Background and Purpose The NINDS-CSN vascular cognitive impairment (VCI) Harmonization working group proposed a brief cognitive protocol for screening of VCI. We investigated the validity, reliability and feasibility of the Montreal Cognitive Assessment 5-minute protocol (MoCA 5-min protocol) administered over the telephone. Methods Four items examining attention, verbal learning and memory, executive functions/language and orientation were extracted from the MoCA to form the MoCA 5-min protocol. One hundred and four patients with stroke or TIA, including 53 with normal cognition (CDR 0) and 51 with cognitive impairment (CDR 0.5 or 1), were administered the MoCA in clinic and a month later, the MoCA 5-min protocol over the telephone. Results Administration of the MoCA 5-min protocol took five minutes over the telephone. Total score of the MoCA 5-min protocol correlated negatively with age (r=-0.36, p<0.001) and positively with years of education (r=0.41, p<0.001) but not with gender (rho=0.03, p=0.773). Total scores of the MoCA and MoCA 5-min protocol were highly correlated (r=0.87, p<0.001). The MoCA 5-min protocol performed equally well as the MoCA in differentiating patients with cognitive impairment from those without (AUC for MoCA 5-min protocol=0.78; MoCA=0.74, p>0.05 for difference; Cohen's d for group difference 0.801.13). It differentiated cognitively impaired patients with executive domain impairment from those without (AUC=0.89, p<0.001; Cohen's d=1.7 for group difference). 30-day test-retest reliability was excellent (Intraclass correlation coefficient=0.89). Conclusions The MoCA 5-min protocol is a free, valid and reliable cognitive screen for stroke and TIA. It is brief and highly feasible for telephone administration.

Conventional single cutoff scores are associated with substantially high rates of misclassification especially in older and less-educated patients with stroke. These results caution against the use of one-size-fits-all cutoffs on the MoCA.

This study examined the validity and reliability of the Neuropsychiatric Inventory Questionnaire version (NPI-Q), a proxy-reported format of the interview-based NPI, in assessing neuropsychiatric symptoms in 173 patients with stroke or transient ischemic attack (TIA) having cognitive impairment. The NPI-Q was validated against the NPI as a gold standard. Informants took approximately 7 minutes to complete the NPI-Q. Bland-Altman analysis revealed a bias of 0.7 points, with 95% limits of agreement between -8.6 and 10.0 between the total symptom scores of the NPI and NPI-Q. The NPI-Q correlated significantly with the NPI in individual and total symptom scores and caregiver distress scores. In predicting presence of symptoms on the NPI, the NPI-Q yielded, on average, sensitivity of 74.1% and specificity of 79.5%. On the NPI-Q, informants tended to overreport symptoms in patients with less severe symptoms but underreport with increasing symptom severity. Internal consistency of the NPI-Q was acceptable (Cronbach's α = 0.756). One-week test-retest reliability of the NPI-Q was excellent (intraclass correlation coefficient = .990). The NPI-Q is a valid and reliable instrument for screening neuropsychiatric symptoms in patients with stroke and TIA.

BackgroundLeisure activity participation has been shown to lower risks of cognitive decline in non-stroke populations. However, effects of leisure activities participation upon cognitive functions and risk of dementia after stroke are unclear. The purpose of this study is to examine the effects of recent past leisure activities participation upon cognitive functions and risk of incident dementia after stroke.MethodsHospital-based, retrospective cohort study. 88 of 1,013 patients with stroke or TIA having no prestroke dementia were diagnosed to have incident poststroke dementia (PSD) 3–6 months after stroke. Regular participation (≥3 times per week) in intellectual, recreational, social and physical activities over the year before the index stroke was retrospectively recorded at 3–6 months after stroke.ResultsLogistic regression analyses showed that regular participation in intellectual (RR 0.36, 95%CI 0.20–0.63) and stretching & toning physical exercise (0.37, 0.21–0.64) was significantly associated with a reduced risk of PSD after controlling for age, education, prestroke cognitive decline, stroke subtype, prior strokes and chronic brain changes including white matter changes, old infarcts and global atrophy. Results were similar in patients with past strokes in unadjusted models. Participation in increased number of activities in general (r = 0.41, p<0.01) and in intellectual (r = 0.40, p<0.01), recreational (r = 0.24, p<0.01), strenuous aerobic (r = 0.23, p<0.01) and mind-body (r = 0.10, p<0.01) activities was associated with higher poststroke Mini-mental State Examination scores in models adjusted for prestroke cognitive decline.ConclusionsRegular participation in intellectual activities and stretching & toning exercise was associated with a significantly reduced short-term risk of PSD in patients with and without recurrent strokes. Participation in greater number of recent past leisure activities was associated with better poststroke cognitive performance. Findings of this retrospective cohort study call for studies of activity intervention for prevention of cognitive decline in individuals at elevated risk of stroke.

BackgroundThe objectives of this study are 1) to examine the frequencies of neuropsychiatric symptom clusters in patients with stroke or transient ischemic attack (TIA) by cognitive level and stroke subtype; and 2) to evaluate effect of demographic, clinical, and neuroimaging measures of chronic brain changes and amyloid upon neuropsychiatric symptom clusters.MethodsHospital-based, cross-sectional study. 518 patients were administered the Neuropsychiatric Inventory (NPI) 3–6 months post index admission. NPI symptoms were classified into four symptom clusters (Behavioral Problems, Psychosis, Mood Disturbance & Euphoria) derived from a confirmatory factor analysis of the 12 NPI items. Multivariable logistic regression was used to determine independent associations between demographic, clinical and neuroimaging measures of chronic brain changes (white matter changes, old infarcts, whole brain atrophy, medial temporal lobe atrophy [MTLA] and frontal lobe atrophy [FLA]) with the presence of NPI symptoms and all symptom clusters except euphoria. 11C-Pittsburg Compound B Positron Emission Tomography (11C-PiB PET) was performed in 24 patients to measure amyloid retention for Alzheimer’s Disease (AD) pathology.Results50.6% of the whole sample, including 28.7% cognitively normal and 66.7% of patients with mild cognitive symptoms, had ≥1 NPI symptoms. Frequencies of symptom clusters were largely similar between stroke subtypes. Compared to patients with cardioembolic stroke and intracranial haemorrhage, those with TIA had less frequent mood disturbance. Stroke severity at admission and MTLA were the most robust correlates of symptoms. FLA was associated with behavioral problems cluster only. Frequency of symptom clusters did not differ between patients with and without significant amyloid retention.ConclusionFrequency of neuropsychiatric symptoms increased with level of cognitive impairment but was largely similar between stroke subtypes. Stroke severity and MTLA were associated with neuropsychiatric symptoms. AD pathology appeared to be unrelated to neuropsychiatric manifestations but further studies with larger sample size are required to substantiate this finding.

The complex activities of the mitochondrial oxidative phosphorylation chain in muscle were depressed selectively with energy deprivation when compared with normally fed rats. These findings may partly explain the mechanism of reduced muscle energetics in energy malnutrition.

cognitive assessment was effective in screening for delirium in this setting. Data collection is ongoing, with follow up and confirmation of dementia diagnoses due to be completed in May 2016. Further analysis on completion of the study and evaluation of the IDEA brief cognitive assessment against DSM-V diagnosis of delirium by a specialist are awaited.Background: To examine the effects of recent past leisure activities participation upon cognitive functions and risk of incident dementia after stroke. Methods: In the Stroke Registry Investigating Cognitive Decline (STRIDE) study, 88 of 1,013 patients with stroke or transient ischemic attack (TIA) having no prestroke dementia were diagnosed to have incident poststroke dementia (PSD) 3-6 months after the index event. Regular participation was defined as participation of 30 minutes within 24 hours for 3 times a week in intellectual, recreational, social and physical activities over the year before the index event. Results: Logistic regression analyses showed that regular participation in intellectual (RR 0.36, 95%CI 0.20-0.63) and stretching & toning physical exercise (0.37, 0.21-0.64) was significantly associated with a reduced risk of PSD after controlling for age, education, prestroke cognitive decline, stroke subtype, prior strokes and chronic brain changes including white matter changes, old infarcts and global atrophy. Results were similar in patients with past strokes in unadjusted models. Participation in increased number of activities in general (r¼0.41, p<0.01) and in intellectual (r¼0.40, p<0.01), recreational (r¼0.24, p<0.01), strenuous aerobic (r¼0.23, p<0.01) and mind-body (r¼0.10, p<0.01) activities was associated with higher Mini-mental State Examination scores poststroke in models adjusted for prestroke cognitive decline. Conclusions: Regular participation in intellectual activities and stretching & toning exercise was associated with a significantly reduced short-term risk of PSD in stroke or TIA patients with and without prior strokes. Participation in greater number of recent past leisure activities was associated with better poststroke cognitive performance.

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