Serial Montreal Cognitive Assessments Demonstrate Reversible Cognitive Impairment in Patients With Acute Transient Ischemic Attack and Minor Stroke

Sivakumar, Leka; Kate, Mahesh; Jeerakathil, Thomas; Camicioli, Richard; Buck, Brian; Butcher, Ken

doi:10.1161/strokeaha.114.004726

Cited by 70 publications

(63 citation statements)

References 18 publications

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“…19 However, these results should be viewed with caution, because of the shortcomings in study design, 18,19 the short-term follow-up of only 3 months, 17,18 and small sample sizes that makes the use of multivariate analyses impossible.…”

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confidence: 99%

“…Factors associated with reverter status were older age and more severe stroke symptoms at baseline. 17 Determinants ofBackground 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.…”

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confidence: 99%

“…Factors associated with reverter status were older age and more severe stroke symptoms at baseline. 17 Determinants of…”

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confidence: 99%

“…[14][15][16] To date, there are only a few studies that used the MoCA to assess changes in cognitive performance at repeated time points after stroke. [17][18][19] Two studies showed that MoCA scores improved in transient ischemic attack and stroke patients from baseline until 3-month follow-up. 17,18 Another study observed a cognitive decline during a 6-month follow-up period.…”

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confidence: 99%

“…[17][18][19] Two studies showed that MoCA scores improved in transient ischemic attack and stroke patients from baseline until 3-month follow-up. 17,18 Another study observed a cognitive decline during a 6-month follow-up period.…”

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confidence: 99%

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Temporal Evolution of Poststroke Cognitive Impairment Using the Montreal Cognitive Assessment

Nijsse

Visser-Meily

Mierlo

et al. 2017

Stroke

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One of these studies compared cognitively impaired stroke patients (MoCA <26) who improved by ≥2 MoCA points, called reverters, to those who did not improve by ≥2 points. Factors associated with reverter status were older age and more severe stroke symptoms at baseline. 17 Determinants ofBackground 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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confidence: 99%

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confidence: 99%

“…Factors associated with reverter status were older age and more severe stroke symptoms at baseline. 17 Determinants of…”

mentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

See 3 more Smart Citations

Temporal Evolution of Poststroke Cognitive Impairment Using the Montreal Cognitive Assessment

Nijsse

Visser-Meily

Mierlo

et al. 2017

Stroke

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Have the patient's cognitive abilities been affected?

Pantoni

2019

Warlow's Stroke

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Cognitive deficits in acute mild ischemic stroke and TIA and effects of rt‐PA

Halevi

Bursaw

Karamchandani

et al. 2019

Ann Clin Transl Neurol

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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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Serial Montreal Cognitive Assessments Demonstrate Reversible Cognitive Impairment in Patients With Acute Transient Ischemic Attack and Minor Stroke

Cited by 70 publications

References 18 publications

Temporal Evolution of Poststroke Cognitive Impairment Using the Montreal Cognitive Assessment

Temporal Evolution of Poststroke Cognitive Impairment Using the Montreal Cognitive Assessment

Have the patient's cognitive abilities been affected?

Cognitive deficits in acute mild ischemic stroke and TIA and effects of rt‐PA

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