Background/Aims: Cognitive impairment is frequent in cerebrovascular disease but often remains undetected. The Montreal Cognitive Assessment (MoCA) has been proposed in this context. Our aim was to evaluate the MoCA and its subtests in cerebrovascular disease. Methods: We assessed 386 consecutive patients with minor stroke (National Institutes of Health Stroke Score <4) or transient ischemic attack at 3 months. The MoCA and the modified Rankin Scale (mRS) were administered. Computed tomography (CT) scans were assessed for stroke and white matter changes. An unfavorable functional outcome was defined as mRS >1. Results: The prevalence of cognitive impairment (cutoff of 26) was 55% using the MoCA and 13% using the MMSE. In a multivariate analysis, MoCA <26 was associated with the outcome (OR 3.00, CI 1.78-5.03), as were remote lacunar stroke on CT and white matter changes of at least moderate severity. Five subtests (5-word recall, word list generation, trail-making, abstract reasoning and cube copy) formed an optimal short MoCA with 6/10 or less showing a sensitivity of 91% and a specificity of 83%. Conclusion: This study extends the utility of the MoCA to milder forms of cerebrovascular disease. The MoCA is associated with the 3-month functional outcome. Five subtests may constitute an optimal brief tool in vascular cognitive impairment.

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Several epidemiological studies have demonstrated an association between hypocholesterolemia and the incidence of intracerebral hemorrhage (ICH).1-3 HMG-CoA reductase inhibitors (statin) may theoretically increase the risk of cerebral hemorrhage, given its cholesterol-lowering effect. In addition, statins have been associated with decreased platelet function via direct influence on platelet membrane and inhibition of PAR-1, which is a cell-bound protein that links platelet activation. [4][5][6] An exploratory analysis of the Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) trial found that statins overall effect included an increase in the number of treated patients having hemorrhagic stroke (n 55 for active treatment vs n 33 for placebo) with an unadjusted HR 1.68. 7 The Heart Protection Study (HPS) earlier described this ABSTRACT: Background: Some studies have suggested an association between hypocholesterolemia and intracerebral hemorrhage (ICH). In the SPARCL trial, statin use increased ICH risk. We tested the hypothesis that use of statins affects the volume of spontaneous ICH and contributes to the progression of ICH volume between baseline and follow-up CT scans. Methods: Consecutive cases of spontaneous ICH were reviewed. Secondary causes were excluded. We measured ICH volume on the baseline and follow-up CT scans using the AxBxC/2 method. Multivariate analysis and logistic regression modeling were used. The primary outcome was the ICH volume on the baseline CT scan. Secondary outcomes included volume variation between the baseline and the first follow up CT scans and death. Results: Of 303 subjects, 71 were taking a statin at the time of the ICH (23%). Statin users were significantly more likely to be younger, to have co-morbidities and take anticoagulant or anti-platelet medication. They also had a higher baseline ICH volume than non-statin users (median 31.

Our results suggest that treatment with nondextran IV iron may benefit a wide variety of patients. Randomized controlled studies are definitively needed to further evaluate the usefulness and safety of IV iron.