflammatory Disease, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
- Department of Rheumatology, Monash Health, Clayton, Victoria, Australia
| | - Yifat Glikmann-Johnston
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
| | - Eric Morand
- Centre for Inflammatory Disease, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
- Department of Rheumatology, Monash Health, Clayton, Victoria, Australia
| | - Julie C Stout
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
| | - Alberta Hoi
- Centre for Inflammatory Disease, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
- Department of Rheumatology, Monash Health, Clayton, Victoria, Australia
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Slavin SJ, McCune-Richardson L, Moore J, Ecklund-Johnson E, Gronseth GS, Akinwuntan A. Cognitive Testing During Mild Acute Ischemic Stroke Predicts Long-Term Return to Work. J Stroke Cerebrovasc Dis 2021; 31:106132. [PMID: 34706294 DOI: 10.1016/j.jstrokecerebrovasdis.2021.106132] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 09/17/2021] [Accepted: 09/19/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Many survivors of a mild ischemic stroke do not return to work or driving. Cognitive testing is commonly done to assess long-term cognitive impairment after stroke. Inpatient cognitive testing during the acute period of ischemic stroke may also be a predictor for workforce reengagement and functional outcome. MATERIALS AND METHODS At our comprehensive stroke center, we prospectively enrolled previously working adults < 65 years old who were diagnosed with first-ever ischemic stroke, had a prestroke modified Rankin Scale (mRS) ≤ 1 and NIHSS ≤ 3. Testing performed within 1 week of stroke included the Montreal Cognitive Assessment (MOCA), Clock Drawing Test (CDT), Trail Making Tests A and B, Backward Digit Span Test, and Hospital Anxiety and Depression Scale (HADS). Other data obtained included age, gender, years of education, occupation, stroke location, stroke laterality, and presence of white matter disease on imaging. Outcome measures assessed at 3 months, 6 months, and 12 months post-stroke included return to work, return to driving, and mRS. In a logistic regression analysis, we performed both univariate and multivariate analyses. Multivariate analysis was completed on variables with p-value ≤ 0.05 in the univariate analysis. RESULTS Of 39 total stroke patients enrolled and tested (median [IQR] age 55 [46-60] years; 77.5% male; 22.5% female), 36 completed 3-month follow up, of which 58% returned to work, 78% returned to driving, and 72% had mRS of 0-1. In multivariate analysis, a single point increase in the clock drawing task score increased the odds of return to work by 3.79 (95% CI, 1.10-14.14) and return to driving by 6.74 (95% CI, 1.22-37.23) at 3 months. MOCA and HADS were both associated with mRS ≤ 1. MOCA was associated with return to work at 6 months and CDT was associated with return to work at 12 months. CONCLUSION Cognitive testing with CDT and MOCA in the acute period after ischemic stroke may predict common patient goals post stroke, including return to work, driving, and independence. These tools can potentially be used for prognosis and identifying those who may benefit from further interventions.
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Affiliation(s)
- Sabreena J Slavin
- Department of Neurology, University of Kansas Medical Center, 3901 Rainbow Blvd, MS 2012, KS 66207, USA.
| | | | - Justin Moore
- Department of Neurology, University of Kansas Medical Center, USA.
| | | | - Gary S Gronseth
- Department of Neurology, University of Kansas Medical Center, USA.
| | - Abiodun Akinwuntan
- Department of Physical Therapy and Rehabilitation Science, Department of Neurology, University of Kansas Medical Center, USA.
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Quantifying changes over 1 year in motor and cognitive skill after transient ischemic attack (TIA) using robotics. Sci Rep 2021; 11:17011. [PMID: 34426586 PMCID: PMC8382836 DOI: 10.1038/s41598-021-96177-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 07/29/2021] [Indexed: 12/01/2022] Open
Abstract
Recent work has highlighted that people who have had TIA may have abnormal motor and cognitive function. We aimed to quantify deficits in a cohort of individuals who had TIA and measured changes in their abilities to perform behavioural tasks over 1 year of follow-up using the Kinarm Exoskeleton robot. We additionally considered performance and change over time in an active control cohort of migraineurs. Individuals who had TIA or migraine completed 8 behavioural tasks that assessed cognition as well as motor and sensory functionality in the arm. Participants in the TIA cohort were assessed at 2, 6, 12, and 52 weeks after symptom resolution. Migraineurs were assessed at 2 and 52 weeks after symptom resolution. We measured overall performance on each task using an aggregate metric called Task Score and quantified any significant change in performance including the potential influence of learning. We recruited 48 individuals to the TIA cohort and 28 individuals to the migraine cohort. Individuals in both groups displayed impairments on robotic tasks within 2 weeks of symptom cessation and also at approximately 1 year after symptom cessation, most commonly in tests of cognitive-motor integration. Up to 51.3% of people in the TIA cohort demonstrated an impairment on a given task within 2-weeks of symptom resolution, and up to 27.3% had an impairment after 1 year. In the migraine group, these numbers were 37.5% and 31.6%, respectively. We identified that up to 18% of participants in the TIA group, and up to 10% in the migraine group, displayed impairments that persisted for up to 1 year after symptom resolution. Finally, we determined that a subset of both cohorts (25-30%) experienced statistically significant deteriorations in performance after 1 year. People who have experienced transient neurological symptoms, such as those that arise from TIA or migraine, may continue to experience lasting neurological impairments. Most individuals had relatively stable task performance over time, with some impairments persisting for up to 1 year. However, some individuals demonstrated substantial changes in performance, which highlights the heterogeneity of these neurological disorders. These findings demonstrate the need to consider factors that contribute to lasting neurological impairment, approaches that could be developed to alleviate the lasting effects of TIA or migraine, and the need to consider individual neurological status, even following transient neurological symptoms.
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Xiang L, Zhang T, Zhang B, Zhang C, Hou S, Yue W. The associations of increased cerebral small vessel disease with cognitive impairment in neurosyphilis presenting with ischemic stroke. Brain Behav 2021; 11:e02187. [PMID: 33998172 PMCID: PMC8213652 DOI: 10.1002/brb3.2187] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 04/26/2021] [Accepted: 04/27/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND AND PURPOSE Ischemic stroke is a common clinical feature of neurosyphilis, but its accompanying cognitive decline is often overlooked. The mechanisms of cognitive impairment in neurosyphilis presenting with ischemic stroke are not fully understood. Cerebral small vessel disease (CSVD) was recently shown to predict post-stroke cognitive decline. Therefore, this study aims to validate the correlation between CSVD and cognitive impairment in neurosyphilis presenting with ischemic stroke. METHODS We enrolled 179 neurosyphilis patients diagnosed as acute ischemic stroke and performed a 12-month cognitive assessment follow-up. CSVD burden was evaluated by neuroimaging markers, including white matter hyperintensities (WMHs), lacunes, cerebral microbleeds (CMBs), and perivascular spaces (PVS). We performed multivariate logistic regression analysis to determine the association between cognitive decline and total CSVD burden score in neurosyphilis patients. RESULTS The neurosyphilis participants had a significantly higher total CSVD score and lower cognitive function score compared with the syphilis-uninfected patients. Acute cognitive impairment was associated with total CSVD score, extensive microbleeds, and Grade 3 WMHs. After 12-month follow-up, the poor prognosis of post-stroke cognitive impairment was associated with a higher burden of CSVD and extensive microbleeds. CONCLUSIONS Cerebral small vessel disease loads in neurosyphilis patients presenting with ischemic stroke are independently associated with acute cognitive impairment and have a prospective value for post-stroke cognitive outcomes.
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Affiliation(s)
- Lei Xiang
- Tianjin Key Laboratory of Cerebrovascular and Neurodegenerative Diseases, Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China
| | - Tao Zhang
- Department of Intensive Care Unit, Tianjin Huanhu Hospital, Tianjin, China
| | - Biao Zhang
- Department of Clinical Laboratory, Tianjin Huanhu Hospital, Tianjin, China
| | - Chao Zhang
- Tianjin Key Laboratory of Cerebrovascular and Neurodegenerative Diseases, Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China
| | - Shuping Hou
- Department of Dermatovenereology, Tianjin Medical University General Hospital, Tianjin, China
| | - Wei Yue
- Tianjin Key Laboratory of Cerebrovascular and Neurodegenerative Diseases, Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China
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15
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Tan XW, Abdin E, Tor PC. Accelerated transcranial magnetic stimulation (aTMS) to treat depression with treatment switching: study protocol of a pilot, randomized, delayed-start trial. Pilot Feasibility Stud 2021; 7:104. [PMID: 33952345 PMCID: PMC8097929 DOI: 10.1186/s40814-021-00845-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 04/28/2021] [Indexed: 12/28/2022] Open
Abstract
Background Repetitive transcranial magnetic stimulation (rTMS) is a technique for stimulating brain activity using a transient magnetic field to induce an electrical current in the brain producing depolarization of focal groups of brain cells. TMS is a protocol approved by the U.S. Food and Drug Administration in routine clinical practice as a treatment for depression. A major limitation of rTMS is the large amount of time taken for a standard protocol (38 min a day for 20–30 working days). The optimal type and duration of TMS are still uncertain, as is the optimal strategy for continuing or changing the type of rTMS if there is a poor initial response. Objectives The trial aims to assess whether a 1-week compressed course of left dorsolateral prefrontal (L DLPFC) 5 Hz accelerated rTMS (aTMS) treatment is as effective as an established 4-week course of non-accelerated rTMS and if additional 5 Hz L DLPFC aTMS treatments will be efficacious in non-responders as compared to 1 Hz right DLPFC aTMS treatment. Methods A randomized, single-blind, delayed-start trial was planned to commence in Jan 2020. A total of 60 patients will be enrolled from the Institute of Mental Health Singapore within a 2-year period and randomized into the early or delayed-start phase of the trial. The primary outcome of the trial is the improvement of Montgomery-Asberg Depression Rating scale at the end of the active treatment phase. Discussion If this study protocol proves to be effective, the findings of this trial will be updated to the College of Psychiatrists, Academy of Medicine Singapore, as well as published in a peer-reviewed journal to enhance local and international TMS treatment guidelines. Trial registration ClinicalTrials.gov ID: NCT03941106
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Affiliation(s)
- Xiao Wei Tan
- Department of Mood and Anxiety, Institute of Mental Health, 10 Buangkok View, Singapore, 539747, Singapore
| | - Edimansyah Abdin
- Research Division, Institute of Mental Health, Singapore, 539747, Singapore
| | - Phern Chern Tor
- Department of Mood and Anxiety, Institute of Mental Health, 10 Buangkok View, Singapore, 539747, Singapore. .,Neurostimulation Service, Institute of Mental Health, Singapore, 539747, Singapore. .,Duke-NUS Graduate Medical School, Singapore, 169857, Singapore.
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16
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Cognition in the first week after stroke: how does it relate to personal and instrumental activities of daily living at follow-up? BRAIN IMPAIR 2021. [DOI: 10.1017/brimp.2021.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Abstract
Background:
The Montreal Cognitive Assessment (MoCA) is routinely used during the early assessment of people after stroke to indicate cognitive effects and inform clinical decision-making.
Aim:
The purpose of this study was to examine the relationship between cognition in the first week post-stroke and personal and instrumental activities of daily skills at 1 month and 3 months post-stroke.
Method:
A prospective cohort study consecutively recruited people admitted to the acute stroke ward. Acute cognitive status was measured using the MoCA within 1 week post-stroke onset. Functional outcomes were measured using the Functional Independence Measure (FIM) and the Australian Modified Lawton’s Instrumental Activities of Daily Living Scale (Lawton’s) at 1 month and 3 months post-stroke.
Results:
Fifty participants with predominantly mild stroke (n = 47) and mean age of 69.8 achieved a mean MoCA score of 23.1. Controlling for age, the MoCA was associated with the overall FIM score at 1 month (P = 0.02). It was nearing significance for the Lawton’s at 1 month (P = 0.06) but was not associated with either outcome at 3 months. A score of less than 23 on the MoCA was indicative of lower scores on both outcomes.
Conclusions:
A low MoCA score within 1 week of stroke may indicate need for support or rehabilitation due to early impacts on personal activities of daily living, but is not associated with poor functional outcomes at 3 months.
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17
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Wong JS, Nikoo M, Kianpoor K, Gholami A, Jazani M, Mohammadian F, Lafooraki NY, Jang KL, Schütz CG, Akhondzadeh S, Krausz MR. The effects of opium tincture and methadone on the cognitive function of patients with opioid use disorder. PERSONALITY AND INDIVIDUAL DIFFERENCES 2021. [DOI: 10.1016/j.paid.2020.110091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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18
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D'Souza CE, Greenway MRF, Graff-Radford J, Meschia JF. Cognitive Impairment in Patients with Stroke. Semin Neurol 2021; 41:75-84. [PMID: 33418591 DOI: 10.1055/s-0040-1722217] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Despite substantial advances in stroke care, vascular cognitive impairment remains a prominent source of disability. Unlike sensorimotor impairments, cognition often continues to decline after stroke. An aging population will increase the prevalence of vascular cognitive impairment, with stroke playing an important role. Ten percent of patients presenting with stroke have pre-stroke dementia; an additional 10% will develop incident dementia with a first stroke, and 30% with a recurrent stroke. While stroke increases the risk of cognitive impairment, the presence of cognitive impairment also impacts acute stroke treatment and increases risk of poor outcome by nearly twofold. There is substantial overlap in the clinical and pathological aspects of vascular and degenerative dementias in many patients. How they relate to one another is controversial. The treatment of vascular cognitive impairment remains supportive, focusing on treating vascular risk factors. Cognitive rehabilitation after stroke is an area of active research, and existing pharmacologic treatments have limited benefit. Heightened awareness of cognitive impairment in the setting of stroke is imperative for prognostication and management, impetus for research and, ultimately, the discovery of efficacious treatments.
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Affiliation(s)
- Caitlin E D'Souza
- Department of Neurology, Mayo Clinic Florida, Jacksonville, Florida.,Department of Neurology, Baptist Health, Jacksonville, Florida
| | | | | | - James F Meschia
- Department of Neurology, Mayo Clinic Florida, Jacksonville, Florida
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19
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Cui L, Lu P, Li S, Pan Y, Wang M, Li Z, Liao X, Wang Y. Relationship Among Homocysteine, Inflammation and Cognitive Impairment in Patients with Acute Ischemic Stroke and Transient Ischemic Attack. Neuropsychiatr Dis Treat 2021; 17:3607-3616. [PMID: 34924754 PMCID: PMC8674150 DOI: 10.2147/ndt.s333753] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 11/27/2021] [Indexed: 12/21/2022] Open
Abstract
PURPOSE To investigate the associations among homocysteine (Hcy), inflammation and cognitive impairment in patients with acute ischemic stroke (AIS) and transient ischemic attack (TIA). PATIENTS AND METHODS Patients included were enrolled from a subgroup of China National Stroke Registry-III (CNSR-III). We used a Chinese version of Montreal Cognitive Assessment (MoCA) to screen for cognitive impairment. We used high-sensitivity C-reactive protein (hsCRP) level to reflect the inflammatory status, which was assessed at baseline together with Hcy concentration. The primary outcome was the incidence of post-stroke cognitive impairment (PSCI) at 3 months after AIS and TIA. Multivariable logistic regression analysis was used to evaluate the correlation between Hcy and hsCRP, and their effects on cognition. RESULTS We enrolled 1466 patients with a median age of 62 (54-70) years old, including 895 (61.05%) patients with elevated Hcy levels, 466 (31.79%) with increased hsCRP concentrations, and 755 (51.50%) with PSCI. In the group of patients with hyperhomocysteinemia (HHcy), higher hsCRP levels were related to cognitive impairment, whether or not adjusted for multiple potential confounders (crude OR: 1.71,95% CI: 1.29-2.27, p < 0.01; adjusted OR: 1.42, 95% CI: 1.04-1.93, p = 0.03). No significant interactions for the impact on PSCI were observed in subgroups stratified by age, sex or Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification (P interaction > 0.05 for all). CONCLUSION High inflammatory levels increase the risk of cognitive impairment in HHcy patients after AIS and TIA.
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Affiliation(s)
- Lingyun Cui
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Ping Lu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Shiyu Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - YueSong Pan
- China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China
| | - Mengxing Wang
- China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China
| | - Zixiao Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China.,China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China
| | - Xiaoling Liao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China.,China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China.,China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China
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20
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Screening for Cognitive Impairment, Being Cognizant of the Liminal Deities and Demons. Can J Neurol Sci 2020; 47:731-733. [DOI: 10.1017/cjn.2020.137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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21
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Ahmed T, Kumar R, Bahurupi Y. Factors Affecting Quality of Life among Post-Stroke Patients in the Sub-Himalayan Region. J Neurosci Rural Pract 2020; 11:616-622. [PMID: 33144800 PMCID: PMC7595802 DOI: 10.1055/s-0040-1716927] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background
Stroke is one of the most debilitating conditions contributing to significant disability and death globally. Identifying risk factors for quality of life (QoL) will enable to improve home-based rehabilitation in post-stroke phase.
Objective
This study was aimed to identify the risk factors of QoL in stroke patients in the sub-Himalayan region.
Materials and Methods
A cross-sectional hospital-based study assessed the QoL among stroke patients within a week after the onset of acute stroke and then re-evaluated at 3 months. World Health Organization QoL-BREF, Beck Depression Inventory, the Barthel Index, and Montreal Cognitive Assessment (MOCA) were used to seek data on QoL, depression, cognitive, and functional dependence status, respectively. Appropriate statistics were used to compute the results.
Results
In total, 129 stroke patients recruited, out of which 102 returned to a 3-month follow-up. QoL, MOCA, disability index, and depression score were compared using Wilcoxon Singed-rank test. In multivariate analysis, depression and disability together predicted 60% of the variance for physical QoL (
p
< 0.0001). Similarly, poststroke depression and disability together predicted 61% of the variance for psychological QoL (
p
< 0.0001) in stroke patients.
Conclusion
Findings indicated that depression and disability are leading risk factors of QoL in stroke patients. Early identification of poststroke depression and functional dependence status is, therefore, essential to devise screening procedure and to develop targeted intervention to improve rehabilitation outcomes.
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Affiliation(s)
- Tarannum Ahmed
- College of Nursing, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | | | - Rajesh Kumar
- College of Nursing, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Yogesh Bahurupi
- Department of Community & Family Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
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22
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Draaisma LR, Wessel MJ, Hummel FC. Neurotechnologies as tools for cognitive rehabilitation in stroke patients. Expert Rev Neurother 2020; 20:1249-1261. [DOI: 10.1080/14737175.2020.1820324] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Laurijn R. Draaisma
- Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), Swiss Federal Institute of Technology (EPFL), Geneva, Switzerland
- Defitech Chair of Clinical Neuroengineering, Clinique Romande de Réadaptation, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI, Swiss Federal Institute of Technology (EPFL Valais), Sion, Switzerland
| | - Maximilian J. Wessel
- Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), Swiss Federal Institute of Technology (EPFL), Geneva, Switzerland
- Defitech Chair of Clinical Neuroengineering, Clinique Romande de Réadaptation, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI, Swiss Federal Institute of Technology (EPFL Valais), Sion, Switzerland
| | - Friedhelm C. Hummel
- Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), Swiss Federal Institute of Technology (EPFL), Geneva, Switzerland
- Defitech Chair of Clinical Neuroengineering, Clinique Romande de Réadaptation, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI, Swiss Federal Institute of Technology (EPFL Valais), Sion, Switzerland
- Clinical Neuroscience, University of Geneva Medical School, Geneva, Switzerland
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23
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Liao X, Zuo L, Pan Y, Xiang X, Meng X, Li H, Zhao X, Wang Y, Shi J, Wang Y. Screening for cognitive impairment with the montreal cognitive assessment at six months after stroke and transient ischemic attack. Neurol Res 2020; 43:15-21. [PMID: 32967577 DOI: 10.1080/01616412.2020.1819070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Cognitive impairment usually occurs in the acute phase after stroke, but most stroke survivors experience some form of long-term cognitive deficit. The aim of this study was to establish the cutoff point of the Montreal Cognitive Assessment (MoCA-Beijing) in screening for cognitive impairment (CI) at 6 months of ischemic stroke or transient ischemic attack (TIA). METHODS A total of 301 stroke patients and 15 TIA patients were recruited. Patients were assessed at six months by the MoCA-Beijing and a formal neuropsychological battery. The 1.5 SD below the level of the norm on several tests indicated cognitive impairment (CI). RESULTS Most stroke and TIA patients were in their 60s (61.23 ± 10.60 years old). The optimal cutoff point for MoCA-Beijing in discriminating patients with CI from those with no cognitive impairment (NCI) was 24/25 (sensitivity 63.28%, specificity 71.22%, PPV = 73.68%, NPV = 60.37%, classification accuracy = 66.72%). The predominant cognitive deficits were visuospatial ability (84.85%), and then attention/executive function (79.27%). CONCLUSION The MoCA-Beijing cutoff score for differentiating CI from NCI after stroke and TIA at six months was at 24/25, and it is important for routine clinical practice.
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Affiliation(s)
- Xiaoling Liao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University , Beijing, China
| | - Lijun Zuo
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University , Beijing, China
| | - Yuesong Pan
- National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University , Beijing, China
| | - Xianglong Xiang
- National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University , Beijing, China
| | - Xia Meng
- National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University , Beijing, China
| | - Hao Li
- National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University , Beijing, China
| | - Xingquan Zhao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University , Beijing, China
| | - Yilong Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University , Beijing, China
| | - Jiong Shi
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University , Beijing, China
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University , Beijing, China
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24
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Metabolic syndrome is associated with cognitive impairment after transient ischemic attack/mild stroke, but does not affect cognitive recovery in short term. Neuroreport 2020; 31:918-922. [PMID: 32658124 DOI: 10.1097/wnr.0000000000001500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The metabolic syndrome (MetS) is a cluster of risk factors for cognitive impairment. We aimed to investigate the association between MetS and risk of persistent cognitive impairment in patients with a transient ischemic attack (TIA) or mild ischemic stroke. This is a prospective and observational study in consecutive patients with first-ever TIA or mild stroke (National Institutes of Health Stroke Scale score ≤ 6). Patients underwent Montreal cognitive assessment (MoCA) at hospital admission and day 30 after discharge. We defined cognitive impairment as a MoCA score of ≤26. Persistent cognitive impairment was defined as baseline cognitive impairment and an increase of <2 point or decrease in MoCA score at 1 month after discharge. Three hundred eleven eligible patients were enrolled, aged 21-80 years, and mean age was 61.87 ± 9.643 years and 211 patients were males (70.1%). Cognitive impairments were present in 166 (53.4%) patients at admission. The cognitive impairment rate was significantly higher in MetS patients than those without MetS both at admission and day 30 after discharge (66.1% vs 33.6%, P < 0.001 and 56.6% vs 27.9%, P < 0.001). In logistic regression analysis, MetS, hyperglycemia, hypertension, dyslipidemia, and obesity had no significant interaction with persistent cognitive impairment. However, hypertension had a tendency to be a predictor of persistent cognitive impairment, although this tendency had no statistical significance (odds ratio = 2.545, 95% confidence interval 0.872, 7.430, P = 0.0874). Baseline MetS is associated with the risk of cognitive impairment, but MetS does not affect short-term cognitive recovery from cognitively impaired in patients with TIA/mild stroke.
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25
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Methods for Improving Screening for Vascular Cognitive Impairment Using the Montreal Cognitive Assessment. Can J Neurol Sci 2020; 47:756-763. [PMID: 32522309 DOI: 10.1017/cjn.2020.121] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Vascular cognitive impairment (VCI) post-stroke is frequent but may go undetected, which highlights the need to better screen cognitive functioning following a stroke. AIM We examined the clinical utility of the Montreal Cognitive Assessment (MoCA) in detecting cognitive impairment against a gold-standard neuropsychological battery. METHODS We assessed cognitive status with a comprehensive battery of neuropsychological tests in 161 individuals who were at least 3-months post-stroke. We used receiver operating characteristic (ROC) curves to identify two cut points for the MoCA to maximize sensitivity and specificity at a minimum 90% threshold. We examined the utility of the Symbol Digit Modalities Test, a processing speed measure, to determine whether this additional metric would improve classification relative to the MoCA total score alone. RESULTS Using two cut points, 27% of participants scored ≤ 23 and were classified as high probability of cognitive impairment (sensitivity 92%), and 24% of participants scored ≥ 28 and were classified as low probability of cognitive impairment (specificity 91%). The remaining 48% of participants scored from 24 to 27 and were classified as indeterminate probability of cognitive impairment. The addition of a processing speed measure improved classification for the indeterminate group by correctly identifying 65% of these individuals, for an overall classification accuracy of 79%. CONCLUSIONS The utility of the MoCA in detecting cognitive impairment post-stroke is improved when using a three-category approach. The addition of a processing speed measure provides a practical and efficient method to increase confidence in the determined outcome while minimally extending the screening routine for VCI.
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26
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Tsuchiya S, Matsumoto Y, Suzuki H, Takanami K, Kikuchi Y, Takahashi J, Miyata S, Tomita N, Kumagai K, Taki Y, Saiki Y, Arai H, Shimokawa H. Transcatheter aortic valve implantation and cognitive function in elderly patients with severe aortic stenosis. EUROINTERVENTION 2020; 15:e1580-e1587. [PMID: 31951203 DOI: 10.4244/eij-d-19-00489] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS The aim of this study was to examine the mechanisms of cognitive impairment and reversibility in elderly patients with severe aortic stenosis (AS) after transcatheter aortic valve implantation (TAVI) with special reference to cerebral blood flow (CBF). METHODS AND RESULTS We examined 15 elderly patients with severe AS (mean age 83.2±4.5 years, 12 female) who underwent TAVI. Before and three months after TAVI, we evaluated cognitive function with the Logical Memory II test (LM II), cardiac output (CO) with echocardiography, and CBF with 99mTc single-photon emission computed tomography (SPECT). LM II score and CO were significantly increased after TAVI compared with baseline (p<0.01 for LM II, p<0.005 for CO). Notably, CBF in the local regions, including that in the right hippocampus, was significantly increased after TAVI (p<0.005 at each voxel). The patients with increased CO after TAVI also showed significantly increased CBF in the right hippocampus compared with those without it (p<0.01). Importantly, CBF in the right hippocampus was positively correlated with LM II scores (p<0.05). CONCLUSIONS These results provide the first evidence that TAVI may improve cognitive functions associated with increased cerebral perfusion especially in the hippocampus in elderly patients with severe AS.
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Affiliation(s)
- Satoshi Tsuchiya
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
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27
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Suda S, Nishimura T, Ishiwata A, Muraga K, Aoki J, Kanamaru T, Suzuki K, Sakamoto Y, Katano T, Nishiyama Y, Mishina M, Kimura K. Early Cognitive Impairment after Minor Stroke: Associated Factors and Functional Outcome. J Stroke Cerebrovasc Dis 2020; 29:104749. [PMID: 32178931 DOI: 10.1016/j.jstrokecerebrovasdis.2020.104749] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 01/18/2020] [Accepted: 02/09/2020] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES Evaluation of cognitive status is not performed routinely in the acute stroke setting. This study aimed to evaluate the frequency of early cognitive impairment in patients with minor ischemic stroke, analyze the factors associated with early cognitive impairment, and assess functional outcomes. METHODS In this prospective study, 112 consecutive patients with acute minor ischemic stroke were enrolled. Neuroimages were assessed for semiquantitative evaluation of brain atrophy and small vessel disease (SVD) markers. Cognitive performance was measured within 5 days of onset using Montreal Cognitive Assessment (MoCA) scores. Functional outcome analyses were adjusted for demographic variables, premorbid cognitive status, education level, vascular risk factors, neuroimaging characteristics, stroke severity, and MoCA scores. RESULTS The median MoCA score was 22, and 63% of patients had cognitive impairment. Factors independently associated with cognitive impairment were education (odds ratios [OR], .79; confidence intervals [CI], .63-.99), smoking (OR, .26; 95%CI, .073-.89), and temporal horn atrophy (OR, 4.73; 95% CI, 1.66-13.49). Factors independently associated with poor functional outcome were total MoCA score (OR, .78; 95%CI, .62-.95) and the sum of 4 MoCA subscores (visuospatial/executive, attention, language, and orientation; OR, .72; 95%CI, .53-.92). The cutoff value of the sum of 4 MoCA subscores for predicting poor outcome was 13 points with 76.5% sensitivity and 81.1% specificity. CONCLUSIONS Early cognitive impairment was common after minor ischemic stroke and was associated with preexisting temporal horn atrophy but not SVD markers. The sum of 4 MoCA subscores was useful in predicting the functional outcome.
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Affiliation(s)
- Satoshi Suda
- Department of Neurology, Nippon Medical School, Bunkyo-ku, Tokyo, Japan.
| | - Takuya Nishimura
- Department of Neurology, Nippon Medical School, Bunkyo-ku, Tokyo, Japan
| | - Akiko Ishiwata
- Department of Neurology, Nippon Medical School, Bunkyo-ku, Tokyo, Japan
| | - Kanako Muraga
- Department of Neurology, Nippon Medical School, Bunkyo-ku, Tokyo, Japan
| | - Junya Aoki
- Department of Neurology, Nippon Medical School, Bunkyo-ku, Tokyo, Japan
| | - Takuya Kanamaru
- Department of Neurology, Nippon Medical School, Bunkyo-ku, Tokyo, Japan
| | - Kentaro Suzuki
- Department of Neurology, Nippon Medical School, Bunkyo-ku, Tokyo, Japan
| | - Yuki Sakamoto
- Department of Neurology, Nippon Medical School, Bunkyo-ku, Tokyo, Japan
| | - Takehiro Katano
- Department of Neurology, Nippon Medical School, Bunkyo-ku, Tokyo, Japan
| | | | - Masahiro Mishina
- Department of Neurology, Nippon Medical School, Bunkyo-ku, Tokyo, Japan
| | - Kazumi Kimura
- Department of Neurology, Nippon Medical School, Bunkyo-ku, Tokyo, Japan
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Suda S, Muraga K, Ishiwata A, Nishimura T, Aoki J, Kanamaru T, Suzuki K, Sakamoto Y, Katano T, Nagai K, Hatake S, Satoi S, Matsumoto N, Nito C, Nishiyama Y, Mishina M, Kimura K. Early Cognitive Assessment Following Acute Stroke: Feasibility and Comparison between Mini-Mental State Examination and Montreal Cognitive Assessment. J Stroke Cerebrovasc Dis 2020; 29:104688. [PMID: 32063455 DOI: 10.1016/j.jstrokecerebrovasdis.2020.104688] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 01/02/2020] [Accepted: 01/21/2020] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVES Cognitive assessment is not performed routinely in the acute stroke setting. We investigated factors associated with cognitive impairment and the differences between the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) scores in patients with acute stroke. METHODS In this prospective study, 881 consecutive patients (median age, 73 years) with acute stroke were enrolled. Clinical characteristics, such as education, vascular risk factors, premorbid cognitive status using the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE), and stroke severity, were assessed. Cognitive performance was measured using MMSE and MoCA within 5 days of stroke onset. RESULTS Both MMSE and MoCA were feasible in 621 (70.5%) patients. Factors independently associated with nonfeasibility were age (odds ratio [OR]: 1.05; 95% confidence interval [CI]: 1.02-1.08), IQCODE score (OR: 1.02; 95%CI: 1.00-1.04), and National Institutes of Health Stroke Scale (NIHSS) score (OR, 1.16; 95%CI, 1.12-1.20). Impaired MoCA (with a cut-off <26/30) performance was observed in 544 of 621 (87.6%) patients. Factors independently associated with cognitive impairment were age (OR: 1.06; 95%CI: 1.03-1.10) and NIHSS score (OR: 1.34; 95%CI: 1.14-1.57). Eighty percent of patients with normal MMSE scores had an impaired MoCA score (MMSE-MoCA mismatch). The differences were highest in the visuospatial (94.8% versus 65.3%; P < .0001), recall (76.6% versus 35.6%; P < .0001), abstraction (82.5% versus 49.8%; P < .0001), and language (72.3% versus 65.9%; P < .0001) domains between the normal MMSE and MoCA group and MMSE-MoCA mismatch group. CONCLUSIONS The MoCA can be particularly useful in patients with cognitive deficits undetectable on the MMSE in the acute stroke phase.
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Affiliation(s)
- Satoshi Suda
- Department of Neurology, Nippon Medical School, Tokyo, Japan.
| | - Kanako Muraga
- Department of Neurology, Nippon Medical School, Tokyo, Japan
| | - Akiko Ishiwata
- Department of Neurology, Nippon Medical School, Tokyo, Japan
| | | | - Junya Aoki
- Department of Neurology, Nippon Medical School, Tokyo, Japan
| | - Takuya Kanamaru
- Department of Neurology, Nippon Medical School, Tokyo, Japan
| | - Kentaro Suzuki
- Department of Neurology, Nippon Medical School, Tokyo, Japan
| | - Yuki Sakamoto
- Department of Neurology, Nippon Medical School, Tokyo, Japan
| | - Takehiro Katano
- Department of Neurology, Nippon Medical School, Tokyo, Japan
| | - Koichiro Nagai
- Department of Neurology, Nippon Medical School, Tokyo, Japan
| | - Seira Hatake
- Department of Neurology, Nippon Medical School, Tokyo, Japan
| | - Sera Satoi
- Department of Neurology, Nippon Medical School, Tokyo, Japan
| | | | - Chikako Nito
- Department of Neurology, Nippon Medical School, Tokyo, Japan
| | | | | | - Kazumi Kimura
- Department of Neurology, Nippon Medical School, Tokyo, Japan
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Jin MN, Kim TH, Kang KW, Yu HT, Uhm JS, Joung B, Lee MH, Kim E, Pak HN. Atrial Fibrillation Catheter Ablation Improves 1-Year Follow-Up Cognitive Function, Especially in Patients With Impaired Cognitive Function. Circ Arrhythm Electrophysiol 2019; 12:e007197. [PMID: 31442075 DOI: 10.1161/circep.119.007197] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Although atrial fibrillation (AF) has a risk of cognitive dysfunction, it is not clear whether AF catheter ablation improves or worsens cognitive function. This prospective case-control study sought to assess the 1-year serial changes in the cognitive function with or without AF catheter ablation. METHODS We evaluated the Montreal Cognitive Assessment score in 308 patients (71.4% male, 60.6±9.1 years of age, 34.1% persistent AF) who underwent AF ablation (ablation group) and 50 AF patients on medical therapy who met the same indication for AF ablation (control group), at baseline and 3 and 12 months after enrollment. Cognitive impairment was defined as a published cutoff score of <23 points. To exclude any learning effects, we used the practice-adjusted reliable change index for assessing the cognitive changes. RESULTS Preablation cognitive impairment was detected in 18.5% (57/308). The Montreal Cognitive Assessment score significantly improved 1 year after radiofrequency catheter ablation in both overall ablation group (24.9±2.9-26.4±2.5; P<0.001) and the propensity-matched ablation group (25.4±2.4-26.5±2.3; P<0.001), but not in the control group (25.4±2.5-24.8±2.5; P=0.012). Preablation cognitive impairment (odds ratio, 13.70; 95% CI, 4.83-38.87; P<0.001) was independently associated with an improvement in the 1-year post-ablation cognitive function. In the reliable change index analyses, 94.7% of propensity-matched ablation group showed an improved/stable cognitive function at the 1-year follow-up. CONCLUSIONS Catheter ablation of AF, at least, does not deteriorate the cognitive function, but rather improves the performance on 1-year follow-up neurocognitive tests, especially in patients with a preablation cognitive impairment.
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Affiliation(s)
- Moo-Nyun Jin
- Division of Cardiology, Yonsei University Health System, Seoul (M.-N.J., T.-H.K., H.T.Y., J.-S.U., B.J., M.-H.L., H.-N.P.)
| | - Tae-Hoon Kim
- Division of Cardiology, Yonsei University Health System, Seoul (M.-N.J., T.-H.K., H.T.Y., J.-S.U., B.J., M.-H.L., H.-N.P.)
| | - Ki-Woon Kang
- Division of Cardiology, Eulji University Hospital, Daejeon (K.-W.K.)
| | - Hee Tae Yu
- Division of Cardiology, Yonsei University Health System, Seoul (M.-N.J., T.-H.K., H.T.Y., J.-S.U., B.J., M.-H.L., H.-N.P.)
| | - Jae-Sun Uhm
- Division of Cardiology, Yonsei University Health System, Seoul (M.-N.J., T.-H.K., H.T.Y., J.-S.U., B.J., M.-H.L., H.-N.P.)
| | - Boyoung Joung
- Division of Cardiology, Yonsei University Health System, Seoul (M.-N.J., T.-H.K., H.T.Y., J.-S.U., B.J., M.-H.L., H.-N.P.)
| | - Moon-Hyoung Lee
- Division of Cardiology, Yonsei University Health System, Seoul (M.-N.J., T.-H.K., H.T.Y., J.-S.U., B.J., M.-H.L., H.-N.P.)
| | - Eosu Kim
- Department of Psychiatry, Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea (E.K.)
| | - Hui-Nam Pak
- Division of Cardiology, Yonsei University Health System, Seoul (M.-N.J., T.-H.K., H.T.Y., J.-S.U., B.J., M.-H.L., H.-N.P.)
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Sczesny-Kaiser M, Trost R, Aach M, Schildhauer TA, Schwenkreis P, Tegenthoff M. A Randomized and Controlled Crossover Study Investigating the Improvement of Walking and Posture Functions in Chronic Stroke Patients Using HAL Exoskeleton - The HALESTRO Study (HAL-Exoskeleton STROke Study). Front Neurosci 2019; 13:259. [PMID: 30983953 PMCID: PMC6450263 DOI: 10.3389/fnins.2019.00259] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 03/05/2019] [Indexed: 01/26/2023] Open
Abstract
Background: The exoskeleton HAL (hybrid assistive limb) has proven to improve walking functions in spinal cord injury and chronic stroke patients when using it for body-weight supported treadmill training (BWSTT). Compared with other robotic devices, it offers the possibility to initiate movements actively. Previous studies on stroke patients did not compare HAL-BWSTT with conventional physiotherapy (CPT). Therefore, we performed a crossover clinical trial comparing CPT and HAL-BWSTT in chronic stroke patients with hemiparesis, the HALESTRO study. Our hypothesis was that HAL-training would have greater effects on walking and posture functions compared to a mixed-approach CPT. Methods: A total of 18 chronic stroke patients participated in this study. Treatment consisted of 30 CPT sessions and of 30 sessions of BWSTT with a double leg type HAL exoskeleton successively in a randomized, crossover study design. Primary outcome parameters were walking time and speed in 10-meter walk test (10MWT), time in timed-up-and-go test (TUG) and distance in 6-min walk test (6MWT). Secondary outcome parameters were the functional ambulatory categories (FAC) and the Berg-Balance Scale (BBS). Data were assessed at baseline, at crossover and at the end of the study, all without using and wearing HAL. Results: Our study demonstrate neither a significant difference in walking parameters nor in functional and balance parameters. When HAL-BWSTT was applied to naïve patients, it led to an improvement in walking parameters and in balance abilities. Pooling all data, we could show a significant effect in 10MWT, 6MWT, FAC and BBS, both therapies sequentially applied over 12 weeks. Thereby, FAC improve from dependent to independent category (3 to 4). One patient dropped out of the study due to intensive fatigue after each training session. Conclusion: HAL-BWSTT and mixed-approach CPT were effective therapies in chronic stroke patients. However, compared with CPT, HAL training with 30 sessions over 6 weeks was not more effective. The combination of both therapies led to an improvement of walking and balance functions. Robotic rehabilitation of walking disorders alone still lacks the proof of superiority in chronic stroke. Robotic treatment therapies and classical CPT rehabilitation concepts should be applied in an individualized therapy program.
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Affiliation(s)
| | - Rebecca Trost
- Department of Neurology, BG University Hospital Bergmannsheil Bochum, Bochum, Germany
| | - Mirko Aach
- Department of Spinal Cord Injury, BG University Hospital Bergmannsheil Bochum, Bochum, Germany
| | - Thomas A Schildhauer
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil Bochum, Bochum, Germany
| | - Peter Schwenkreis
- Department of Neurology, BG University Hospital Bergmannsheil Bochum, Bochum, Germany
| | - Martin Tegenthoff
- Department of Neurology, BG University Hospital Bergmannsheil Bochum, Bochum, Germany
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Banerjee G, Chan E, Ambler G, Wilson D, Cipolotti L, Shakeshaft C, Cohen H, Yousry T, Lip GYH, Muir KW, Brown MM, Jäger HR, Werring DJ. Effect of small-vessel disease on cognitive trajectory after atrial fibrillation-related ischaemic stroke or TIA. J Neurol 2019; 266:1250-1259. [PMID: 30847646 PMCID: PMC6469837 DOI: 10.1007/s00415-019-09256-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 02/16/2019] [Accepted: 02/19/2019] [Indexed: 01/12/2023]
Abstract
Post-stroke dementia is common but has heterogenous mechanisms that are not fully understood, particularly in patients with atrial fibrillation (AF)-related ischaemic stroke or TIA. We investigated the relationship between MRI small-vessel disease markers (including a composite cerebral amyloid angiopathy, CAA, score) and cognitive trajectory over 12 months. We included patients from the CROMIS-2 AF study without pre-existing cognitive impairment and with Montreal Cognitive Assessment (MoCA) data. Cognitive impairment was defined as MoCA < 26. We defined “reverters” as patients with an “acute” MoCA (immediately after the index event) score < 26, who then improved by ≥ 2 points at 12 months. In our cohort (n = 114), 12-month MoCA improved overall relative to acute performance (mean difference 1.69 points, 95% CI 1.03–2.36, p < 0.00001). 12-month cognitive impairment was associated with increasing CAA score (per-point increase, adjusted OR 4.09, 95% CI 1.36–12.33, p = 0.012). Of those with abnormal acute MoCA score (n = 66), 59.1% (n = 39) were “reverters”. Non-reversion was associated with centrum semi-ovale perivascular spaces (per-grade increase, unadjusted OR 1.83, 95% CI 1.06–3.15, p = 0.03), cerebral microbleeds (unadjusted OR 10.86, 95% CI 1.22–96.34, p = 0.03), and (negatively) with multiple ischaemic lesions at baseline (unadjusted OR 0.11, 95% CI 0.02–0.90, p = 0.04), as well as composite small-vessel disease (per-point increase, unadjusted OR 2.91, 95% CI 1.23–6.88, p = 0.015) and CAA (per-point increase, unadjusted OR 6.71, 95% CI 2.10–21.50, p = 0.001) scores. In AF-related acute ischaemic stroke or TIA, cerebral small-vessel disease is associated both with cognitive performance at 12 months and failure to improve over this period.
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Affiliation(s)
- Gargi Banerjee
- Department of Brain Repair and Rehabilitation, Stroke Research Centre, UCL Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery, Russell Square House, 10-12 Russell Square, London, WC1B 5EH, UK
| | - Edgar Chan
- Department of Neuropsychology, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Gareth Ambler
- Department of Statistical Science, University College London, Gower Street, London, UK
| | - Duncan Wilson
- Department of Brain Repair and Rehabilitation, Stroke Research Centre, UCL Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery, Russell Square House, 10-12 Russell Square, London, WC1B 5EH, UK.,New Zealand Brain Research Institute, Christchurch, New Zealand
| | - Lisa Cipolotti
- Department of Neuropsychology, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Clare Shakeshaft
- Department of Brain Repair and Rehabilitation, Stroke Research Centre, UCL Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery, Russell Square House, 10-12 Russell Square, London, WC1B 5EH, UK
| | - Hannah Cohen
- Haemostasis Research Unit, Department of Haematology, University College London, 51 Chenies Mews, London, UK
| | - Tarek Yousry
- Lysholm Department of Neuroradiology and the Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, Queen Square, London, UK
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, UK.,Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Keith W Muir
- Institute of Neuroscience and Psychology, University of Glasgow, Queen Elizabeth University Hospital, Glasgow, UK
| | - Martin M Brown
- Department of Brain Repair and Rehabilitation, Stroke Research Centre, UCL Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery, Russell Square House, 10-12 Russell Square, London, WC1B 5EH, UK
| | - Hans Rolf Jäger
- Lysholm Department of Neuroradiology and the Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, Queen Square, London, UK
| | - David J Werring
- Department of Brain Repair and Rehabilitation, Stroke Research Centre, UCL Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery, Russell Square House, 10-12 Russell Square, London, WC1B 5EH, UK.
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Ramírez-Moreno JM, Bartolomé Alberca S, Muñoz Vega P, Guerrero Barona EJ. Screening for cognitive impairment with the Montreal Cognitive Assessment in Spanish patients with minor stroke or transient ischaemic attack. Neurologia 2019; 37:38-44. [PMID: 30737125 DOI: 10.1016/j.nrl.2018.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Revised: 11/08/2018] [Accepted: 11/17/2018] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE The symptoms of minor stroke and transient ischemic attack (TIA) are temporary and mild. Despite the transient nature of the focal symptoms and the absence of visible brain lesions in some patients, many experience persistent cognitive problems subsequently. We aimed to establish the discriminant capacity of the Montreal Cognitive Assessment (MoCA) in screening for cognitive impairment (CI) within 90 days of TIA. METHOD A total of 50 patients with minor stroke or TIA were recruited. Patients were administered the MoCA test and a formal neuropsychological test battery. CI was defined clinically according to neuropsychological test findings. RESULTS The average age of recruited patients was 57.7±8.0 years; 70.0% were men; all patients had completed at least primary education. Thirty-seven patients (74.0%) presented CI. Receiver operating characteristic curve analysis obtained an optimal MoCA cut-off point of 25 for discriminating between patients with CI and those without, with an area under the curve of 0.835 (95% confidence interval [95% CI] 0.720-0.949), sensitivity of 78.4% (95% CI 62.8-88.6%), specificity of 76.9% (95% CI 49.7-91.8%), positive predictive value of 90.6% (95% CI 81.0-95.6%), and negative predictive value of 55.6% (95% CI 39.5-70.4%). CONCLUSIONS More than half of the patients presented CI as determined by the formal battery of neuropsychological tests. A MoCA cut-off point of 25 is sufficiently sensitive and specific for detecting CI after minor stroke or TIA, and may be implemented as a screening technique in routine clinical practice.
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Affiliation(s)
- J M Ramírez-Moreno
- Departamento de Ciencias Biomédicas, Universidad de Extremadura, Badajoz, España; Centro de Ictus, Sección de Neurología, Hospital Universitario Infanta Cristina, Badajoz, España; Grupo de Investigación Multidisciplinar de Extremadura (GRIMEX), Villanueva de la Serena, España.
| | - S Bartolomé Alberca
- Centro de Ictus, Sección de Neurología, Hospital Universitario Infanta Cristina, Badajoz, España
| | - P Muñoz Vega
- Centro de Neurorrehabilitación Casaverde, Mérida, España
| | - E J Guerrero Barona
- Departamento de Psicología y Antropología, Universidad de Extremadura, Badajoz, España
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Rosenbaum Halevi D, Bursaw AW, Karamchandani RR, Alderman SE, Breier JI, Vahidy FS, Aden JK, Cai C, Zhang X, Savitz SI. Cognitive deficits in acute mild ischemic stroke and TIA and effects of rt-PA. Ann Clin Transl Neurol 2019; 6:466-474. [PMID: 30911570 PMCID: PMC6414481 DOI: 10.1002/acn3.719] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 10/21/2018] [Accepted: 12/06/2018] [Indexed: 12/16/2022] Open
Abstract
Introduction It is unknown if treatment with rt-PA in mild acute ischemic stroke (MIS) is associated with improvement in long term cognition. Methods Forty-five patients with suspected acute mild stroke or transient ischemic attacks with NIHSS ≤6 were enrolled in a prospective cohort. Cognitive testing was performed within 24 h of symptom onset. Follow-up assessment was performed at Day 90 on 25 patients. Prestroke baseline cognition was based on age, years of education (YrE), history of cognitive impairment, and the Fazekas score. Results Eighty-five percent patients with suspected MIS or TIA showed cognitive abnormalities within 24 h of onset. There was no significant difference in age, sex, Fazekas score, or YrE between rt-PA versus No-rt-PA groups (N = 8 vs. 17).Two sample t-test for change in performance in the WMS-III sub-tests (follow-up - baseline) ± SD, indicated a difference between rt-PA 0.74 ± 0.77 and no-rt-PA groups -0.02 ± 0.83 (P = 0.044). Logistic regression for predicting normal status using the mental control subtest, at follow-up showed an OR 8.96, CI 0.98-82.12 (P = 0.05) favoring the rt-PA group. Improvement in Mental Control at 90 days occurred in patients with low white matter disease compared to high white matter disease, 0.60 ± 0.46 (P = 0.048). A statistical trend was observed and suggested an improvement on SDMT and Trail Making tests, 1.43 ± 0.8 (P = 0.077). Conclusion Suspected MIS and TIA patients have cognitive impairment within 24 h of onset. rt-PA administration might be associated with improvement on some cognitive tests at 90 days.
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Affiliation(s)
- David Rosenbaum Halevi
- Department of Neurology and Institute for Stroke and Cerebrovascular Disease UTHealth Houston Texas
| | | | | | | | | | - Farhaan S Vahidy
- Department of Neurology and Institute for Stroke and Cerebrovascular Disease UTHealth Houston Texas
| | - James K Aden
- Institute for Surgical Research Joint Base San Antonio San Antonio Texas
| | - Chunyan Cai
- Department of Neurology and Institute for Stroke and Cerebrovascular Disease UTHealth Houston Texas
| | - Xu Zhang
- Department of Neurology and Institute for Stroke and Cerebrovascular Disease UTHealth Houston Texas
| | - Sean I Savitz
- Department of Neurology and Institute for Stroke and Cerebrovascular Disease UTHealth Houston Texas
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Yu AYX, Kapral MK, Fang J, Redelmeier DA. Increased Risk of Traffic Injury After a Cerebrovascular Event. Stroke 2018; 49:3006-3011. [PMID: 30571416 DOI: 10.1161/strokeaha.118.022657] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose- We aimed to determine the long-term risks of a motor vehicle collision after a cerebrovascular event and whether the risks were similar after left- or right-hemispheric events. Methods- We used a population-based registry to identify patients diagnosed with a transient ischemic attack or stroke (hemorrhagic or ischemic) between 2003 and 2013 in Ontario, Canada. Hemispheric laterality was determined using radiological and clinical findings. We identified subsequent serious injuries involving the patient as a driver using linked administrative data. Secondary outcomes included serious injuries involving the patient as a pedestrian, as a passenger, or other traumatic events (fall, fracture, ankle sprain). We used proportional hazard models accounting for death as a competing risk to test the association of hemispheric laterality and outcomes with and without adjustment for age, sex, discharge modified Rankin Scale score, home location, and prior driving record. Patients were followed through to 2017. Results- Among 26 144 patients with hemispheric cerebrovascular events, 377 subsequent serious traffic injuries as a driver (2.2 per 1000 person-year) were identified over a median follow-up of 6.4 person-years. The rate did not differ by laterality (adjusted hazard ratio, 1.00; 95% CI, 0.82-1.23). The risk of a serious traffic injury as a pedestrian was significantly higher after a right-sided than left-sided event (adjusted hazard ratio, 1.27; 95% CI, 1.02-1.58). Subsequent risks for other traumatic injuries did not differ by laterality of cerebrovascular event. Conclusions- The risk of a serious traffic injury as a pedestrian is substantially higher after a right-hemispheric cerebrovascular event compared with a left-sided event. Walking should be promoted for exercise in survivors of a stroke or transient ischemic attack, but these vulnerable road users may benefit from additional poststroke rehabilitation to optimize safety.
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Affiliation(s)
- Amy Y X Yu
- From the Division of Neurology (A.Y.X.Y.), Department of Medicine, University of Toronto, Sunnybrook Health Sciences Centre, Ontario, Canada
| | - Moira K Kapral
- Division of General Internal Medicine, Department of Medicine, University of Toronto-University Health Network (M.K.K.), Ontario, Canada
| | - Jiming Fang
- Research and Analysis Department, Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada (J.F.)
| | - Donald A Redelmeier
- Division of General Internal Medicine (D.A.R.), Department of Medicine, University of Toronto, Sunnybrook Health Sciences Centre, Ontario, Canada
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Yu F, Li H, Tai C, Guo T, Pang D. Effect of family education program on cognitive impairment, anxiety, and depression in persons who have had a stroke: A randomized, controlled study. Nurs Health Sci 2018; 21:44-53. [PMID: 30112788 DOI: 10.1111/nhs.12548] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 05/22/2018] [Accepted: 06/07/2018] [Indexed: 12/14/2022]
Abstract
People who have had a stroke face high risks of cognitive impairment, anxiety, and depression. Health education for family members contributes to better outcomes in various diseases, but the effects of health education on family members of people who have had a stroke are unclear. The aim of the present study was to evaluate the effects of the family member education program (FMEP) on cognitive impairment, anxiety, and depression in persons who have had a stroke. In total, 144 persons who experienced a stroke were randomly allocated to the FMEP group or control group (1:1 ratio). In the FMEP group, the FMEP and conventional treatment were provided, while in control group only conventional treatment was provided. The increase in the Montreal Cognitive Assessment (MOCA) score from baseline to 12 months (M12 - baseline) in the FMEP group was higher compared with the control group, and the FMEP led to a decreased cognitive impairment rate (MOCA score ≤26) after 12 months compared to the control group. Changes in the Hospital Anxiety and Depression Scale anxiety and depression score (M12 - baseline) decreased in the FMEP group compared with the control group. Fewer participants with depression and a lower depression grade were observed in the FMEP group compared with the control group. The FMEP could reduce cognitive impairment, anxiety, and depression in persons who have had a stroke.
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Affiliation(s)
- Fang Yu
- Department of Basic Nursing, The Nursing College of Harbin Medical University, Harbin, China
| | - Hongyu Li
- Department of Basic Nursing, The Nursing College of Harbin Medical University, Harbin, China
| | - Chunling Tai
- Department of Basic Nursing, The Nursing College of Harbin Medical University, Harbin, China
| | - Ting Guo
- Department of Nursing, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Dong Pang
- Department of Neurology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
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Comprehensive Cardiac Rehabilitation for Secondary Prevention After Transient Ischemic Attack or Mild Stroke: PSYCHOLOGICAL PROFILE AND OUTCOMES. J Cardiopulm Rehabil Prev 2018; 37:428-436. [PMID: 28727668 DOI: 10.1097/hcr.0000000000000274] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Having previously reported that comprehensive cardiac rehabilitation (CCR) is effective for secondary prevention post-transient ischemic attack (TIA)/mild nondisabling stroke (MNDS), we present psychometric findings for the same sample that elucidate subacute TIA/MNDS psychological outcomes and test whether CCR would be independently associated with psychological improvements. METHODS In this prospective cohort trial patients with ≥1 risk factor, recruited from a stroke prevention clinic within 12 months (mean = 11.5 weeks) post-TIA/MNDS, entered CCR. RESULTS Of the 110 recruited patients, 100 (mean age = 65.4 years; 46 females) entered CCR and 80 completed CCR (mean duration = 7.6 months). At CCR entry, 16.5% and 39.2% screened positively for depression and anxiety, decreasing nonsignificantly at exit to 4.2%, and significantly to 16.9% (P = .008), respectively. Age-corrected deficits occurred more frequently than expected (P ≤ .03); at entry, mental health status (13.3%), clock-drawing (31.6%), oral-verbal fluency (16.9%), word-list learning (11.2%), and recall (12.6%); at exit, clock-drawing (30.0%). Entry-to-exit, mean depression, anxiety, mental and physical health status, word-list learning, memory, digit-symbol coding, and oral-verbal fluency scores improved significantly (P ≤ .031). No reliable change indices were significant. Psychological service recipients improved significantly more than nonrecipients in depression (P = .049). Baseline North American Adult Reading Test score predicted exercise attendance (R = 0.275; P = .044); New York Heart Association (NYHA) class and depression score predicted exit physical health status (R = 0.770, P < .001); and depression score predicted exit mental health status (R = 0.523, P < .001). CONCLUSIONS Anxiety and executive dysfunction persisted post-TIA/MNDS. Although promising for secondary prevention post-TIA/MNDS, CCR was not independently associated with psychological improvements. CCR psychological treatment may benefit depression. Subacute NYHA class and depression may later affect quality of life.
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Legris N, Devilliers H, Daumas A, Carnet D, Charpy JP, Bastable P, Giroud M, Béjot Y. French validation of the Stroke Specific Quality of Life Scale (SS-QoL). NeuroRehabilitation 2018; 42:17-27. [PMID: 29400672 DOI: 10.3233/nre-172178] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To adapt the SS-QoL into French and test its psychometric properties. METHODS Seventy-seven patients from a population-based registry were enrolled 3 months after their stroke. SS-QoL, NIHSS score, Barthel index, HAD, FSS, SF-36 scales, and MMSE were administered at enrolment. SS-QoL was re-administered at 15 days and 2 months. Internal consistency was assessed by Cronbach's α coefficients, factorial validity by an exploratory factor analysis and external validity by Mann-Whitney test and Spearman's correlations (ρ), comparing SS-QoL scores with those obtained from established scales. Reliability was assessed by intra-class correlation coefficients (ICC) and responsiveness by standardized effect sizes (ES). RESULTS Test-retest and inter-observer reliabilities were excellent (ICC> 0.88). Internal consistency was acceptable (α= 0.65-0.91), except for the Personality domain (α= 0.58). Factor analysis individualized eight homogenous axes. SS-QoL scores were different between groups opposed by their modified Rankin score at enrolment or their overall quality of life compared with pre-stroke status (p < 0.001). Ten of the twelve domains correlated moderately (ρ> 0.35) to strongly (ρ> 0.5) with established measures. Nine domains were mildly to moderately responsive to change (ES> 0.3). CONCLUSION The French version of the SS-QoL is a valid, reliable and moderately responsive instrument.
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Affiliation(s)
- Nicolas Legris
- Department of Neurology, Dijon Stroke Registry, University Hospital and Medical School of Dijon, University of Burgundy, France
| | - Hervé Devilliers
- Department of Internal Medicine and Systemic Disease, University Hospital and Medical School of Dijon, University of Burgundy, France.,Clinical Investigation Center INSERM CIC 1423, University Hospital and Medical School of Dijon, University of Burgundy, France
| | - Anaïs Daumas
- Department of Neurology, Dijon Stroke Registry, University Hospital and Medical School of Dijon, University of Burgundy, France
| | - Didier Carnet
- Department of Medical English, Medical School of Dijon, University of Burgundy, France
| | - Jean-Pierre Charpy
- Department of Medical English, Medical School of Dijon, University of Burgundy, France
| | - Philip Bastable
- Department of Internal Medicine and Systemic Disease, University Hospital and Medical School of Dijon, University of Burgundy, France
| | - Maurice Giroud
- Department of Neurology, Dijon Stroke Registry, University Hospital and Medical School of Dijon, University of Burgundy, France
| | - Yannick Béjot
- Department of Neurology, Dijon Stroke Registry, University Hospital and Medical School of Dijon, University of Burgundy, France
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Frain JA, Chen L. Examining the effectiveness of a cognitive intervention to improve cognitive function in a population of older adults living with HIV: a pilot study. Ther Adv Infect Dis 2018; 5:19-28. [PMID: 29344357 PMCID: PMC5761923 DOI: 10.1177/2049936117736456] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE The purpose of this randomized-controlled pilot study was to explore the effectiveness of a home-based computerized cognitive training intervention in improving cognitive function in a population of older adults with mild cognitive impairment who are living with HIV. METHODS In all, 24 participants were enrolled in this study. All study participants were impaired [defined as Montreal Cognitive Assessment (MoCA) score < 26]; 12 were randomly assigned to a computer-training intervention group and 12 to a control group. The intervention group used a home-based computerized cognitive training program for 8 weeks, while the control group received health-related newsletter via email and follow-up phone calls. Cognitive function was measured at study entry, immediately post intervention, and 8 and 16 weeks post intervention. RESULTS This study achieved a 92% retention rate, losing two persons from the intervention group. Participants in the intervention group scored significantly higher on cognitive testing immediately post intervention compared to the control group: F(1, 19) = 4.92, p = 0.04. The partial Eta squared of 0.32 indicates a small to moderate effect size. DISCUSSION Cognitive improvement was seen immediately after the intervention, and cognitive improvement was still evident 16 weeks post intervention. Cognitive training could be considered as an option for older adults with HIV experiencing mild cognitive impairment.
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Affiliation(s)
- Judy A. Frain
- Goldfarb School of Nursing at Barnes-Jewish College, St. Louis, MO, USA
| | - Ling Chen
- Washington University in St. Louis, St. Louis, MO, USA
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Myint PK, Loke YK, Davison W, Mattishent K, Fox GC, Fleetcroft R, Turner D, Shepstone L, Potter JF. Protocol for a feasibility randomised controlled trial of Screening and Enhanced Risk management for Vascular Event-related Decline in Memory (SERVED Memory). BMJ Open 2017; 7:e017416. [PMID: 29183926 PMCID: PMC5719289 DOI: 10.1136/bmjopen-2017-017416] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Revised: 09/08/2017] [Accepted: 10/16/2017] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Stroke is a leading cause of death and disability. The development of dementia after stroke is common. Vascular risk factors (VRF) which contribute to stroke risk can also contribute to cognitive decline, especially in vascular dementia (VaD). There is no established treatment for VaD, therefore strategies for prevention could have major health resource implications. This study was designed to assess whether patients with early cognitive decline after stroke/transient ischaemic attack (TIA) can be easily identified and whether target-driven VRF management can prevent progression to dementia. OBJECTIVES The primary objective is to establish the feasibility of recruitment and retention of patients with early cognitive decline to a randomised controlled trial of enhanced VRF management. Secondary objectives include: (a) to determine the potential clinical benefit of the intervention; (b) to estimate the sample size for a future definitive multicentre randomised controlled trial; (c) to inform a future economic evaluation; (d) to explore the link between VRF control and the incidence of cognitive impairment on longitudinal follow-up in a UK population after stroke/TIA with current routine management. METHODS 100 patients with cognitive decline poststroke/TIA will be recruited from stroke services at the Norfolk and Norwich University Hospital. After collection of baseline data, they will be randomised to intervention (3 monthly follow-up with enhanced management) or control (treatment as usual by the general practitioner). At 12 months outcomes (repeat cognitive testing, VRF assessment) will be assessed. A further 100 patients without cognitive decline will be recruited to a parallel observational group from the same site. At 12 months they will have repeat cognitive testing. ETHICS AND DISSEMINATION Ethical approval has been granted in England. Dissemination is planned via publication in peer-reviewed medical journals and presentation at relevant conferences. TRIAL REGISTRATION NUMBER 42688361; Pre-results.
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Affiliation(s)
- Phyo Kyaw Myint
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Yoon K Loke
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - William Davison
- Norwich Medical School, University of East Anglia, Norwich, UK
| | | | | | | | - David Turner
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Lee Shepstone
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - John F Potter
- Norwich Medical School, University of East Anglia, Norwich, UK
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Wan J, Zhang L, Lu G, Gu W, Huang L, Ge L, Zhang X, Ji L, Chen Q, Di R, Jiang Y. Midterm outcomes of intracranial aneurysms with bleb formation with densely coiling of the aneurismal neck or entire aneurysm. Medicine (Baltimore) 2017; 96:e7046. [PMID: 28816934 PMCID: PMC5571671 DOI: 10.1097/md.0000000000007046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
To evaluate whether the efficacy and safety of embolization of the aneurysmal neck were better than those of embolization of the entire aneurysm. Previous studies found that embolization of the aneurysmal neck can be used for treating ruptured intracranial aneurysm with bleb formation.In all, 163 patients with ruptured aneurysms with bleb formation who underwent endovascular embolization at the Shanghai Municipal Jing'an District Central Hospital from January 2014 to August 2015 were divided into the embolization of aneurysmal neck group (neck group; 87 cases) and embolization of entire aneurysm group (aneurysm group; 76 cases). A retrospective analysis of clinical data, follow-up Glasgow Outcome Scale (GOS) score, and occurrence of complications was performed. The impacts of different embolisms on the prognosis were compared.The median follow-up time in the neck and aneurysm groups was 17 months (9.62) and 16.5 months (9.54), respectively (P = .799). No differences were found in recurrence, postoperative GOS score, and GOS score at the last follow-up between the 2 groups. The numbers of coils and surgical complications in the neck group were smaller than those in the aneurysm group (P < .001 and P < .030, respectively). After adjusting for age and sex, the embolization method was found to be an independent predictor for surgery-related complications (odds ratio 2.419, 95% confidence interval 1.111-5.269, P = .026).The numbers of coils and surgery-related complications were smaller when embolizing the aneurysmal neck than the entire aneurysm, showing potential advantages of embolization of the aneurysmal neck.
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Affiliation(s)
- Jun Wan
- Department of Interventional Radiology, Jing’an District Centre Hospital of Shanghai, Huashan Hospital Fudan University Jing’an Branch
| | - Lei Zhang
- Department of Interventional Radiology, Jing’an District Centre Hospital of Shanghai, Huashan Hospital Fudan University Jing’an Branch
| | - Gang Lu
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Weijin Gu
- Department of Interventional Radiology, Jing’an District Centre Hospital of Shanghai, Huashan Hospital Fudan University Jing’an Branch
| | - Lei Huang
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Liang Ge
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Xiaolong Zhang
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Lihua Ji
- Department of Interventional Radiology, Jing’an District Centre Hospital of Shanghai, Huashan Hospital Fudan University Jing’an Branch
| | - Qing Chen
- Department of Interventional Radiology, Jing’an District Centre Hospital of Shanghai, Huashan Hospital Fudan University Jing’an Branch
| | - Ruoyu Di
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Yeqing Jiang
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China
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Dichgans M, Leys D. Vascular Cognitive Impairment. Circ Res 2017; 120:573-591. [PMID: 28154105 DOI: 10.1161/circresaha.116.308426] [Citation(s) in RCA: 308] [Impact Index Per Article: 44.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 07/28/2016] [Accepted: 08/29/2016] [Indexed: 01/10/2023]
Abstract
Cerebrovascular disease typically manifests with stroke, cognitive impairment, or both. Vascular cognitive impairment refers to all forms of cognitive disorder associated with cerebrovascular disease, regardless of the specific mechanisms involved. It encompasses the full range of cognitive deficits from mild cognitive impairment to dementia. In principle, any of the multiple causes of clinical stroke can cause vascular cognitive impairment. Recent work further highlights a role of microinfarcts, microhemorrhages, strategic white matter tracts, loss of microstructural tissue integrity, and secondary neurodegeneration. Vascular brain injury results in loss of structural and functional connectivity and, hence, compromise of functional networks within the brain. Vascular cognitive impairment is common both after stroke and in stroke-free individuals presenting to dementia clinics, and vascular pathology frequently coexists with neurodegenerative pathology, resulting in mixed forms of mild cognitive impairment or dementia. Vascular dementia is now recognized as the second most common form of dementia after Alzheimer's disease, and there is increasing awareness that targeting vascular risk may help to prevent dementia, even of the Alzheimer type. Recent advances in neuroimaging, neuropathology, epidemiology, and genetics have led to a deeper understanding of how vascular disease affects cognition. These new findings provide an opportunity for the present reappraisal of vascular cognitive impairment. We further briefly address current therapeutic concepts.
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Affiliation(s)
- Martin Dichgans
- From the Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilians-Universität LMU, Munich, Germany (M.D.); German Center for Neurodegenerative Diseases (DZNE), Munich, Germany (M.D.); Munich Cluster for Systems Neurology (SyNergy), Germany (M.D.); and University of Lille, INSERM, CHU Lille, U1171-Degenerative & Vascular Cognitive Disorders, F-59000 Lille, France (D.L.).
| | - Didier Leys
- From the Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilians-Universität LMU, Munich, Germany (M.D.); German Center for Neurodegenerative Diseases (DZNE), Munich, Germany (M.D.); Munich Cluster for Systems Neurology (SyNergy), Germany (M.D.); and University of Lille, INSERM, CHU Lille, U1171-Degenerative & Vascular Cognitive Disorders, F-59000 Lille, France (D.L.)
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van der Kemp J, Kruithof WJ, Nijboer TCW, van Bennekom CAM, van Heugten C, Visser-Meily JMA. Return to work after mild-to-moderate stroke: work satisfaction and predictive factors. Neuropsychol Rehabil 2017; 29:638-653. [DOI: 10.1080/09602011.2017.1313746] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Jet van der Kemp
- Department of Rehabilitation, Physical Therapy Science & Sports, Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, the Netherlands
- De Hoogstraat Rehabilitation, Utrecht, the Netherlands
| | - Willeke J. Kruithof
- Department of Rehabilitation, Physical Therapy Science & Sports, Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, the Netherlands
- De Hoogstraat Rehabilitation, Utrecht, the Netherlands
| | - Tanja C. W. Nijboer
- Department of Rehabilitation, Physical Therapy Science & Sports, Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, the Netherlands
- De Hoogstraat Rehabilitation, Utrecht, the Netherlands
- Department of Experimental Psychology, Helmholtz Institute, Utrecht University, Utrecht, the Netherlands
| | - Coen A. M. van Bennekom
- Department of Research and Development, Heliomare Rehabilitation Centre, Wijk aan Zee, the Netherlands
- Coronel Institute of Occupational Health, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - Caroline van Heugten
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, the Netherlands
- Department of Neuropsychology and Psychopharmacology, Maastricht University, Maastricht, the Netherlands
| | - Johanna M. A. Visser-Meily
- Department of Rehabilitation, Physical Therapy Science & Sports, Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, the Netherlands
- De Hoogstraat Rehabilitation, Utrecht, the Netherlands
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Tan HH, Xu J, Teoh HL, Chan BPL, Seet RCS, Venketasubramanian N, Sharma VK, Chen CLH, Dong Y. Decline in changing Montreal Cognitive Assessment (MoCA) scores is associated with post-stroke cognitive decline determined by a formal neuropsychological evaluation. PLoS One 2017; 12:e0173291. [PMID: 28346532 PMCID: PMC5367691 DOI: 10.1371/journal.pone.0173291] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 02/17/2017] [Indexed: 11/18/2022] Open
Abstract
Objectives We aimed to examine changes in the Montreal Cognitive Assessment (MoCA) and Mini-Mental State Examination (MMSE) scores within a one-year period after stroke/transient ischemic attack (TIA) in associating cognitive decline determined by a formal neuropsychological test battery. Methods Patients with ischemic stroke/TIA received MoCA and MMSE at baseline within 14 days after stroke/TIA, at 3–6 months and 1-year follow-ups. The scores of MoCA and MMSE were considered to have declined if there were a reduction of ≥2 points in the respective scores measured across two time points. The decline in neuropsychological diagnosis transitional status was defined by a category transition from no cognitive impairment or any cognitive impairment to a more severe cognitive impairment or dementia. Results 275 patients with a mean age of 59.8 ± 11.6 years, and education of 7.7 ± 4.3 years completed all the assessments at baseline, 3–6 months and 1-year follow-ups. A decline in MoCA scores from 3–6 months to 1 year was associated with higher risk of decline in diagnosis transitional status (odd ratio = 3.21, p = 0.004) in the same time period whereas there was no association with a decline in MMSE scores. Conclusions The decline in MoCA scores from 3–6 months to 1 year after stroke/TIA has three times higher risk for decline in the diagnosis transitional status. The decline of MoCA scores (reduction ≥ 2points) is associated with the decline in neuropsychological diagnosis transitional status.
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Affiliation(s)
- Hui Hui Tan
- Division of Neurology, Department of Medicine, Yong Loo Lin School of Medicine, National University Health System, Singapore
| | - Jing Xu
- Singapore Clinical Research Institute, Singapore
| | - Hock Luen Teoh
- Division of Neurology, Department of Medicine, Yong Loo Lin School of Medicine, National University Health System, Singapore
| | - Bernard Poon-Lap Chan
- Division of Neurology, Department of Medicine, Yong Loo Lin School of Medicine, National University Health System, Singapore
| | - Raymond Chee Seong Seet
- Division of Neurology, Department of Medicine, Yong Loo Lin School of Medicine, National University Health System, Singapore
| | - Narayanaswarmy Venketasubramanian
- Memory Ageing and Cognition Center, Department of Pharmacology, Yong Loo Lin School of Medicine, National University Health System, Singapore
- Neuroscience Centre, Raffles Hospital, Singapore
| | - Vijay Kumar Sharma
- Division of Neurology, Department of Medicine, Yong Loo Lin School of Medicine, National University Health System, Singapore
| | - Christopher Li-Hsian Chen
- Memory Ageing and Cognition Center, Department of Pharmacology, Yong Loo Lin School of Medicine, National University Health System, Singapore
| | - YanHong Dong
- Division of Neurology, Department of Medicine, Yong Loo Lin School of Medicine, National University Health System, Singapore
- Centre for Healthy Brain Ageing (CHeBA) and Dementia Collaborative Research Centre – Assessment and Better Care, School of Psychiatry, UNSW Medicine, The University of New South Wales, Sydney, New South Wales, Australia
- * E-mail:
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Zhang Z, Ren W, Shao B, Xu H, Cheng J, Wang Q, Gu Y, Zhu B, He J. Leukoaraiosis is Associated with Worse Short-Term Functional and Cognitive Recovery after Minor Stroke. Neurol Med Chir (Tokyo) 2017; 57:136-143. [PMID: 28190826 PMCID: PMC5373686 DOI: 10.2176/nmc.oa.2016-0188] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Whether leukoaraiosis burden retards short-term recovery after minor stroke is unclear. We investigated the association between leukoaraiosis and early recovery of neurological function after a first minor ischemic stroke in 217 acute stroke patients (National Institutes of Health Stroke Scale (NIHSS) score ≤5). Leukoaraiosis severity was graded according to the Fazekas scale and categorized into none to mild (0-2; n = 143) or severe (3-6; n = 74) groups. NIHSS and Minimum Mental State Examination (MMSE) were assessed at baseline and at 30 days. Univariate analysis revealed that the severe leukoaraiosis group was older in age (P < 0.001) and had fewer low MMSE patients than non-mild group at baseline (39.1% vs 55.9%, P = 0.003). However, the MMSE improved in none to mild group but not in the severe group at 30-day (15.4% vs 36.5%, P < 0.001). At 30-day, the severe leukoaraiosis group had higher NIHSS scores than the none-mild group (P = 0.04). Multiple linear regression analyses demonstrated that leukoaraiosis severity and admission NIHSS were independently associated with the NIHSS score on day 30 (P = 0.034, 95% CI 0.004-0.091 and P = 0.001, 95% CI 0.011-0.04). Binary regression analyses showed that leukoaraiosis severity and admission MMSE were significantly associated with MMSE (dichotomized) at 30-day (OR 2.1, P < 0.01, 95% CI 1.7-2.6 and OR 5.1, P < 0.01, 95% CI 2.1-12.8). Leukoaraiosis burden is an independent predictor of worse short-term functional and cognitive recovery after a minor ischemic stroke.
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Affiliation(s)
- Zheng Zhang
- Department of Neurology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
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Yang Y, Shi YZ, Zhang N, Wang S, Ungvari GS, Ng CH, Wang YL, Zhao XQ, Wang YJ, Wang CX, Xiang YT. Suicidal ideation at 1-year post-stroke: A nationwide survey in China. Gen Hosp Psychiatry 2017; 44:38-42. [PMID: 28041574 DOI: 10.1016/j.genhosppsych.2016.09.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2016] [Revised: 09/08/2016] [Accepted: 09/24/2016] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Few studies on suicidal ideation have been conducted in post-stroke patients in China. This national study examined suicidal ideation at 1-year post-stroke and explored its demographic and clinical correlates. METHODS A total of 1418 patients with ischemic stroke were included in 56 hospitals nationwide. Demographic, clinical characteristics and neuro-imaging information were collected with standardized instruments, including assessment of stroke severity, depression, cognitive impairment, stroke recurrence, physical disability and insomnia. Suicidal ideation was measured using item 3 of the Hamilton Rating Scale for Depression. RESULTS The frequency of suicidal ideation in this study was 6.6%. Multivariate analyses revealed that disability (OR=2.07, 95% CI=1.09-3.05), stroke recurrence (OR=4.13, 95% CI=1.74-9.77) and insomnia early (OR=1.87, 95% CI=1.03-3.39), middle (OR=2.66, 95% CI=1.46-4.85) and late (OR=2.35, 95% CI=1.31-4.19) at the 1-year follow-up and post-stroke depression (OR=2.16, 95% CI=1.23-3.82) were significantly associated with post-stroke suicidal ideation. CONCLUSION Post-stroke depression, disability, insomnia and stroke recurrence are possible risk factors of suicidal ideation that warrant attention in clinical practice.
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Affiliation(s)
- Yang Yang
- Department of Neurology, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China; Department of Neuropsychiatry & Behavioral Neurology and Clinical Psychology, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China; Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Yu-Zhi Shi
- Department of Neurology, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China; Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Ning Zhang
- Department of Neurology, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China; Department of Neuropsychiatry & Behavioral Neurology and Clinical Psychology, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China; Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Shuo Wang
- Department of Neurology, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China; Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Gabor S Ungvari
- University of Notre Dame Australia/Marian Centre, Perth, Australia; School of Psychiatry & Clinical Neurosciences, University of Western Australia, Perth, Australia
| | - Chee H Ng
- Department of Psychiatry, University of Melbourne, Melbourne, Victoria, Australia
| | - Yi-Long Wang
- Department of Neurology, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China; Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Xing-Quan Zhao
- Department of Neurology, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China; Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Yong-Jun Wang
- Department of Neurology, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China; Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Chun-Xue Wang
- Department of Neurology, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China; Department of Neuropsychiatry & Behavioral Neurology and Clinical Psychology, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China; Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China.
| | - Yu-Tao Xiang
- Unit of Psychiatry, Faculty of Health Sciences, University of Macau, Macao SAR, China.
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Nijsse B, Visser-Meily JMA, van Mierlo ML, Post MWM, de Kort PLM, van Heugten CM. Temporal Evolution of Poststroke Cognitive Impairment Using the Montreal Cognitive Assessment. Stroke 2016; 48:98-104. [PMID: 27899753 DOI: 10.1161/strokeaha.116.014168] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 10/07/2016] [Accepted: 11/02/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE The Montreal Cognitive Assessment (MoCA) is nowadays recommended for the screening of poststroke cognitive impairment. However, little is known about the temporal evolution of MoCA-assessed cognition after stroke. The objective of this study was to examine the temporal pattern of overall and domain-specific cognition at 2 and 6 months after stroke using the MoCA and to identify patient groups at risk for cognitive impairment at 6 months after stroke. METHODS Prospective cohort study in which 324 patients were administered the MoCA at 2 and 6 months post stroke. Cognitive impairment was defined as MoCA<26. Differences in cognitive impairment rates between 2 and 6 months post stroke were analyzed in different subgroups. Patients with MoCA score <26 at 2 months, who improved by ≥2 points by 6 months, were defined as reverters. Logistic regression analyses were used to identify determinants of (1) cognitive impairment at 6 months post stroke and (2) reverter status. RESULTS Between 2 and 6 months post stroke, mean MoCA score improved from 23.7 (3.9) to 24.7 (3.5), P<0.001. Prevalence of cognitive impairment at 2 months was 66.4%, compared with 51.9% at 6 months (P<0.001). More comorbidity and presence of cognitive impairment at 2 months were significant independent predictors of cognitive impairment 6 months post stroke. No significant determinants of reverter status were identified. CONCLUSIONS Although cognitive improvement is seen ≤6 months post stroke, long-term cognitive deficits are prevalent. Identifying patients at risk of cognitive impairment is, therefore, important as well as targeting interventions to this group.
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Affiliation(s)
- Britta Nijsse
- From the Department of Neurology, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands (B.N., P.L.M.d.K.); Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and Hoogstraat Rehabilitation, The Netherlands (J.M.A.V.-M., M.L.v.M., M.W.M.P.); Department of Rehabilitation Medicine, University Medical Center Groningen, The Netherlands (M.W.M.P.); and Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (C.M.v.H.) and Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience (C.M.v.H.), Maastricht University, The Netherlands
| | - Johanna M A Visser-Meily
- From the Department of Neurology, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands (B.N., P.L.M.d.K.); Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and Hoogstraat Rehabilitation, The Netherlands (J.M.A.V.-M., M.L.v.M., M.W.M.P.); Department of Rehabilitation Medicine, University Medical Center Groningen, The Netherlands (M.W.M.P.); and Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (C.M.v.H.) and Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience (C.M.v.H.), Maastricht University, The Netherlands.
| | - Maria L van Mierlo
- From the Department of Neurology, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands (B.N., P.L.M.d.K.); Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and Hoogstraat Rehabilitation, The Netherlands (J.M.A.V.-M., M.L.v.M., M.W.M.P.); Department of Rehabilitation Medicine, University Medical Center Groningen, The Netherlands (M.W.M.P.); and Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (C.M.v.H.) and Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience (C.M.v.H.), Maastricht University, The Netherlands
| | - Marcel W M Post
- From the Department of Neurology, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands (B.N., P.L.M.d.K.); Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and Hoogstraat Rehabilitation, The Netherlands (J.M.A.V.-M., M.L.v.M., M.W.M.P.); Department of Rehabilitation Medicine, University Medical Center Groningen, The Netherlands (M.W.M.P.); and Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (C.M.v.H.) and Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience (C.M.v.H.), Maastricht University, The Netherlands
| | - Paul L M de Kort
- From the Department of Neurology, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands (B.N., P.L.M.d.K.); Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and Hoogstraat Rehabilitation, The Netherlands (J.M.A.V.-M., M.L.v.M., M.W.M.P.); Department of Rehabilitation Medicine, University Medical Center Groningen, The Netherlands (M.W.M.P.); and Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (C.M.v.H.) and Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience (C.M.v.H.), Maastricht University, The Netherlands
| | - Caroline M van Heugten
- From the Department of Neurology, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands (B.N., P.L.M.d.K.); Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and Hoogstraat Rehabilitation, The Netherlands (J.M.A.V.-M., M.L.v.M., M.W.M.P.); Department of Rehabilitation Medicine, University Medical Center Groningen, The Netherlands (M.W.M.P.); and Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (C.M.v.H.) and Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience (C.M.v.H.), Maastricht University, The Netherlands
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Schinkel-Ivy A, Huntley AH, Inness EL, Mansfield A. Timing of reactive stepping among individuals with sub-acute stroke: effects of 'single-task' and 'dual-task' conditions. Heliyon 2016; 2:e00186. [PMID: 27861645 PMCID: PMC5103078 DOI: 10.1016/j.heliyon.2016.e00186] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 09/23/2016] [Accepted: 10/21/2016] [Indexed: 10/26/2022] Open
Abstract
Performance decrements in balance tasks are often observed when a secondary cognitive task is performed simultaneously. This study aimed to determine whether increased cognitive load resulted in altered reactive stepping in individuals with sub-acute stroke, compared to a reactive stepping trial with no secondary task. The secondary purpose was to determine whether differences existed between the first usual-response trial, subsequent usual-response trials, and the dual-task condition. Individuals with sub-acute stroke were exposed to external perturbations to elicit reactive steps. Perturbations were performed under a usual-response (single-task) and dual-task condition. Measures of step timing and number of steps were based on force plate and video data, respectively; these measures were compared between the usual-response and dual-task trials, and between the first usual-response trial, later usual-response trials (trials 2-5) and a dual-task trial. A longer time of unloading onset and greater number of steps were identified for the first usual-response trial compared to later usual-response trials. No significant differences were identified between usual-response and dual-task trials. Although improvements were observed from the first to subsequent usual-response lean-and-release trials, performance then tended to decrease with the introduction of the dual-task condition. These findings suggest that when introduced after usual-response trials, the dual-task trial may represent the first trial of a new condition, which may be beneficial in reducing the potential for adaptation that may occur after multiple repetitions of a reactive stepping task. Therefore, these findings may lend support to the introduction of a new condition (i.e. a dual-task trial) in addition to usual-response trials when assessing reactive balance in individuals with stroke.
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Affiliation(s)
- Alison Schinkel-Ivy
- Toronto Rehabilitation Institute-University Health Network, 550 University Ave, Toronto, Ontario M5G 2A2, Canada; School of Physical and Health Education, Nipissing University, 100 College Drive, Box 5002, North Bay, Ontario P1B 8L7, Canada
| | - Andrew H Huntley
- Human Health and Nutritional Sciences, University of Guelph, 50 Stone Road East, Guelph, Ontario N1G 2W1, Canada
| | - Elizabeth L Inness
- Toronto Rehabilitation Institute-University Health Network, 550 University Ave, Toronto, Ontario M5G 2A2, Canada; Department of Physical Therapy, University of Toronto, 500 University Ave, Toronto, Ontario M5G 1V7, Canada
| | - Avril Mansfield
- Toronto Rehabilitation Institute-University Health Network, 550 University Ave, Toronto, Ontario M5G 2A2, Canada; Department of Physical Therapy, University of Toronto, 500 University Ave, Toronto, Ontario M5G 1V7, Canada; Evaluative Clinical Sciences, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, 2075 Bayview Ave, Toronto, Ontario M4N 3M5, Canada
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48
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Sivakumar L, Riaz P, Kate M, Jeerakathil T, Beaulieu C, Buck B, Camicioli R, Butcher K. White matter hyperintensity volume predicts persistent cognitive impairment in transient ischemic attack and minor stroke. Int J Stroke 2016; 12:264-272. [PMID: 27784823 DOI: 10.1177/1747493016676612] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Temporary and permanent cognitive changes following transient ischemic attack/minor stroke have been described previously. It is unknown if persisting cognitive deficits in these patients are correlated with acute infarction identified using magnetic resonance imaging. Aims We tested the hypothesis that persistent cognitive impairment after transient ischemic attack/minor stroke can be predicted by the volume of diffusion-weighted imaging lesions. Methods Acute transient ischemic attack/minor stroke (NIH stroke scale score ≤ 3) patients were prospectively recruited within 72 h of onset. Patients underwent Montreal cognitive assessment and magnetic resonance imaging, including diffusion-weighted imaging and Fluid-Attenuated Inverse Recovery sequences, at baseline, days 7 and 30. Cognitive testing was repeated at day 90. Diffusion-weighted imaging lesion and Fluid-Attenuated Inverse Recovery chronic white matter hyperintensity volumes were measured planimetrically. Cognitive impairment was defined a priori as Montreal cognitive assessment score < 26. Results One hundred fifteen patients were imaged at a median (inter-quartile range) of 24.0 (16.6) h after onset. Acute ischemic lesions were present in 91 (79%) patients. Cognitive impairment rates were similar in patients with (47/91, 52%) and without diffusion-weighted imaging lesions (13/24, 54%; p = 0.83). Although linear regression indicated no relationship between acute diffusion-weighted imaging lesion volume and day 30 Montreal cognitive assessment scores (β = -0.163, [-2.243, 0.334], p = 0.144), white matter hyperintensity volumes at baseline were predictive of persistent cognitive deficits after 30 days (β = 2.24, [1.956, 45.369], p = 0.005). Conclusions In most transient ischemic attack/minor stroke patients who suffer acute cognitive impairment post event, deficits are temporary. Deficits after 30 days of onset are correlated with chronic white matter hyperintensity, suggesting subclinical cognitive impairment and/or impaired ability to compensate for the effects of acute ischemic infarcts.
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Affiliation(s)
- Leka Sivakumar
- 1 Division of Neurology, University of Alberta, Alberta, Canada
| | - Parnian Riaz
- 1 Division of Neurology, University of Alberta, Alberta, Canada
| | - Mahesh Kate
- 1 Division of Neurology, University of Alberta, Alberta, Canada
| | | | - Christian Beaulieu
- 2 Division of Biomedical Engineering, University of Alberta, Alberta, Canada
| | - Brian Buck
- 1 Division of Neurology, University of Alberta, Alberta, Canada
| | | | - Ken Butcher
- 1 Division of Neurology, University of Alberta, Alberta, Canada
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49
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Mazzucco S, Li L, Tuna MA, Pendlebury ST, Wharton R, Rothwell PM. Hemodynamic correlates of transient cognitive impairment after transient ischemic attack and minor stroke: A transcranial Doppler study. Int J Stroke 2016; 11:978-986. [PMID: 27462099 PMCID: PMC5490782 DOI: 10.1177/1747493016661565] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 06/09/2016] [Indexed: 11/15/2022]
Abstract
Background and aims Transient cognitive impairment (TCI) on the Mini Mental State Evaluation score is common after transient ischemic attack/minor stroke and might identify patients at increased risk of dementia. We aimed to replicate TCI using the Montreal Cognitive Assessment (MoCA), compare it with persistent Mild Cognitive Impairment (PMCI), and to determine whether global cerebral hemodynamic changes could explain transient impairment. Methods Consecutive patients with transient ischemic attack/minor stroke (NIHSS ≤ 3) were assessed with the MoCA and transcranial Doppler ultrasound acutely and at 1 month. We compared patients with TCI (baseline MoCA < 26 with ≥ 2 points increase at 1 month), PMCI (MoCA < 26 with < 2 points increase), and no cognitive impairment (NCI; MoCA ≥ 26). Results Of 326 patients, 46 (14.1%) had PMCI, 98 (30.1%) TCI, and 182 (55.8%) NCI. At baseline, TCI patients had higher systolic blood pressure (150.95 ± 21.52 vs 144.86 ± 22.44 mmHg, p = 0.02) and lower cerebral blood flow velocities, particularly end-diastolic velocity (30.16 ± 9.63 vs 35.02 ± 9.01 cm/s, p < 0.001) and mean flow velocity (48.95 ± 12.72 vs 54 ± 12.46 cm/s, p = 0.001) than those with NCI, but similar clinical and hemodynamic profiles to those with PMCI. Systolic BP fell between baseline and 1 month (mean reduction = 14.01 ± 21.26 mmHg) and end-diastolic velocity and mean flow velocity increased (mean increase = + 2.42 ± 6.41 and 1.89 ± 8.77 cm/s, respectively), but these changes did not differ between patients with TCI, PMCI, and NCI. Conclusions TCI is detectable with the MoCA after transient ischemic attack and minor stroke and has similar clinical and hemodynamic profile to PMCI. However, TCI does not appear to be due to exaggerated acute reversible global hemodynamic changes.
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Affiliation(s)
- Sara Mazzucco
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Linxin Li
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Maria A Tuna
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Sarah T Pendlebury
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Rose Wharton
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Peter M Rothwell
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
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50
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Zuo L, Dong Y, Zhu R, Jin Z, Li Z, Wang Y, Zhao X, Sachdev P, Zhang W, Wang Y. Screening for cognitive impairment with the Montreal Cognitive Assessment in Chinese patients with acute mild stroke and transient ischaemic attack: a validation study. BMJ Open 2016; 6:e011310. [PMID: 27406642 PMCID: PMC4947786 DOI: 10.1136/bmjopen-2016-011310] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE We aimed to establish the cut-off point of the Montreal Cognitive Assessment (MoCA-Beijing) in screening for cognitive impairment (CI) within 2 weeks of mild stroke or transient ischaemic attack (TIA). METHODS A total of 80 acute mild ischaemic stroke patients and 22 TIA patients were recruited. They received the MoCA-Beijing and a formal neuropsychological test battery. CI was defined by 1.5 SD below the established norms on a formal neuropsychological test battery. RESULTS Most stroke and TIA patients were in their 50s (53.95±11.43 years old), with greater than primary school level of education. The optimal cut-off point for MoCA-Beijing in discriminating patients with CI from those with no cognitive impairment (NCI) was 22/23 (sensitivity 85%, specificity 88%, positive predictive value=91%, negative predictive value=80%, classification accuracy=86%). The predominant cognitive deficits were characteristic of frontal-subcortical impairment, such as visuomotor speed (46.08%), attention/executive function (42.16%) and visuospatial ability (40.20%). CONCLUSIONS A MoCA-Beijing cut-off score of 22/23 is optimally sensitive and specific for detecting CI after mild stroke, and TIA in the acute stroke phase, and is recommended for routine clinical practice.
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Affiliation(s)
- Lijun Zuo
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yanhong Dong
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University Health System, Singapore, Singapore
- Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Rongyan Zhu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zhao Jin
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zixiao Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yilong Wang
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- Department of Neurology, Tiantan Clinical Trial and Research Center for Stroke, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xingquan Zhao
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Perminder Sachdev
- Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, University of New South Wales, Sydney, Australia
- Neuropsychiatric Institute, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Wei Zhang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- Department of Geriatrics, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Center of Parkinson Disease, Beijing Institute for Brain Disorders, Beijing, China
- Beijing Key Laboratory on Parkinson Disease, Beijing, China
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- Department of Neurology, Tiantan Clinical Trial and Research Center for Stroke, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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