Post-stroke cognitive impairment: screening with MMSE and MoCA and predictors of their persistence after treatment at the Stroke Center

2021 ◽  
Author(s):  
Y. V. Flomin ◽  
V. G. Gurianov ◽  
L. I. Sokolova
Keyword(s):  
Cognitive Impairment ◽  
Mmse Score ◽  
Cerebral Arteries ◽  
High Rate ◽  
Cerebral Stroke ◽  
Time Interval ◽  
Post Stroke ◽  
Lower Baseline ◽  
Stroke Center ◽  
Moca Score

Objective — to analyze the results of screening for post‑stroke cognitive impairment (PCI) in patients with cerebral stroke (CS) admitted to the Stroke Center (SC) in different disease phases, and to determine independent predictors of the PCI persistence at discharge. Methods and subjects. 399 patients were enrolled, including 242 (60.7 %) men and 157 (39.3 %) women with the median age was 66.2 years (IQR 58.5 — 76.3). IS was diagnosed in 331 (82.9 %), and ICH in 68 (17.1 %) patients. Among patients with IS, 137 (41.4 %) had an atherothrombotic subtype, 152 (46.0 %) had a cardioembolic subtype, 21 (6.3 %) had a lacunar subtype, another 21 (6.3 %) had another or unknown cause of stroke. Patients were screened for PCI using the Mini‑Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) on admission and at discharge. Participants with MMSE score of 0 — 24 or a MoCA score of 0 — 25 were considered having PCI. Upon admission, all patients were assessed using the National Institutes of Health Stroke Scale (NIHSS), Bartel Index, and Modified Rankine Scale (mRS). The method of constructing and analyzing logistic regression models was used to determine independent predictors of the preservation of PCI at discharge. The analysis was carried out using the MedCalc v. 19.1. Results. The baseline NIHSS score ranged from 0 to 39 (median 11, IQR 6 — 18). The majority (64.2 %) of the subjects were hospitalized within the first 30 days from the CS onset. The MMSE score on admission ranged from 0 to 30 (median 20, IQR 2 — 27), and in 179 (44.9 %) of the patients the initial score was 0 to 17 (severe PCI), whereas in 61 (15 3 %) of the participants it was 18 to 24 (moderately severe PCI) and only 159 (39.8 %) persons scored 25 to 30 (no PCI). The baseline MoCA score ranged from 0 to 30 (median 15, IQR 1 — 24), and 356 (89.2 %) patients were shown to have PCI (score 0 to 25). According to screening with MMSE at discharge, 125 (31.4 %) patients had severe PCI, and 67 (16.8 %) had moderately severe PCI. The MoCA assessment before discharge indicated PCI in 324 (81.2 %) patients. According to both MMSE and MoCA, the rate of PCI on admission was significantly higher than at discharge (p < 0.001). Among the 240 patients who had PCI according to MMSE score, 239 (99.6 %) had PCI according to the MoCA score. However, among 159 patients who screened negative for PCI with MMSE at admission, 117 (73.6 %) screened positive with MoCA. Screening results using both MMSE and MoCA were not significantly associated with affected hemisphere. ICH was associated with lower (p < 0.0001) MMSE and MoCA scores compared with IS. Predictors of PCI according to MMSE score at discharge were a longer time interval from CS onset to SC admission, and a lower baseline MMSE score. However, with MoCA, the predictors were AT subtype IS, lesions in the distribution of the right or both middle cerebral arteries, older patient age, and a lower baseline MoCA score. Conclusions. In patients with MI, a high rate of PCI was documented on admission, but was significantly lower at discharge. In patients with established PCI, according to MMSE score, the use of MoCA for screening seems useless, however, screening with MoCA identified PCI in 3/4 in patients with a normal MMSE score. The independent predictors of scores on these two scales, indicating PCI, were significantly different, so they should not be considered interchangeable.

scholarly journals 122 Use of Pimavanserin in Patients With Parkinson’s Disease Psychosis: Subgroup Analysis of Efficacy and Safety in Patients With and Without Cognitive Impairment

CNS Spectrums ◽  
2018 ◽  
Vol 23 (1) ◽  
pp. 77-77 ◽  
Author(s):  
Daniel Weintraub ◽  
James Norton ◽  
Bruce Coate ◽  
Candace Andersson ◽  
Doral Fredericks ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Cognitive Impairment ◽  
Subgroup Analysis ◽  
Serotonin Receptor ◽  
Mmse Score ◽  
Cognitively Impaired ◽  
Efficacy And Safety ◽  
Impaired Group ◽  
Moca Score

AbstractObjectiveA planned subgroup analysis of a phase 3 study was performed to evaluate the efficacy and safety of pimavanserin (PIM) in Parkinson’s disease psychosis (PDP) patients withglobal cognitive impairment.BackgroundPDP is frequent, distressing, a leading cause of institutionalization, complicates PD management and is linked to increased morbidity, incident dementia and mortality. PIM, a selective serotonin receptor (5-HT2A) inverse agonist/antagonist, is newly FDA-approved for the treatment of hallucinations and delusions associated with PDP.MethodsIn Study 020, a 6-week FDA registration study, 199 patients with baseline Mini-Mental State Examination (MMSE) score ≥21, moderate-severe psychosis, and on stable PD meds, were randomized to PIM (34 mg/day) or placebo (PBO) for 6 weeks. This subgroup analysis evaluates efficacy and safety between two groups: those with MMSE total score ≥21 but <25 (cognitively impaired; equivalent to Montreal Cognitive Assessment [MoCA] score 15-19) and those with score ≥25 (cognitively normal; equivalent to MoCA score 20-30). Safety assessments were performed on the full safety dataset (i.e., three 6-week placebo-controlled studies) including 614 subjects (PIM=382, PBO=231).ResultsOverall, patients in the PIM group experienced a statistically significant improvement in SAPS-PD scores from baseline to Day 43 compared with PBO (-5.79 vs. -2.73; p=0.001). In the subgroup analysis stratifying by baseline MMSE score, the change from baseline to Day 43 compared with PBO in the cognitively-impaired group (N=50) was numerically larger (-7.11 vs. -0.47; p=0.002). In the full safety dataset examining cognitively impaired patients, there were no between-group (PIM vs. PBO) differences in any treatment-emergent adverse event (TEAE) (57.6% vs. 56.1%) or serious TEAE (6.8% vs. 5.3%). The most common TEAEs occurring at ≥5% in either group were fall (7.4% vs.10.5%), confusional state (6.5% vs.1.8%), and orthostatic hypotension (0.0% vs. 8.8%).ConclusionsIn this subgroup analysis of PDP patients, the treatment effect of PIM on SAPS-PD was larger in the cognitively-impaired group, with similar TEAE and serious TEAE rates. These results hold promise for cognitively-impaired patients that will be further elucidated in future studies.Funding AcknowledgementsClinical study was funded by ACADIA Pharmaceuticals Inc.

scholarly journals GAMBARAN FUNGSI KOGNITIF DENGAN INA-MoCA DAN MMSE PADA PENDERITA POST-STROKE DI POLIKLINIK SARAF BLU RSUP KANDOU MANADO NOVEMBER - DESEMBER 2014

e-CliniC ◽  
2015 ◽  
Vol 3 (3) ◽  
Author(s):  
Martinus M. Wibowo ◽  
Winifred Karema ◽  
J. Maja. P. S
Keyword(s):  
Cognitive Function ◽  
Mmse Score ◽  
High School Education ◽  
Age Group ◽  
Stroke Patients ◽  
Cross Sectional ◽  
Post Stroke ◽  
Neurology Clinic ◽  
Cross Sectional Design ◽  
Moca Score

Abstract: In stroke patients there are damages of neurons resulting in disabilities of sensoric, motoric, and cognitive functions. Evaluation of cognitive function is needed to determine the level of functional ability that is useful in management and prognosis. This study aimed to obtain the cognitive function of post-stroke patients in Neurology Clinic Prof. Dr. R. D. Kandou Hospital Manado form November-December 2014 by using INA-MoCA and MMSE. This was a descriptive study with a cross sectional design. There were 35 patients as samples. The results showed that most of the patients were males (48.57%), age group 56-65 years old (37.1%), high school education (45.7%), and ischemic type stroke (97.1%). There were 97.1% of patients with INA-MoCA score <26. Moreover, there were 91.4% of patients with normal MMSE score, 5.7% probable, and 2.9% definite.Keywords: cognitive function disturbance, INA-MoCA, MMSE, post strokeAbstrak: Pada pasien stroke terjadi kerusakan sel-sel neuron yang dapat berakibat kecacatan fungsi sensoris, motoris, maupun kognitif. Evaluasi fungsi kognitif sangat diperlukan untuk menentukan tingkat kemampuan fungsional yang berguna untuk penanganan dan prognosis. Penelitian ini bertujuan untuk mendapatkan gambaran fungsi kognitif yang diperiksa dengan INA-MoCA dan MMSE pada penderita post-stroke di poliklinik saraf BLU RSUP Prof. Dr. R. D. Kandou Manado. Penelitian ini menggunakan metode deskriptif dengan desain potong lintang. Sampel berjumlah 35 pasien dengan karakteristik populasi paling banyak laki-laki 48,57%, kategori umur 56-65 tahun 37,1%, tingkat pendidikan SMA 45,7%, tipe stroke iskemik 97,1%. Pasien dengan skor INA-MoCA <26 sejumlah 97,1%. Dengan skor MMSE terdapat 91,4% pasien Normal, 5,7% Probable, dan 2,9% Definite.Kata kunci: gangguan fungsi kognitif, INA-MoCA, MMSE, post stroke

scholarly journals Genomic Association Study for Cognitive Impairment in Parkinson's Disease

2021 ◽  
Vol 11 ◽  
Author(s):  
Kye Won Park ◽  
Sungyang Jo ◽  
Mi Sun Kim ◽  
Sang Ryong Jeon ◽  
Ho-Sung Ryu ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Cognitive Impairment ◽  
Association Study ◽  
Mmse Score ◽  
Genome Wide Association ◽  
Functional Study ◽  
Genome Wide ◽  
A Genome ◽  
Moca Score

Background: Cognitive impairment is very common in Parkinson's disease (PD) and constitutes the most debilitating complication of this disease. However, to date, few studies have investigated a genome-wide association in the development of cognitive impairment of PD. We aimed to identify the genetic loci associated with cognitive impairment in patients with sporadic PD by ethnicity-specific genotyping.Materials and methods: We recruited 1,070 patients with PD and performed a genome-wide association study using the Korean Chip, a microarray chip containing 827,400 single-nucleotide polymorphisms (SNPs) optimized for the Korean population. Multiple logistic regression models adjusting for age, sex, years of education, and disease duration were used to compare between patients with and without cognitive impairment, which was defined using the Mini-Mental Status Examination (MMSE) score (MMSE score ≥ 26 vs. &lt; 26) or the Montreal Cognitive Assessment (MoCA) score (MoCA score ≥24 vs. &lt; 24).Results:RYR2 SNP rs10495397 was most significantly associated with cognitive impairment based on the MMSE scores (OR = 3.21; 95% CI = 1.96–5.25, P = 3.36 × 10−6) and CASC17 showed the strongest association with cognitive impairment based on the MoCA scores. However, none of the SNPs were statistically significant after Bonferroni correction.Conclusion:RYR2 may play a role in cognitive impairment in PD by the pathogenic mechanism of neuroinflammation. However, more studies are needed to replicate and validate the results of our functional study.

scholarly journals Early Post-stroke Cognition: In-hospital Predictors and the Association With Functional Outcome

2020 ◽  
Vol 11 ◽  
Author(s):  
Richa Sharma ◽  
Dania Mallick ◽  
Rafael H. Llinas ◽  
Elisabeth B. Marsh
Keyword(s):  
Logistic Regression ◽  
Cognitive Impairment ◽  
Functional Status ◽  
Critical Time ◽  
Minor Stroke ◽  
Post Stroke ◽  
C Statistic ◽  
The Relationship ◽  
Moca Score

Purpose: To characterize and predict early post-stroke cognitive impairment by describing cognitive changes in stroke patients 4–8 weeks post-infarct, determining the relationship between cognitive ability and functional status at this early time point, and identifying the in-hospital risk factors associated with early dysfunction.Materials and Methods: Data were collected for 214 patients with ischemic stroke and 39 non-stroke controls. Montreal Cognitive Assessment (MoCA) exams were administered at post-hospitalization clinic visits approximately 4–8 weeks after infarct. MoCA scores were compared for patients with: no stroke, minor stroke [NIH Stroke Scale (NIHSS) &lt; 5], and major stroke. Ordinal logistic regression was performed to assess the relationship between MoCA score and functional status [modified Rankin Scale score (mRS)] at follow-up. Predictors of MoCA &lt; 26 and &lt; 19 (cutoffs for mild and severe cognitive impairment, respectively) at follow-up were identified by multivariable logistic regression using variables available during hospitalization.Results: Post stroke cognitive impairment was common, with 66.8% of patients scoring &lt; 26 on the MoCA and 22.9% &lt; 19. The average total MoCA score at follow-up was 18.7 (SD 7.0) among major strokes, 23.6 (SD 4.8) among minor strokes, and 27.2 (SD 13.0) among non-strokes (p = &lt;0.0001). The follow-up MoCA score was associated with the follow-up mRS in adjusted analysis (OR 0.69; 95% C.I. 0.59–0.82). Among patients with no prior cognitive impairment (N = 201), a lack of pre-stroke employment, admission NIHSS &gt; 6, and left-sided infarct predicted a follow-up MoCA &lt; 26 (c-statistic 0.75); while admission NIHSS &gt; 6 and infarct volume &gt; 17 cc predicted a MoCA &lt; 19 (c-statistic 0.75) at follow-up.Conclusion: Many patients experience early post-stroke cognitive dysfunction that significantly impacts function during a critical time period for decision-making regarding return to work and future independence. Dysfunction measured at 4–8 weeks can be predicted during the inpatient hospitalization. These high-risk individuals should be identified for targeted rehabilitation and counseling to improve longer-term post-stroke outcomes.

scholarly journals Soluble ST2 and Risk of Cognitive Impairment after Acute Ischemic Stroke: A Prospective Observational Study

2021 ◽  
Author(s):  
Yinwei Zhu ◽  
Chongquan Fang ◽  
Qi Zhang ◽  
Yaling Lu ◽  
Rui Zhang ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Cognitive Impairment ◽  
Acute Ischemic Stroke ◽  
Sex Education ◽  
Mmse Score ◽  
Cognitive Status ◽  
The Impact ◽  
State Examination ◽  
Moca Score ◽  
Conventional Risk Factors

Abstract Background: Soluble suppression of tumorigenesis-2 (sST2) was reported to be associated with cognitive performance and risk of incident stroke. However, the impact of sST2 on cognitive function after ischemic stroke is unclear. We aimed to assess the association of sST2 and cognitive impairment at 3 months in acute ischemic stroke patients.Methods: Baseline plasma sST2 levels were measured in 619 ischemic stroke patient (mean age: 60.0 ± 10.5 years) from 7 participating hospitals of the China Antihypertensive Trial in Acute Ischemic Stroke. Montreal Cognitive Assessment (MoCA) and Mini-Mental State Examination (MMSE) were used to assess cognitive status. Cognitive impairment was defined as a MoCA score <23 or MMSE score <27. The association between sST2 and cognitive impairment was evaluated by logistic regression analysis.Results: 325 (52.5%) or 323 (52.2%) participants developed cognitive impairment according to MoCA or MMSE. After adjustment for age, sex, education, and other covariates, the odds ratio for the highest vs lowest quartile of sST2 was 2.35 (95% CI, 1.41-3.94) and 1.77 (95% CI 1.07-2.95) risk of cognitive impairment defined by MoCA and MMSE score, respectively. Incorporation sST2 into a model containing conventional risk factors significantly improved discrimination and reclassification.Conclusions: Elevated plasma sST2 levels were significantly associated with post-stroke cognitive impairment.

scholarly journals Post-stroke cognitive impairment on the Mini-Mental State Examination primarily relates to left middle cerebral artery infarcts

2021 ◽  
pp. 174749302098455
Author(s):  
Nick A Weaver ◽  
Angelina K Kancheva ◽  
Jae-Sung Lim ◽  
J Matthijs Biesbroek ◽  
Irene MC Huenges Wajer ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Cognitive Deficits ◽  
Mini Mental State Examination ◽  
Left Middle Cerebral Artery ◽  
Post Stroke ◽  
Lesion Symptom Mapping ◽  
State Examination ◽  
Left Middle

Background Post-stroke cognitive impairment can occur after damage to various brain regions, and cognitive deficits depend on infarct location. The Mini-Mental State Examination (MMSE) is still widely used to assess post-stroke cognition, but it has been criticized for capturing only certain cognitive deficits. Along these lines, it might be hypothesized that cognitive deficits as measured with the MMSE primarily involve certain infarct locations. Aims This comprehensive lesion-symptom mapping study aimed to determine which acute infarct locations are associated with post-stroke cognitive impairment on the MMSE. Methods We examined associations between impairment on the MMSE (<5th percentile; normative data) and infarct location in 1198 patients (age 67 ± 12 years, 43% female) with acute ischemic stroke using voxel-based lesion-symptom mapping. As a frame of reference, infarct patterns associated with impairments in individual cognitive domains were determined, based on a more detailed neuropsychological assessment. Results Impairment on the MMSE was present in 420 patients (35%). Large voxel clusters in the left middle cerebral artery territory and thalamus were significantly (p < 0.01) associated with cognitive impairment on the MMSE, with highest odds ratios (>15) in the thalamus and superior temporal gyrus. In comparison, domain-specific impairments were related to various infarct patterns across both hemispheres including the left medial temporal lobe (verbal memory) and right parietal lobe (visuospatial functioning). Conclusions Our findings indicate that post-stroke cognitive impairment on the MMSE primarily relates to infarct locations in the left middle cerebral artery territory. The MMSE is apparently less sensitive to cognitive deficits that specifically relate to other locations.

Post-stroke Cognitive Impairment and Malnutrition in the Elderly (PCIME): study design and protocol

2021 ◽  
Author(s):  
Zahra Vahabi ◽  
M. Reza Azarpazhooh ◽  
Shima Raeesi ◽  
Shahram Oveisgharan ◽  
Farnaz Etesam ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Study Design ◽  
The Elderly ◽  
Post Stroke

Real-World Experience with Artificial Intelligence-Based Triage in Transferred Large Vessel Occlusion Stroke Patients

2021 ◽  
pp. 1-6
Author(s):  
Jacob R. Morey ◽  
Xiangnan Zhang ◽  
Kurt A. Yaeger ◽  
Emily Fiano ◽  
Naoum Fares Marayati ◽  
...  
Keyword(s):  
Artificial Intelligence ◽  
Clinical Outcomes ◽  
Warning System ◽  
Large Vessel ◽  
Time Interval ◽  
Large Vessel Occlusion ◽  
Time Intervals ◽  
Vessel Occlusion ◽  
Left Behind ◽  
Stroke Center

<b><i>Background and Purpose:</i></b> Randomized controlled trials have demonstrated the importance of time to endovascular therapy (EVT) in clinical outcomes in large vessel occlusion (LVO) acute ischemic stroke. Delays to treatment are particularly prevalent when patients require a transfer from hospitals without EVT capability onsite. A computer-aided triage system, Viz LVO, has the potential to streamline workflows. This platform includes an image viewer, a communication system, and an artificial intelligence (AI) algorithm that automatically identifies suspected LVO strokes on CTA imaging and rapidly triggers alerts. We hypothesize that the Viz application will decrease time-to-treatment, leading to improved clinical outcomes. <b><i>Methods:</i></b> A retrospective analysis of a prospectively maintained database was assessed for patients who presented to a stroke center currently utilizing Viz LVO and underwent EVT following transfer for LVO stroke between July 2018 and March 2020. Time intervals and clinical outcomes were compared for 55 patients divided into pre- and post-Viz cohorts. <b><i>Results:</i></b> The median initial door-to-neuroendovascular team (NT) notification time interval was significantly faster (25.0 min [IQR = 12.0] vs. 40.0 min [IQR = 61.0]; <i>p</i> = 0.01) with less variation (<i>p</i> &#x3c; 0.05) following Viz LVO implementation. The median initial door-to-skin puncture time interval was 25 min shorter in the post-Viz cohort, although this was not statistically significant (<i>p</i> = 0.15). <b><i>Conclusions:</i></b> Preliminary results have shown that Viz LVO implementation is associated with earlier, more consistent NT notification times. This application can serve as an early warning system and a failsafe to ensure that no LVO is left behind.

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