Evaluation of cognitive impairment by the Montreal Cognitive Assessment in patients with aneurysmal subarachnoid haemorrhage: prevalence, risk factors and correlations with 3 month outcomes

Wong, George Kwok Chu; Lam, S.S.; Ngai, Karine; Wong, Adrian; Mok, Vincent; Poon, Wai Sang; Investigators, Cognitive Dysfunction after Aneurysmal Subarachnoid Haemorrhage

doi:10.1136/jnnp-2012-302217

Cited by 93 publications

(77 citation statements)

References 33 publications

(32 reference statements)

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“…28 Two studies compared MoCA and MMSE 3 to 6 months after aneurysmal subarachnoid hemorrhage. 29,30 MoCA was more sensitive than MMSE in detecting PSCI in patients who had returned to work, and, unlike MMSE, correlated with performances on a comprehensive neuropsychological battery and with the functional outcome (Glasgow Outcome Scale). 29 Wong et al 30 examined the ability of MoCA and MMSE to differentiate favorable functional outcome (modified Rankin Scale, 0-2) and Instrumental Activities in Daily Living score in patients with postaneurysmal subarachnoid hemorrhage and found similar accuracy for both tests at their optimal cutoff values.…”

Section: Use Of Moca In the Chronic Poststroke Phasementioning

confidence: 99%

“…11 Similarly, Lees et al, 33 using the original cut-off of 26, diagnosed cognitive impairments in 86% of acute stroke unit patients; the proportion decreased to 49% if the cut-off was decreased to 20. Most studies found that the cut-off of 26, suggested by Nasreddine et al 5 to detect MCI in a memory clinic, is inadequate for the stroke setting. The optimal values for normality range from 19 to 22 in studies in which MoCA was administered in the acute stroke phase, 11,12,17,20 and from 20 to 27 in studies in which the test was administered in the chronic phase, 24,27,28,30,[34][35][36] once performances were compared with those on extensive batteries at follow-up.…”

Section: Use Of Moca In the Chronic Poststroke Phasementioning

confidence: 99%

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Use of Montreal Cognitive Assessment in Patients With Stroke

Chiti

Pantoni

2014

Stroke

125

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Section: Use Of Moca In the Chronic Poststroke Phasementioning

confidence: 99%

Section: Use Of Moca In the Chronic Poststroke Phasementioning

confidence: 99%

Use of Montreal Cognitive Assessment in Patients With Stroke

Chiti

Pantoni

2014

Stroke

125

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“…23,24 These activities were modulated via effects on geranylated proteins. 23 Our results related to simvastatin doses and hence to serum simvastatin concentrations that corresponded to the low proangiogenic doses in experimental studies. One shortcoming was that we did not measure serum simvastatin concentrations to compare outcomes with the concentrations achieved.…”

Section: Discussionmentioning

confidence: 99%

“…Мы разделили пациентов на группы высокой и низ-кой дозы в соответствии с диапазоном клинических доз, но лечение симвастатином в таких дозах соответс-твовало эффективной концентрации, способствующей пролиферации эндотелиальных клеток, миграции их и дифференцировки в экспериментальных исследо-ваниях двухфазных эффектов низких доз [23,24]. Эти эффекты подвергались модуляции посредством воздействия на геранилированные протеины [23].…”

Section: ■ обсуждениеunclassified

High-Dose Simvastatin for Aneurysmal Subarachnoid Hemorrhage

Wong

Chan

Siu

et al. 2015

Stroke

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A lthough aneurysmal subarachnoid hemorrhage (SAH) accounts for only 3% to 5% of strokes, its profound consequences and unique window of intervention justify its classification as a separate entity.1 Early aneurysm occlusion, expert endovascular neurosurgery and microsurgery, and the use of oral nimodipine and neurointensive care are now standard treatment procedures. 2,3 Nevertheless, aneurysmal SAH is still associated with mortality after 1 month for half of all patients, whereas another quarter is left with disabilities. 1 After aneurysmal SAH, 18% to 56% of patients demonstrate the evidence of secondary ischemia with clinical deterioration, which is also known as delayed ischemic deficit (DID). 4,5 The time lag of 3 to 10 days is unique and offers the potential to intervene before clinical deterioration. Pathologically, the basal subarachnoid distribution of deoxyhemoglobin and early hypoxic-ischemic brain injury contribute to the diffuse distribution of complex biological processes that involve endothelial cells. 6,7 Statin improves endothelial vasomotor function; increases nitric oxide bioavailability; possesses antioxidant properties; counters thrombus formation; induces angiogenesis, endogenous cell proliferation, and neurogenesis; increases the synaptic protein synaptophysin; induces vascular stabilization and neuroblast migration; and suppresses cytokine responses during cerebral ischemia. [7][8][9][10][11][12] Experimental evidence also indicates the benefit of simvastatin in the treatment of aneurysmal SAH. 13 Three randomized placebo-controlled pilot trials have supported the use of statins (2 with 80 mg of simvastatin and 1 with 40 mg of pravastatin) for the treatment of aneurysmal SAH. [14][15][16] In the Duke University Medical Center study, clinical vasospasm was significantly reduced from 60% to 26% by simvastatin treatment (80 mg daily).14 In the Massachusetts General Hospital study, vasospasm-related ischemic infarct was reduced from 25% to 11% by simvastatin treatment (80 mg daily). 16Background and Purpose-Experimental evidence has indicated the benefits of simvastatin for the treatment of subarachnoid hemorrhage. Two randomized placebo-controlled pilot trials that used the highest clinically approved dose of simvastatin (80 mg daily) gave positive results despite the fact that a lower dose of simvastatin (40 mg daily) did not improve clinical outcomes. We hypothesized that a high dose of 80 mg of simvastatin daily for 3 weeks would reduce the incidence of delayed ischemic deficits after subarachnoid hemorrhage compared with a lower dose (40 mg of simvastatin daily) and lead to improved clinical outcomes. Methods-The study design was a randomized controlled double-blinded clinical trial. Patients with aneurysmal subarachnoid hemorrhage (presenting within 96 hours of the ictus) from 6 neurosurgical centers were recruited for 3 years. The primary outcome measure was the presence of delayed ischemic deficits, and secondary outcome measures included a modified Rankin disability score ...

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“…A score between 22-26 points suggests a mild cognitive dysfunction, while a score below 22 points, around the average of 16 may indicate a severe cognitive dysfunction, phenomenom of Alzheimer dementia type [5][6][7][8][9].…”

Section: Patient Managementmentioning

confidence: 99%

Evaluation of Early Postoperative Cognitive Dysfunction Incidence and Involved Neurocognitive Functions in Patients with Cardiac and Noncardiac Surgery Under General Anesthesia

Sircuța

Lucza²,

Mihaly

et al. 2017

Acta Medica Marisiensis

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Objective: To analyse postoperative cognitive dysfunction's (POCD) incidence and cognitive areas involved, in patients with cardiac and general surgery. Material and Methods: Prospective observational study on 130 patients undergoing general or heart surgery on cardiopulmonary bypass, under general anesthesia. Two groups, 65 members each. Group A had a heart surgery and group B a noncardiac surgery. The same type of anesthetic drugs were used. All patients completed the Montreal Cognitive Assesment (MoCA) questionnaire: preoperative, 24 hours after stopping any medicine acting on central nervous system and 7 days postoperative. We compared the MoCA scores obtained on different cognitive domains in this moments for each group of patients, for neurocognitive functions: visuo-spatial executive, naming, attention, verbal fluency, abstraction, recall, orientation, final score. We compared the scores between the two groups at 24 hours and 7 days postoperatively for the same domains. Results: POCD was found at 24 hours testing in both groups. At 7 days postoperatively POCD was not found in any of the groups. There was no statistically significant difference in total final score between two groups at 24 hours nor at 7 days postoperative testing. There are significant differences between the two groups, with lower score in cardiac group in 5 of 7 fields at 24 hours testing, with the persistence of difference in 2 of 7 fields at 7 days. Conclusions: Overall POCD was present at 24 hours but was not found at 7 days testing for none of the groups. POCD is present in some neurocognitive domains and this depends on surgery type.

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Evaluation of cognitive impairment by the Montreal Cognitive Assessment in patients with aneurysmal subarachnoid haemorrhage: prevalence, risk factors and correlations with 3 month outcomes

Abstract: MoCA defined cognitive impairment was common at 3 months after aSAH and MoCA correlated with functional outcomes similar, but not superior, to the MMSE. The study is registered at ClinicalTrials.gov of the US National Institutes of Health (NCT01038193).

Cited by 93 publications

References 33 publications

Use of Montreal Cognitive Assessment in Patients With Stroke

Use of Montreal Cognitive Assessment in Patients With Stroke

High-Dose Simvastatin for Aneurysmal Subarachnoid Hemorrhage

Evaluation of Early Postoperative Cognitive Dysfunction Incidence and Involved Neurocognitive Functions in Patients with Cardiac and Noncardiac Surgery Under General Anesthesia

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