Improving screening for vascular cognitive impairment at three to six months after mild ischemic stroke and transient ischemic attack

2014 ◽  
Vol 26 (5) ◽  
pp. 787-793 ◽  
Author(s):  
YanHong Dong ◽  
Melissa Jane Slavin ◽  
Bernard Poon-Lap Chan ◽  
Narayanaswamy Venketasubramanian ◽  
Vijay Kumar Sharma ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Cognitive Impairment ◽  
Transient Ischemic Attack ◽  
Predictive Value ◽  
Characteristic Curve ◽  
Neuropsychological Testing ◽  
Vascular Cognitive Impairment ◽  
Cognitive Domain ◽  
Speed Test ◽  
Ischemic Attack

ABSTRACTBackground:The Montreal Cognitive Assessment (MoCA) and Mini-Mental State Examination (MMSE) were compared with and without the addition of a brief processing speed test, the symbol digit modalities test (SDMT), for vascular cognitive impairment (VCI) screening at three to six months after stroke.Methods:Patients with ischemic stroke and transient ischemic attack were assessed with MoCA and MMSE, as well as a formal neuropsychological battery three to six months after stroke. VCI was defined by impairment in any cognitive domain on neuropsychological testing. The area under the receiver operating characteristic curve (AUC) was used to compare test discriminatory ability.Results:One hundred and eighty-nine patients out of 327 (58%) had VCI, of whom 180 (95%) had vascular mild cognitive impairment (VaMCI), and nine (5%) had dementia. The overall AUCs of the MoCA and MMSE scores and performance at their respective cut-off points were equivalent in detecting VCI (AUCs: 0.87 (95% CI 0.83–0.91) vs. 0.84 (95% CI 0.80–0.88), p = 0.13; cut-offs: MoCA (≤23) vs. MMSE (≤26), sensitivity: 0.78 vs. 0.71; specificity: 0.80 vs. 0.82; positive predictive value: 0.84 vs. 0.84; negative predictive value: 0.72 vs. 0.67; and correctly classified 78.6% vs. 75.5%; p = 0.42). The AUCs of MMSE and MoCA were improved significantly by the SDMT (AUCs: MMSE+SDMT 0.90 (95% CI 0.87–0.93), p <0.001; MoCA+SDMT 0.91 (95% CI 0.88–0.94), p < 0.02).Conclusions:The MoCA and MMSE are equivalent and moderately sensitive, and can be supplemented with the SDMT to improve their accuracy in VCI screening.

scholarly journals Serum soluble ST2 is a predictor for poor long-term prognosis after transient ischemic attack and ischemic stroke: a cohort study

2019 ◽  
Author(s):  
Xuan Tian ◽  
Yinan Guo ◽  
Xiao Wang ◽  
Lulu Pei ◽  
Xin Wang ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Adverse Events ◽  
Transient Ischemic Attack ◽  
Predictive Value ◽  
Adverse Outcomes ◽  
Soluble St2 ◽  
Logistic Regression Models ◽  
C Statistic ◽  
Kaplan Meier ◽  
Ischemic Attack

Abstract Background Soluble ST2 (sST2) is a novel inflammation marker for the prediction of adverse outcomes in patients with cardiovascular disease and diabetes mellitus. The aim of the present study was to examine the predictive value of serum sST2 for prognostic outcomes in patients with transient ischemic attack (TIA)/ischemic stroke.Methods Patients within 24 h after symptom onset were prospectively enrolled based on the TIA/ischemic stroke database of the First Affiliated Hospital of Zhengzhou University. The 1-year prognostic outcomes were composite adverse events (including ischemic and hemorrhagic stroke, myocardial infarction, and all-cause death) and a combination of major disability and death [modified Rankin Scale (mRS), 3-6]. Cox proportional hazard and logistic regression models were used to evaluate the association between serum sST2 and TIA/ischemic stroke prognosis. The C statistic, net reclassification index (NRI), and integrated discrimination index (IDI) were used to present improvement in risk classification.Results Serum sST2 levels were positively correlated with National Institutes of Health Stroke Scale (NIHSS) scores. Kaplan-Meier analysis indicated a significantly different risk in composite adverse events between patients with higher and those with lower levels of sST2 (P=0.006). Serum sST2 was an independent predictor for composite adverse events (HR: 2.517, 95% CI: 1.279-4.956, P=0.008) and major disability or death (OR: 3.126, 95% CI: 1.452-6.728, P=0.004) after multivariate adjustment. The addition of the sST2 to the NIHSS score significantly improved the predictive value for prognostic outcomes in patients with TIA/ischemic stroke (C statistic: 0.021, IDI: 1.91%, P=0.042 for composite adverse events; NRI: 32.82%, P=0.042 for major disability or death).Conclusions Serum sST2 levels were positively associated with the severity of TIA/ischemic stroke and could independently predict composite adverse events and major disability or death, indicating that sST2 may be a potential prognostic marker for TIA/ischemic stroke.

scholarly journals Prediction of stroke risk in patients with transient ischemic attack: ABCD score and its derived scores

2017 ◽  
Vol 5 (12) ◽  
pp. 5093
Author(s):  
Wu Xin-Tong ◽  
Chen Jin-Bo ◽  
Xu Wen-Xiang ◽  
Lu Wen-Xian
Keyword(s):  
Risk Factors ◽  
Risk Assessment ◽  
Ischemic Stroke ◽  
High Risk ◽  
Transient Ischemic Attack ◽  
Predictive Value ◽  
Stroke Risk ◽  
Ischemic Cerebrovascular Disease ◽  
Ischemic Attack ◽  
Abcd Score

Transient Ischemic Attack (TIA) is a high-risk signal of acute ischemic cerebrovascular disease, indicates a significant increase in the risk of ischemic stroke, especially within 7 days. Risk assessment and stratification are important in patient with TIA. A variety of simple prediction scales were developed based on the risk factors for stroke in patients with TIA, such as the California scale, ABCD scale, and ABCD2 scale. Among them, the ABCD scale score is used most commonly, but as its application becomes more and more common, the defects of this scale are also increasingly apparent. In recent years, some derived scales of ABCD score were introduced in order to improve the sensitivity and specificity of prediction. This article reviews the evolution, contents, characteristics, and predictive value of the ABCD score and its derived scales in the prediction of the stroke risk in patients with TIA.

Cerebral Microbleeds and Cognitive Function in Ischemic Stroke or Transient Ischemic Attack Patients

2015 ◽  
Vol 40 (3-4) ◽  
pp. 130-136 ◽  
Author(s):  
Zhaolu Wang ◽  
Adrian Wong ◽  
Wenyan Liu ◽  
Jie Yang ◽  
Winnie C.W. Chu ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Cognitive Impairment ◽  
Cognitive Function ◽  
Transient Ischemic Attack ◽  
Cerebral Microbleeds ◽  
Cognitive Domains ◽  
Deep Region ◽  
Ischemic Attack ◽  
The Impact

Background: We explored the association between cerebral microbleeds (CMBs) and cognitive impairment in patients with ischemic stroke/transient ischemic attack (TIA). Methods: A total of 488 ischemic stroke/TIA patients received magnetic resonance imaging. Montreal Cognitive Assessment (MoCA) was used to evaluate global cognitive function and cognitive domains. The association of CMB quantity with cognitive function and the impact of CMB locations (strictly lobar, strictly deep, and mixed regions) on cognitive impairment were examined in regression models with adjustments for confounders. Results: A total of 113 subjects (23.2%) had ≥1 CMB. Strictly lobar, strictly deep, and mixed CMBs were identified in 36, 40, and 37 patients, respectively. The presence of ≥5 CMBs or strictly deep CMBs was associated with the MoCA total score (p = 0.007 and 0.020, respectively). Of all MoCA domains tested, a lower score in the attention domain was related to the presence of ≥5 CMBs (p = 0.014) and strictly deep CMBs (p = 0.028). Conclusion: CMBs were associated with cognitive dysfunction in stroke/TIA patients, especially in the attention domain. This association was mainly driven by CMBs in the deep region, underlining the role of hypertensive microangiopathy in stroke-related cognitive impairment.

Abstract T MP116: Coated-Platelets Predict Stroke at 30 days in Patients with Transient Ischemic Attack

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Angelia Kirkpatrick ◽  
Andrea Vincent ◽  
George Dale ◽  
Calin Prodan
Keyword(s):  
Negative Predictive Value ◽  
Transient Ischemic Attack ◽  
Predictive Value ◽  
Roc Analysis ◽  
Characteristic Curve ◽  
Neurological Dysfunction ◽  
Stroke Recurrence ◽  
Normal Brain ◽  
Lacunar Stroke ◽  
Ischemic Attack

Background: Coated-platelets, a subset of procoagulant platelets observed upon dual agonist stimulation with collagen and thrombin, support a robust prothrombinase activity and provide a unique measure of platelet thrombotic potential. Coated-platelet levels are increased both in non-lacunar stroke and transient ischemic attack (TIA) compared to controls free of stroke or TIA. In addition, higher levels in non-lacunar stroke are associated with stroke recurrence. We now examine whether coated-platelet levels predict stroke at 30 days in TIA patients. Methods: Consecutive patients with a diagnosis of TIA established by a board certified neurologist were enrolled in this pilot study. The diagnosis was consistent with the tissue-based definition of TIA: a transient episode of neurological dysfunction without acute infarction. The absence of infarction was demonstrated by normal brain imaging studies. Those taking anticoagulants or with dementia were excluded. Coated-platelets were determined at baseline and reported as percent of cells converted to coated-platelets. A receiver operating characteristic curve (ROC) analysis was conducted to compare the ability of coated-platelets versus chance alone to predict incident stroke at 30 days. Results: We enrolled 171 patients. Ten strokes were observed at 30 days. ROC analysis showed significant improvement in the predictive ability of the coated-platelets model compared to chance (AUC: 0.78 ± 0.07 versus 0.50 ± 0, respectively; p < 0.0001). A cut-off of 51.1% for coated-platelet levels yielded a sensitivity of 0.80 (0.55-1.0; 95% CI), specificity of 0.73 (0.66-0.80), positive predictive value of 0.16 (0.06-0.26), and a negative predictive value of 0.98 (0.96-1.0). Conclusions: Among these subjects with TIA, coated platelet levels <51.1% at time of presentation had a negative predictive value of 98% for stroke at 30 days. These findings suggest a role for coated-platelets in stroke risk stratification following TIA.

scholarly journals Acute EEG Patterns Associated With Transient Ischemic Attack

2018 ◽  
Vol 50 (3) ◽  
pp. 196-204 ◽  
Author(s):  
Jeffrey M. Rogers ◽  
Jacob Bechara ◽  
Sandy Middleton ◽  
Stuart J. Johnstone
Keyword(s):  
Ischemic Stroke ◽  
Transient Ischemic Attack ◽  
Healthy Aging ◽  
Characteristic Curve ◽  
Signs And Symptoms ◽  
Tertiary Hospital ◽  
Left Frontal Lobe ◽  
Functional Brain ◽  
Beta Power ◽  
Ischemic Attack

Background. Transient ischemic attack (TIA) is characterized by stroke-like neurologic signs and symptoms in the absence of demonstrable structural neuropathology. There is no test for TIA, with classification often reliant on subjective, retrospective report. Functional brain measures such as the electroencephalogram (EEG) may be helpful in objectively detecting and describing the pathophysiology of TIA, but this has not been adequately examined. Methods. EEG was obtained from a single electrode over the left frontal lobe during 3-minute resting-state and auditory oddball conditions administered to consecutive patients within 72 hours of admission to the acute stroke ward of a tertiary hospital. Separately, patients were classified by their treating team as having suffered either an ischemic stroke (n = 10) or a TIA (n = 10). Relative power of delta, theta, alpha, and beta EEG frequency bands were extracted for comparison between the 2 clinical groups and an existing normative sample of 10 healthy, age-, gender-, and education-matched older adults. Results. Analysis of variance with post hoc testing identified pronounced delta activity in stroke patients, while alpha and beta power were elevated in TIA patients. Both patient groups exhibited attenuated theta activity compared with healthy controls. Receiver operating characteristic curve analysis identified thresholds for each EEG frequency capable of distinguishing the 3 participant groups. Conclusions. TIA, ischemic stroke, and healthy aging are each associated with distinct electrophysiological profiles. These preliminary findings suggest that acute EEG may be helpful in elucidating the pathophysiology and reversibility of TIA symptoms, and further exploration of the value of this unique functional brain data is encouraged.

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