scholarly journals Neuropsychology in Multidisciplinary Stroke Care: Clinical Feasibility of the NINDS-CSN Vascular Cognitive Impairment Harmonization Standards

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Dong Y. Han ◽  
Amelia J. Anderson ◽  
Jana E. Jones ◽  
Bruce P. Hermann ◽  
Justin A. Sattin
Keyword(s):  
Patient Satisfaction ◽  
Cognitive Impairment ◽  
Neuropsychological Testing ◽  
Stroke Care ◽  
Vascular Cognitive Impairment ◽  
Turnaround Time ◽  
Cognitive Assessments ◽  
Provider Satisfaction ◽  
Assessment Protocol ◽  
Neuropsychological Assessments

As a significant number of stroke victims exhibit cognitive impairment, neuropsychological assessments can enhance poststroke management by identifying pertinent cognitive sequelae and providing salient care recommendations. However, due to operational differences between traditional neuropsychology and stroke services, neuropsychological assessments often remain underutilized in stroke care. We developed a novel care model that incorporated neuropsychological testing into a comprehensive stroke program using the modified vascular cognitive impairment (VCI) half-hour assessment protocol proposed by the National Institute of Neurological Disorders and Stroke—Canadian Stroke Network (NINDS-CSN). The test batteries were administered during the patients’ acute admissions and then again upon follow-up in the multidisciplinary stroke clinic. Patient and provider satisfaction was then evaluated. Surveys revealed high provider satisfaction with improved clinic efficacy, improved data turnaround time, and with value neuropsychology services added to the comprehensive stroke program. Results from the 18-item industry standard Press-Ganey surveys showed all scores above 4.4/5.0 for patient satisfaction. This clinic garnered high provider and patient satisfaction after the first year. The (modified) NINDS-CSN VCI assessment protocol demonstrated clinical feasibility, suggestive of an efficient method of providing focused neuropsychological services in a clinical setting that otherwise prohibits traditional, comprehensive cognitive assessments.

IC-P-036: MRI validation of the NINDS-CSN proposed neuropsychological assessment protocol for vascular cognitive impairment

2009 ◽  
Vol 5 (4S_Part_1) ◽  
pp. P19-P19
Author(s):  
Christopher M. Murphy ◽  
Joe Zhou ◽  
Simon J. Graham ◽  
Nancy J. Lobaugh ◽  
Novena Rangwala ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Neuropsychological Assessment ◽  
Vascular Cognitive Impairment ◽  
Assessment Protocol

scholarly journals Progression in Vascular Cognitive Impairment: Pathogenesis, Neuroimaging Evaluation, and Treatment

2018 ◽  
Vol 28 (1) ◽  
pp. 18-25 ◽  
Author(s):  
Xin Zhang ◽  
Jiabin Su ◽  
Chao Gao ◽  
Wei Ni ◽  
Xinjie Gao ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Functional Neuroimaging ◽  
Neuropsychological Testing ◽  
Vascular Cognitive Impairment ◽  
Neurological Rehabilitation ◽  
Vessel Occlusion ◽  
Cerebral Vascular Disease ◽  
Clinical Evaluations ◽  
Neurologic Disorders ◽  
Neurological Protection

Vascular cognitive impairment (VCI) defines an entire spectrum of neurologic disorders from mild cognitive impairment to dementia caused by cerebral vascular disease. The pathogenesis of VCI includes ischemic factors (e.g., large vessel occlusion and small vessel dysfunction); hemorrhagic factors (e.g., intracerebral hemorrhage and subarachnoid hemorrhage); and other factors (combined with Alzheimer’s disease). Clinical evaluations of VCI mainly refer to neuropsychological testing and imaging assessments, including structural and functional neuroimaging, with different advantages. At present, the main treatment for VCI focuses on neurological protection, cerebral blood flow reconstruction, and neurological rehabilitation, such as pharmacological treatment, revascularization, and cognitive training. In this review, we discuss the pathogenesis, neuroimaging evaluation, and treatment of VCI.

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 Vascular cognitive impairment in Pemphigus vulgaris: a case report

2012 ◽  
Vol 6 (3) ◽  
pp. 192-195
Author(s):  
José Ibiapina Siqueira- Neto ◽  
Paulo Marcelo Gondim Sales ◽  
Emmanuelle Silva Tavares Sobreira ◽  
Aline Miranda Limeira ◽  
Heline Bessa Araujo ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Executive Function ◽  
Case Report ◽  
Magnetic Resonance ◽  
Medical Condition ◽  
Neuropsychological Testing ◽  
Pemphigus Vulgaris ◽  
Vascular Cognitive Impairment ◽  
Immunomodulatory Therapy ◽  
Histopathologic Diagnosis

ABSTRACT Pemphigus vulgaris is a systemic auto-immune medical condition that mainly manifests with changes in skin and vasculopathy. This is a case report of a 69-year-old male with confirmed histopathologic diagnosis of Pemphigus vulgaris presenting ulterior Cognitive Impairment, mostly in executive function. The patient was treated using steroids, immunomodulatory therapy, fluoxetine and galantamine. Neuropsychological testing and magnetic resonance (MRI) were performed. This is the first report of correlational cognitive impairment with Pemphigus vulgaris in the literature. Physicians should be aware of vascular causes for cognitive impairment in patients presenting auto-immune conditions.

scholarly journals The Missing Link in the Pathophysiology of Vascular Cognitive Impairment: Design of the Heart-Brain Study

2017 ◽  
Vol 7 (3) ◽  
pp. 140-152 ◽  
Author(s):  
Astrid M. Hooghiemstra ◽  
Anne Suzanne Bertens ◽  
Anna E. Leeuwis ◽  
Esther E. Bron ◽  
Michiel L. Bots ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Neuropsychological Testing ◽  
Brain Mri ◽  
Vascular Cognitive Impairment ◽  
Imaging Data ◽  
Hemodynamic Changes ◽  
Hemodynamic Status ◽  
The Brain ◽  
Brain Study

Background: Hemodynamic balance in the heart-brain axis is increasingly recognized as a crucial factor in maintaining functional and structural integrity of the brain and thereby cognitive functioning. Patients with heart failure (HF), carotid occlusive disease (COD), and vascular cognitive impairment (VCI) present themselves with complaints attributed to specific parts of the heart-brain axis, but hemodynamic changes often go beyond the part of the axis for which they primarily seek medical advice. The Heart-Brain Study hypothesizes that the hemodynamic status of the heart and the brain is an important but underestimated cause of VCI. We investigate this by studying to what extent hemodynamic changes contribute to VCI and what the mechanisms involved are. Here, we provide an overview of the design and protocol. Methods: The Heart-Brain Study is a multicenter cohort study with a follow-up measurement after 2 years among 645 participants (175 VCI, 175 COD, 175 HF, and 120 controls). Enrollment criteria are the following: 1 of the 3 diseases diagnosed according to current guidelines, age ≥50 years, no magnetic resonance contraindications, ability to undergo cognitive testing, and independence in daily life. A core clinical dataset is collected including sociodemographic factors, cardiovascular risk factors, detailed neurologic, cardiac, and medical history, medication, and a physical examination. In addition, we perform standardized neuropsychological testing, cardiac, vascular and brain MRI, and blood sampling. In subsets of participants we assess Alz­heimer biomarkers in cerebrospinal fluid, and assess echocardiography and 24-hour blood pressure monitoring. Follow-up measurements after 2 years include neuropsychological testing, brain MRI, and blood samples for all participants. We use centralized state-of-the-art storage platforms for clinical and imaging data. Imaging data are processed centrally with automated standardized pipelines. Results and Conclusions: The Heart-Brain Study investigates relationships between (cardio-)vascular factors, the hemodynamic status of the heart and the brain, and cognitive impairment. By studying the complete heart-brain axis in patient groups that represent components of this axis, we have the opportunity to assess a combination of clinical and subclinical manifestations of disorders of the heart, vascular system and brain, with hemodynamic status as a possible binding factor.

A Conceptual Framework for Research on Cognitive Impairment with no Dementia in Memory Clinic

2020 ◽  
Vol 17 (6) ◽  
pp. 517-525
Author(s):  
Lin Huang ◽  
Keliang Chen ◽  
Zhao Liu ◽  
Qihao Guo
Keyword(s):  
Cognitive Impairment ◽  
Diagnostic Methods ◽  
Diagnostic Process ◽  
Memory Clinic ◽  
Cognitive Assessments ◽  
Cognitively Normal ◽  
Diagnostic Strategies ◽  
Clinical Support ◽  
Neuropsychological Assessments ◽  
Definition Of

Background: Identifying and classifying individuals with Cognitive Impairment-No Dementia (CIND) has further challenged diagnostic methods, since varying the cutoffs for objective impairment as well as the neuropsychological tests considered can significantly affect diagnosis. Therefore, we investigated the applicability of an actuarial neuropsychological approach for clinical subdivision of CIND and quantified the variability in diagnostic outcomes that results from diverse neuropsychologically derived definition of objective cognitive impairment. Methods: 1459 non-demented, clinic-based individuals were recruited from a monocentric memory clinic from 1/1/2016/ to 1/1/2018 and classified as Cognitively Normal (NC), Slight Cognitive Symptom (SCS), SSubtle Cognitive Decline (SCD) or Mild Cognitive Impairment (MCI) via different diagnostic strategies, which varied the composition of objective cognitive assessments involved in the diagnostic process. Results: We compared two methods of criteria proposed by Jak/Bondi and Petersen/Winblad to classify individuals with CIND. A substantial range of differences in the percentages recognized as NC, SCS, SCD, and MCI was presented, depending on the classification criteria adopted. Our data revealed that the application of a set of six neuropsychological scores dividing CIND into 4 subgroups (NC, SCS, SCD, and MCI) was able to classify all non-demented individuals without overlap or omission. Conclusion: Our study provided clinical support for an operational framework of the CIND classification system and underlined the value of applying comprehensive neuropsychological assessments for definition. The concept of SCS, considered appropriate for a preclinical stage, was proposed as the symptomatic definition for early intervention.

Cognitive Impairment in Patients with Stroke

2021 ◽  
Author(s):  
Caitlin E. D'Souza ◽  
Melanie R. F. Greenway ◽  
Jonathan Graff-Radford ◽  
James F. Meschia
Keyword(s):  
Cognitive Impairment ◽  
Cognitive Rehabilitation ◽  
Recurrent Stroke ◽  
Stroke Care ◽  
Vascular Cognitive Impairment ◽  
Vascular Risk ◽  
Stroke Treatment ◽  
Incident Dementia ◽  
Active Research ◽  
Pharmacologic Treatments

AbstractDespite substantial advances in stroke care, vascular cognitive impairment remains a prominent source of disability. Unlike sensorimotor impairments, cognition often continues to decline after stroke. An aging population will increase the prevalence of vascular cognitive impairment, with stroke playing an important role. Ten percent of patients presenting with stroke have pre-stroke dementia; an additional 10% will develop incident dementia with a first stroke, and 30% with a recurrent stroke. While stroke increases the risk of cognitive impairment, the presence of cognitive impairment also impacts acute stroke treatment and increases risk of poor outcome by nearly twofold. There is substantial overlap in the clinical and pathological aspects of vascular and degenerative dementias in many patients. How they relate to one another is controversial. The treatment of vascular cognitive impairment remains supportive, focusing on treating vascular risk factors. Cognitive rehabilitation after stroke is an area of active research, and existing pharmacologic treatments have limited benefit. Heightened awareness of cognitive impairment in the setting of stroke is imperative for prognostication and management, impetus for research and, ultimately, the discovery of efficacious treatments.

P1-081: MRI validation of the NINDS-CSN proposed neuropsychological assessment protocol for vascular cognitive impairment

2009 ◽  
Vol 5 (4S_Part_7) ◽  
pp. P196-P196
Author(s):  
Christopher M. Murphy ◽  
Joe Zhou ◽  
Simon J. Graham ◽  
Nancy J. Lobaugh ◽  
Novena Rangwala ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Neuropsychological Assessment ◽  
Vascular Cognitive Impairment ◽  
Assessment Protocol
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