Background The prehospital identification of stroke patients with large-vessel occlusion (LVO), that should be immediately transported to a thrombectomy capable centre is an unsolved problem. Our aim was to determine whether implementation of a state-wide standard operating procedure (SOP) using the Los Angeles Motor Scale (LAMS) is feasible and enables correct triage of stroke patients to hospitals offering (comprehensive stroke centres, CSCs) or not offering (primary stroke centres, PSCs) thrombectomy. Methods Prospective study involving all patients with suspected acute stroke treated in a 4-month period in a state-wide network of all stroke-treating hospitals (eight PSCs and two CSCs). Primary endpoint was accuracy of the triage SOP in correctly transferring patients to CSCs or PSCs. Additional endpoints included the number of secondary transfers, the accuracy of the LAMS for detection of LVO, apart from stroke management metrics. Results In 1123 patients, use of a triage SOP based on the LAMS allowed triage decisions according to LVO status with a sensitivity of 69.2% (95% confidence interval (95%-CI): 59.0–79.5%) and a specificity of 84.9% (95%-CI: 82.6–87.3%). This was more favourable than the conventional approach of transferring every patient to the nearest stroke-treating hospital, as determined by geocoding for each patient (sensitivity, 17.9% (95%-CI: 9.4–26.5%); specificity, 100% (95%-CI: 100–100%)). Secondary transfers were required for 14 of the 78 (17.9%) LVO patients. Regarding the score itself, LAMS detected LVO with a sensitivity of 67.5% (95%-CI: 57.1–78.0%) and a specificity of 83.5% (95%-CI: 81.0–86.0%). Conclusions State-wide implementation of a triage SOP requesting use of the LAMS tool is feasible and improves triage decision-making in acute stroke regarding the most appropriate target hospital.

Objective: Subjective memory complaints (SMCs) seem to be a promising marker of cognitive decline and progressing dementia in healthy older adults. However, SMCs have not been invariably related to memory performance, probably because objective tests do not always target the specific neurocognitive processes that underlie SMCs. This study disentangles the neurocognitive basis of memory-specific SMCs by investigating their dependence on episodic recollection which relies on the hippocampal relational memory system as well as their predictive value for memory tests that target such processes. Method: In 29 healthy participants, aged 52-70 years, we assessed SMCs, using the Memory Assessment Clinics Self-Rating Scale (MAC-S), episodic recollection and associated event-related potentials (ERPs), the Verbal Learning and Memory Test (VLMT), which assesses hippocampal functions, as well as depressive symptomology, using Beck Depression Inventory II (BDI). We used correlational and regression models to estimate the association of SMCs with recollection and VLMT performance, independent of age, depressive symptomology, and the P300, an ERP correlate of attentional processes. Results: The ERP correlate of sourcerecollection significantly accounted for 9% unique variance in SMCs. Moreover, SMCs explained unique proportions of variance in several VLMT measures (ΔR 2 ranging from .07 to .17). Conclusions: SMCs are partially determined by malfunctioning of the hippocampal relational memory system. In line with this, SMCs predict performance in objective memory tests if they also target hippocampally dependent processes. The study emphasizes the prognostic relevance of SMCs as episodic memory decline is an important preclinical marker for the development of Alzheimer's Disease (AD).