Imaging and Baseline Predictors of Cognitive Performance in Minor Ischemic Stroke and Patients With Transient Ischemic Attack at 90 Days

Mandzia, Jennifer; Smith, Eric E.; Horton, Myles; Hanly, Patrick J.; Barber, Philip A.; Godzwon, Catherine; Donaldson, Emily; Asdaghi, Negar; Patel, Shiel K.; Coutts, Shelagh B.

doi:10.1161/strokeaha.115.011507

Cited by 31 publications

(41 citation statements)

References 27 publications

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“…Our sample size calculations for the PREVENT study are inclusive of an estimated attrition rate of 20%, which is similar to drop out rates in other longitudinal studies of cerebrovascular disease and cognition [46]. Potential bias of our results through the withdrawal or death of subjects at highest risk of dementia will be mitigated by the age inclusion criteria (45–75).…”

Section: Discussionmentioning

confidence: 99%

A longitudinal magnetic resonance imaging study of neurodegenerative and small vessel disease, and clinical cognitive trajectories in non demented patients with transient ischemic attack: the PREVENT study

et al. 2018

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BackgroundLate-life cognitive decline, caused by progressive neuronal loss leading to brain atrophy years before symptoms are detected, is expected to double in Canada over the next two decades. Cognitive impairment in late life is attributed to vascular and lifestyle related risk factors in mid-life in a substantial proportion of cases (50%), thereby providing an opportunity for effective prevention of cognitive decline if incipient disease is detected earlier. Patients presenting with transient ischemic attack (TIA) commonly display some degree of cognitive impairment and are at a 4-fold increased risk of dementia. In the Predementia Neuroimaging of Transient Ischemic Attack (PREVENT) study, we will address what disease processes (i.e., Alzheimer’s vs. vascular disease) lead to neurodegeneration, brain atrophy, and cognitive decline, and whether imaging measurements of brain iron accumulation using quantitative susceptibility mapping predicts subsequent brain atrophy and cognitive decline.MethodsA total of 440 subjects will be recruited for this study with 220 healthy subjects and 220 TIA patients. Early Alzheimer’s pathology will be determined by cerebrospinal fluid samples (including tau, a marker of neuronal injury, and amyloid β1–42) and by MR measurements of iron accumulation, a marker for Alzheimer’s-related neurodegeneration. Small vessel disease will be identified by changes in white matter lesion volume. Predictors of advanced rates of cerebral and hippocampal atrophy at 1 and 3 years will include in vivo Alzheimer’s disease pathology markers, and MRI measurements of brain iron accumulation and small vessel disease. Clinical and cognitive function will be assessed annually post-baseline for a period of 5-years using a clinical questionnaire and a battery of neuropsychological tests, respectively.DiscussionThe PREVENT study expects to demonstrate that TIA patients have increased early progressive rates of cerebral brain atrophy after TIA, before cognitive decline can be clinically detected. By developing and optimizing high-level machine learning models based on clinical data, image-based (quantitative susceptibility mapping, regional brain, and white matter lesion volumes) features, and cerebrospinal fluid biomarkers, PREVENT will provide a timely opportunity to identify individuals at greatest risk of late-life cognitive decline early in the course of disease, supporting future therapeutic strategies for the promotion of healthy aging.

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Section: Discussionmentioning

confidence: 99%

A longitudinal magnetic resonance imaging study of neurodegenerative and small vessel disease, and clinical cognitive trajectories in non demented patients with transient ischemic attack: the PREVENT study

et al. 2018

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“…Previous studies, using extensive neuropsychological assessments, also showed that poststroke cognitive impairment is associated with previous stroke and poststroke disability. 28,29 In our study, the Cumulative Illness Rating Scale was used for assessing comorbidity. Many of these comorbidities can be considered as cardiovascular risk factor (eg, diabetes mellitus, hypertension, and myocardial infarction).…”

Section: Discussionmentioning

confidence: 99%

Temporal Evolution of Poststroke Cognitive Impairment Using the Montreal Cognitive Assessment

Nijsse

Visser-Meily

Mierlo

et al. 2017

Stroke

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One of these studies compared cognitively impaired stroke patients (MoCA <26) who improved by ≥2 MoCA points, called reverters, to those who did not improve by ≥2 points. Factors associated with reverter status were older age and more severe stroke symptoms at baseline. 17 Determinants ofBackground and Purpose-The Montreal Cognitive Assessment (MoCA) is nowadays recommended for the screening of poststroke cognitive impairment. However, little is known about the temporal evolution of MoCA-assessed cognition after stroke. The objective of this study was to examine the temporal pattern of overall and domain-specific cognition at 2 and 6 months after stroke using the MoCA and to identify patient groups at risk for cognitive impairment at 6 months after stroke. Methods-Prospective cohort study in which 324 patients were administered the MoCA at 2 and 6 months post stroke.Cognitive impairment was defined as MoCA<26. Differences in cognitive impairment rates between 2 and 6 months post stroke were analyzed in different subgroups. Patients with MoCA score <26 at 2 months, who improved by ≥2 points by 6 months, were defined as reverters. Logistic regression analyses were used to identify determinants of (1) cognitive impairment at 6 months post stroke and (2) reverter status. Results-Between 2 and 6 months post stroke, mean MoCA score improved from 23.7 (3.9) to 24.7 (3.5), P<0.001. Prevalence of cognitive impairment at 2 months was 66.4%, compared with 51.9% at 6 months (P<0.001). More comorbidity and presence of cognitive impairment at 2 months were significant independent predictors of cognitive impairment 6 months post stroke. No significant determinants of reverter status were identified. Conclusions-Although cognitive improvement is seen ≤6 months post stroke, long-term cognitive deficits are prevalent.Identifying patients at risk of cognitive impairment is, therefore, important as well as targeting interventions to this group.

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“…the findings shown here strengthen this hypothesis further providing case studies of ad patients where vascular insults probably linked to a local hypoxic environment appear to be highlighted by a strong deposition of mcrP and concomitant disproportionate evidence of localised neurodegenerative disease. Since the majority of patients who suffer serious stroke go on to develop cognitive decline, lower executive function, and psychomotor processing speed; and over 10% ad within 5 years (12,13), further research should study potential mechanisms linking the two conditions with a view to creating protective novel therapeutics.…”

Section: Discussionmentioning

confidence: 99%

Expression of monomeric c-reactive protein in infarcted brain tissue from patients with alzheimerÂ’s disease

Slevin¹,

Liu²,

Ferris³

et al. 2016

TJPATH

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Imaging and Baseline Predictors of Cognitive Performance in Minor Ischemic Stroke and Patients With Transient Ischemic Attack at 90 Days

Cited by 31 publications

References 27 publications

A longitudinal magnetic resonance imaging study of neurodegenerative and small vessel disease, and clinical cognitive trajectories in non demented patients with transient ischemic attack: the PREVENT study

A longitudinal magnetic resonance imaging study of neurodegenerative and small vessel disease, and clinical cognitive trajectories in non demented patients with transient ischemic attack: the PREVENT study

Temporal Evolution of Poststroke Cognitive Impairment Using the Montreal Cognitive Assessment

Expression of monomeric c-reactive protein in infarcted brain tissue from patients with alzheimerÂ’s disease

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