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Background: Poststroke vascular cognitive impairment is highly prevalent with significant functional consequences. However, reliable biomarkers for early prediction of cognitive decline after acute ischemic stroke (AIS) are not well established. Although parenchymal imaging in patients with AIS and transient ischemic attack (TIA) may predict the resultant cognitive impairment, it may not explain the progressive deterioration after the index event. We postulated that longitudinal changes in cerebral hemodynamic parameters may influence the cognitive performance after a cerebrovascular event.Methods: One-hundred consecutive AIS/TIA patients were recruited within 2 weeks following a cerebrovascular event. At 3-6 months, 69 patients were followed up with transcranial Doppler (TCD) and brief cognitive tests (Mini-Mental State Examination [MMSE]/Montreal Cognitive Assessment [MoCA]). Basic demographics, vascular risk factors, clinical, cognitive, and neurological status were recorded.Results: Considerable proportion (12%) of patients showed cognitive decline and changes in the hemodynamic parameters over 3-6 months after the index event. We showed that right middle cerebral artery (MCA) stenosis and right internal carotid artery/MCA tandem lesions at 3-6 months are associated with the change in the MMSE scores. Additionally, there was a trend toward association between increased pulsatility index of the right MCA and a decline in the MMSE score. However, we did not observe any association between cognitive decline and longitudinal changes in hemodynamic parameters.Conclusion: Although hemodynamic parameters deteriorate in a considerable proportion of patients during first 3-6 months after a cerebrovascular event, cognitive decline appears to be an independent phenomenon. [ABSTRACT FROM AUTHOR]

Background: The predictive ability of National Institute of Neurological Disease and Stroke-Canadian Stroke Network (NINDS-CSN) 5-minute protocol and Montreal Cognitive Assessment (MoCA) administered sub-acutely and at the convalescent phase after stroke for significant vascular cognitive impairment (VCI) at 1 year is unknown. We compared prognostic values of these tests.Methods: Patients with ischemic stroke and transient ischemic attack (TIA) received MoCA sub-acutely (within 2 weeks) and 3-6 months after stroke followed by a formal neuropsychological evaluation at 1 year. The total score of NINDS-CSN 5-minutes protocol was derived from MoCA. Moderate-severe VCI was defined as neuropsychological impairment in ≥ 3 domains. Area under the receiver operating characteristic curve (AUC) analyses were conducted to establish the optimal cutoff points and discriminatory properties of the MoCA and NINDS-CSN 5-minute protocol in detecting moderate-severe VCI.Results: Four hundre patients were recruited at baseline. Of these, 291 received a formal neuropsychological assessment 1 year after stroke. 19% patients had moderate-severe VCI. The MoCA was superior to the NINDS-CSN 5-minute protocol [sub-acute AUCs: 0.89 vs 0.80, p < 0.01; 3-6 months AUCs: 0.90 vs 0.83, p < 0.01] in predicting for moderate-severe VCI at 1 year. At respective cutoff points, MoCA had significantly higher sensitivity than the NINDS-CSN 5-minute protocol at baseline (p = 0.01) and 3-6 months (p = 0.04).Conclusions: MoCA administered sub-acutely and 3-6 months after stroke is superior to the NINDS-CSN 5-minute protocol in predicting moderate-severe VCI at 1 year. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the prognostic value of the neurocognitive status measured by screening instruments, the Montreal Cognitive Assessment (MoCA) and Mini-Mental State Examination (MMSE), individually and in combination with the stroke severity scale, the National Institute of Health Stroke Scale (NIHSS), obtained at the subacute stroke phase or the baseline (≤2 weeks), for functional outcome 3-6 months later. Design: Prospective observational study. Setting: Tertiary stroke neurology service. Participants: 400 patients with a recent ischaemic stroke or transient ischaemic attack (TIA) received NIHSS, MoCA and MMSE at baseline and were followed up 3-6 months later. Primary outcome measures: At 3-6 months following the index event, functional outcome was measured by the modified Rankin Scale (mRS) scores. Results: Most patients (79.8%) had a mild ischaemic stroke and less disability (median NIHSS=2, median mRS=2 and median premorbid mRS=0), while a minority of patients had TIA (20.3%). Baseline NIHSS, MMSE and MoCA scores individually predicted mRS scores at 3-6 months, with NIHSS being the strongest predictor (NIHSS: R² change=0.043, p<0.001). Moreover, baseline MMSE scores had a small but statistically significant incremental predictive value to the baseline NIHSS for mRS scores at 3-6 months, while baseline MoCA scores did not (MMSE: R² changes=0.006, p=0.03; MoCA: R² changes=0.004, p=0.083). However, in patients with more severe stroke at baseline (defined as NIHSS>2), baseline MoCA and MMSE had a significant and moderately large incremental predictive value to the baseline NIHSS for mRS scores at 3-6 months (MMSE: R² changes=0.021, p=0.010; MoCA: R² changes=0.017, p=0.021). Conclusions: Cognitive screening at the subacute stroke phase can predict functional outcome independently and improve the predictive value of stroke [ABSTRACT FROM AUTHOR]

Objectives To determine the prognostic value of brief cognitive screening tests administered in the subacute stroke phase (initial 2 weeks) for the detection of significant cognitive impairment 3e6 months after stroke, the authors compared the Montreal Cognitive Assessment (MoCA) and the Mini-Mental State Examination (MMSE). Methods Patients with ischaemic stroke and transient ischaemic attack were assessed with both MoCA and MMSE within 14 days after index stroke, followed by a formal neuropsychological evaluation of seven cognitive domains 3e6 months later. Cognitive outcomes were dichotomised as either noemild (impairment in #2 cognitive domains) or moderateesevere (impairment in $3 cognitive domains) vascular cognitive impairment. Area under the receiver operating characteristic (ROC) curve analysis was used to compare discriminatory ability. Results 300 patients were recruited, of whom 239 received formal neuropsychological assessment 3e6 months after the stroke. 60 (25%) patients had moderateesevere VCI. The overall discriminant validity for detection of moderateesevere cognitive impairment was similar for MoCA (ROC 0.85 (95% CI 0.79 to 0.90) and MMSE (ROC 0.83 (95% CI 0.77 to 0.89)), p¼0.96). Both MoCA (21/22) and MMSE (25/26) had similar discriminant indices at their optimal cutoff points; sensitivity 0.88 versus 0.88; specificity 0.64 versus 0.67; 70% versus 72% correctly classified. Moreover, both tests had similar discriminant indices in detecting impaired cognitive domains. Conclusions Brief screening tests during acute admission in patients with mild stroke are predictive of significant vascular cognitive impairment 3e6 months after stroke. [ABSTRACT FROM AUTHOR]

Objectives: Intracranial atherosclerosis has been suggested to be common in Asians. We apply a semi-quantitative CT scoring system to evaluate the degree of intracranial atherosclerotic calcification and determine its distribution, severity, and the associated risk factors. The clinical outcome of these patients after a 3-year follow-up was also evaluated. Methods: Sixty consecutive patients diagnosed clinically to have either a transient ischemic attack (TIA) or minor ischemic stroke and underwent early computed tomographic angiography (CTA) were included into the prospective study. Two radiologists evaluated the axial CTA images for any calcification in the precavernous, cavernous and postcavernous segments of intracranial internal carotid artery (ICA), anterior, middle, and posterior cerebral as well as vertebrobasilar arteries, based on a standard CT scoring system for extent (0-4) and thickness (0-4). The composite CT score for extent and thickness of these vascular segments or vessels were recorded for all patients. The worst site (highest composite score) was chosen as the marker of the degree of intracranial atherosclerosis of each patient. The patients were then classified into mild, moderate, and severe groups, according to a composite CT score of 0-2, 3-5, and 6-8, respectively. These findings were gathered with clinical parameters and outcome after a 3-year follow-up period and corresponding statistical analyses were conducted. Results: The most severely affected vessel was found to be intracranial internal carotid arteries, and severe, moderate, and mild atherosclerosis were present in 16 (26.67%), 30 (50%), and 14 (23.33%) patients, respectively. Using multiple logistic regression analysis, diabetes mellitus (odds ratio = 10.6, P value = .004), and age (odds ratio = 1.07, P value = .02) were found to be significant risk factors for severe intracranial atherosclerosis. Two patients in the severe group, 3 patients in the moderate group, and 1 patient in the mild group were found to have stroke or TIA after a 3-year follow-up, but there was no significant difference among the 3 groups. Conclusion: Significant intracranial atherosclerosis as determined by severe CT calcification was common in a cohort of Chinese patients with TIA and minor stroke. Age and diabetes mellitus were independent significant risk factors, and this CT calcification score might serve as an early indicator of intracranial atherosclerotic disease. [ABSTRACT FROM AUTHOR]

Objectives: Intracranial atherosclerosis has been suggested to be common in Asians. We apply a semi-quantitative CT scoring system to evaluate the degree of intracranial atherosclerotic calcification and determine its distribution, severity, and the associated risk factors. The clinical outcome of these patients after a 3-year follow-up was also evaluated., Methods: Sixty consecutive patients diagnosed clinically to have either a transient ischemic attack (TIA) or minor ischemic stroke and underwent early computed tomographic angiography (CTA) were included into the prospective study. Two radiologists evaluated the axial CTA images for any calcification in the precavernous, cavernous and postcavernous segments of intracranial internal carotid artery (ICA), anterior, middle, and posterior cerebral as well as vertebrobasilar arteries, based on a standard CT scoring system for extent (0-4) and thickness (0-4). The composite CT score for extent and thickness of these vascular segments or vessels were recorded for all patients. The worst site (highest composite score) was chosen as the marker of the degree of intracranial atherosclerosis of each patient. The patients were then classified into mild, moderate, and severe groups, according to a composite CT score of 0-2, 3-5, and 6-8, respectively. These findings were gathered with clinical parameters and outcome after a 3-year follow-up period and corresponding statistical analyses were conducted., Results: The most severely affected vessel was found to be intracranial internal carotid arteries, and severe, moderate, and mild atherosclerosis were present in 16 (26.67%), 30 (50%), and 14 (23.33%) patients, respectively. Using multiple logistic regression analysis, diabetes mellitus (odds ratio = 10.6, P value = .004), and age (odds ratio = 1.07, P value = .02) were found to be significant risk factors for severe intracranial atherosclerosis. Two patients in the severe group, 3 patients in the moderate group, and 1 patient in the mild group were found to have stroke or TIA after a 3-year follow-up, but there was no significant difference among the 3 groups., Conclusion: Significant intracranial atherosclerosis as determined by severe CT calcification was common in a cohort of Chinese patients with TIA and minor stroke. Age and diabetes mellitus were independent significant risk factors, and this CT calcification score might serve as an early indicator of intracranial atherosclerotic disease.