Underestimation of cognitive impairments by the Montreal Cognitive Assessment (MoCA) in an acute stroke unit population
Abstract Background and purpose The Montreal Cognitive Assessment (MoCA) is an increasingly popular clinical screening tool for detecting cognitive impairment in stroke, but few studies have directly compared performance on the MoCA with neuropsychological assessment. Our retrospective study examined the extent to which intact performance on the MoCA reflects intact cognition as determined by neuropsychological assessment. Methods In this retrospective study, cognitive profiles for 136 acute stroke patients admitted to the Acute Stroke Unit who had available MoCA and neuropsychological assessment data were examined. Results 22% of our patients were deemed cognitively intact on the MoCA. Of …
The test accuracy of the Montreal Cognitive Assessment (MoCA) by stroke lateralisation
Abstract Background The Montreal Cognitive Assessment (MoCA) is an increasingly popular screening tool for detecting cognitive impairment post-stroke. However its' test accuracy by stroke lateralisation is as yet unknown. Aim Our aim was to investigate whether the test accuracy of the MoCA differs by stroke lateralisation across different cognitive domains. Methods We retrospectively examined the cognitive profiles of 228 subacute stroke patients (86 Left, 142 Right), comparing MoCA-total and domain-specific scores with performance on detailed neuropsychological assessment. Results The prevalence of cognitive impairment detected on neuropsychological assessment was high and relatively compa…
Cerebral Microbleeds and Long-Term Cognitive Outcome: Longitudinal Cohort Study of Stroke Clinic Patients
<i>Background:</i> Vascular cognitive impairment causes significant disability in the elderly and is common following ischaemic stroke. Although the underlying mechanisms and prognostic factors remain unclear, small vessel diseases are known to contribute. Cerebral microbleeds (CMBs) are a magnetic resonance imaging (MRI) manifestation of small vessel diseases and may contribute to vascular cognitive impairment, particularly frontal-executive functions. We hypothesized that baseline CMBs would predict long-term cognitive outcome, specifically frontal-executive function. <i>Methods:</i> A cohort of consecutive patients found to have CMBs when first referred to a strok…
Recanalization Therapies in Acute Ischemic Stroke Patients Impact of Prior Treatment With Novel Oral Anticoagulants on Bleeding Complications and Outcome A Pilot Study
Background— We explored the safety of intravenous thrombolysis (IVT) or intra-arterial treatment (IAT) in patients with ischemic stroke on non-vitamin K antagonist oral anticoagulants (NOACs, last intake <48 hours) in comparison with patients (1) taking vitamin K antagonists (VKAs) or (2) without previous anticoagulation (no-OAC). Methods and Results— This is a multicenter cohort pilot study. Primary outcome measures were (1) occurrence of intracranial hemorrhage (ICH) in 3 categories: any ICH (ICH any ), symptomatic ICH according to the criteria of the European Cooperative Acute Stroke Study II (ECASS-II) (sICH ECASS-II ) and the National Institute of Neurological Disorders and Stroke …
Cerebral microbleeds and vascular cognitive impairment
Abstract MRI manifestations of small vessel diseases including white matter hyperintensities and lacunes have been recognized as potential substrates of vascular cognitive impairment for many years. Cerebral microbleeds (CMBs) – small, perviascular haemorrhages seen as small, well-demarcated, hypointense, rounded lesions on MRI sequences sensitive to magnetic susceptibility effects – are also now recognized as an imaging marker for small vessel pathology, but their clinical impact on cognition remains uncertain. CMBs are present in about a third of patients with ischaemic stroke, and in a high proportion of patients with Alzheimer's disease, cerebral amyloid angiopathy, and vascular dementi…
PATH56 MRI correlates of vascular cognitive impairment: contribution of microbleeds, white matter changes and infarcts in a large hospital-based cross-sectional study
Background The mechanisms underlying vascular cognitive impairment remain poorly understood. Brain microbleeds may contribute, particularly to executive dysfunction. We investigated the cognitive effects of microbleeds and other neuroimaging markers for cerebrovascular disease in a large, hospital-based study. Methods Consecutive, unselected patients referred to the stroke unit or clinic underwent clinical assessment, detailed neuropsychological testing and vascular MRI. Microbleeds, white matter changes (WMC) and brain infarcts were identified and their effects on cognition assessed. Results 242 patients were included (N=60 with, N=182 without microbleeds). Executive impairment was more pr…
Clinical presentation of strokes confined to the insula: a systematic review of literature
Abstract Background and purpose The insular cortex serves a wide variety of functions in humans, ranging from sensory and affective processing to high-level cognition. Hence, insular dysfunction may result in several different presentations. Ischemic strokes limited to the insular territory are rare and deserve a better characterization, to be quickly recognized and to receive appropriate treatment (e.g. thrombolysis). Methods We reviewed studies on patients with a first-ever acute stroke restricted to the insula. We searched in the Medline database the keywords “insular stroke” and “insular infarction”, to identify previously published cases. Afterwards, the results were divided depending …
Prevalence and Cognitive Impact of Medial Temporal Atrophy in a Hospital Stroke Service: Retrospective Cohort Study
Background Cerebrovascular disease and neurodegeneration cause cognitive impairment and frequently coexist. Aims Our objectives were to investigate the prevalence and cognitive impact of medial temporal lobe atrophy – a radiological marker often associated with Alzheimer's disease – in a hospital stroke service. Methods Retrospective cohort study of patients from a hospital stroke service. Patients assessed for suspected ischemic stroke or transient ischemic attack, irrespective of final diagnosis, underwent neuropsychological testing and magnetic resonance imaging. medial temporal lobe atrophy, white matter hyperintensities, lacunes, and cerebral microbleeds were rated using established cr…
Cognitive dysfunction and depression in Fabry disease: a systematic review.
Background Fabry disease, an X-linked lysosomal storage disorder, leads to multi-organ dysfunction, including cerebrovascular disease and psychological disorders. However, the prevalence and pattern of associated cognitive dysfunction is not well understood. Objectives To investigate whether there is reliable evidence for neuropsychological impairment in patients with Fabry disease and which cognitive domains are affected. To estimate the prevalence of and factors associated with depression in patients with Fabry disease. Method Qualitative systematic review of the literature of studies conducting neuropsychological assessment or measuring the prevalence of depression in adults with Fabry d…
Domain-specific trends in cognitive impairment after acute ischaemic stroke.
Little is known about the pattern of subacute cognitive domain impairments after ischaemic stroke, nor the temporal evolution of such impairments. Our objective was to investigate the pattern of cognitive impairment in different neuropsychological domains up to a year after ischaemic stroke. We included prospectively collected data from an observational database of stroke patients at the National Hospital for Neurology and Neurosurgery, Queen Square, London, UK. Patients were categorised into temporal groups according to the time between the index stroke and neuropsychological profiling. The prevalence of impairment in different cognitive domains was then compared between these categories. …
MRI-visible perivascular spaces: relationship to cognition and small vessel disease MRI markers in ischaemic stroke and TIA.
Background MRI-visible perivascular spaces (PVS) are potential neuroimaging markers of cerebral small vessel disease, but their functional significance and mechanisms remain uncertain. We investigated the association between PVS and cognitive impairment, and other MRI markers of small vessel disease, in a patient cohort of ischaemic stroke/transient ischaemic attack (TIA) referrals. Methods Data were collected from a prospective observational database. Standardised detailed neuropsychological testing was performed. A validated visual rating scale on T-2-weighted MRI was used to categorise PVS severity; validated scales were used to assess white matter hyperintensities (WMH), cerebral microb…
Domain-specific characterisation of early cognitive impairment following spontaneous intracerebral haemorrhage.
Cognitive deficits after spontaneous intracerebral haemorrhage (ICH) are common and result in functional impairment, but few studies have examined deficits across cognitive domains in the subacute phase. This study aims to describe the cognitive profile following acute ICH and explore how cerebral amyloid angiopathy (CAA) may impact performance. We retrospectively reviewed 187 consecutive patients with ICH (mean age 58.9 years, 55.6% male) with available imaging and neuropsychological data (median 12 days after stroke). In our cohort, 84% (n = 158) were impaired in at least one cognitive domain and 65% (n = 122) in two or more domains. Deficits in non-verbal IQ (76.6%), information processi…