EEG biomarkers analysis in different cognitive impairment after stroke: an exploration study

 I hope you realize biomarkers DO ABSOLUTELY NOTHING FOR RECOVERY! And since you don't, everyone here is fired!

EEG biomarkers analysis in different cognitive impairment after stroke: an exploration study

Mengxue Xu^1†Yucheng Zhang^2†Yue Zhang³Xisong Liu^4*Kunqiang Qing^5,6*

• ¹Department of Neurology, Chongqing Public Healthy Medical Center, Chongqing, China
• ²Department of Mathematics, College of Natural Sciences, University of Texas at Austin, Austin, TX, United States
• ³Department of Psychology, School of Psychology, Shenzhen University, Shenzhen, China
• ⁴Intensive Care Unit, Chongqing Public Healthy Medical Center, Chongqing, China
• ⁵Automotive Software Innovation Center, Chongqing, China
• ⁶Research Group of Brain-Computer Interface, Brainup Institute of Science and Technology, Chongqing, China

Stroke is a cerebrovascular illness that brings about the demise of brain tissue. It is the third most prevalent cause of mortality worldwide and a significant contributor to physical impairment. Generally, stroke is triggered by blood clots obstructing the brain’s blood vessels, or when these vessels rupture. And, the cognitive impairment’s evaluation and detection after stroke is crucial research issue and significant project. Thus, the objective of this work is to explore an potential neuroimage tool and find their EEG biomarkers to evaluate and detect four cognitive impairment levels after stroke. In this study, power density spectrum (PSD), functional connectivity map, and one-way ANOVA methods were proposed to analyze the EEG biomarker differences, and the number of patient participants were thirty-two human including eight healthy control, mild, moderate, severe cognitive impairment levels, respectively. Finally, healthy control has significant PSD differences compared to mid, moderate and server cognitive impairment groups. And, the theta and alpha bands of severe cognitive impairment groups have presented consistent superior PSD power at the right frontal cortex, and the theta and beta bands of mild, moderated cognitive impairment (MoCI) groups have shown significant similar superior PSD power tendency at the parietal cortex. The significant gamma PSD power difference has presented at the left-frontal cortex in the mild cognitive impairment (MCI) groups, and severe cognitive impairment (SeCI) group has shown the significant PSD power at the gamma band of parietal cortex. At the point of functional connectivity map, the SeCI group appears to have stronger functional connectivity compared to the other groups. In conclusion, EEG biomarkers can be applied to classify different cognitive impairment groups after stroke. These findings provide a new approach for early detection and diagnosis of cognitive impairment after stroke and also for the development of new treatment options.

1 Introduction

Although the mortality rate of stroke has declined dramatically with the development of stroke research and advances in therapeutic techniques (1–4), disability from stroke continues to plague those who recover from stroke, with studies suggesting that as many as 30% of stroke patients have disability after recovery (5). This disability includes both post-stroke physical disability and post-stroke cognitive impairment (PSCI). PSCI is defined as any severity of cognitive impairment, regardless of cause, noted after an overt stroke (6, 7). This cognitive impairment involves multiple cognitive domains, with executive dysfunction being the primary and core symptom of PSCI (8–10). Depending on the severity of the cognitive impairment, PSCI can be categorized as mild, moderate, and severe. Mild PSCI consists of mild cognitive impairment that does not yet meet the diagnostic criteria for dementia. This may be manifested as memory loss, inattention, etc.; Moderate PSCI stage has more severe cognitive impairment, which may involve multiple cognitive domains, such as memory, language, and judgment. At this stage, the patient’s daily life may be significantly affected. Cognitive function is severely impaired when reaching severe PSCI, and the diagnostic criteria for dementia have been met. Patients may experience severe memory loss, language impairment, and behavioral abnormalities (11–14). Multiple studies have consistently demonstrated that individuals diagnosed with PSCI exhibit poorer rehabilitation outcomes related to physical function. Furthermore, they have a reduced likelihood of resuming a normal social life and exhibit a significantly higher mortality rate compared to those who do not have PSCI (15–18). Therefore, timely and accurate assessment of PSCI is extremely important, as it will help in the prevention and intervention of PSCI.

Currently there are two main types of assessments of the PSCI. One is questionnaire-based neuropsychological assessment, such as the Mini-mental State Examination (MMSE) and scales such as the Montreal Cognitive Assessment Scale (MoCA). However, this type of assessment is highly subjective, and the accuracy and reliability of the assessment results are more questionable. In contrast, biomarker-based assessment may be more objective, accurate and reliable. Specifically, EEG uses low-resistance electrodes placed on the human scalp to record oscillations generated by potential changes in the brain (19). EEG is a widely used non-invasive method for cognitive neurological research due to its high temporal resolution, ease of use, and low cost. A study that developed quantitative EEG (QEEG) to characterize EEG waves in post-stroke patients at risk of developing vascular dementia found that compared to normal subjects, patients with post-stroke with mild cognitive impairment had higher delta relative power, while alpha and beta relative power was lower in patients with post-stroke with mild cognitive impairment compared to normal subjects (20, 21). The study also examined the relationship between brain regions. The study also examined coherence between brain regions, with patients with post-stroke with mild cognitive impairment exhibiting lower interhemispheric and intrahemispheric coherences. Furthermore, event-related potentials (ERPs) were found to be lower in patients with mild cognitive impairment, while the relative power of alpha and beta was higher (20). ERPs derived from EEG have also been used to assess cognitive function in stroke patients. The P300 is sensitive in detecting subtle PSCI and can be used as an important marker for assessing PSCI, while P3 latency is an important marker of recovery from cognitive dysfunction after stroke (22, 23). From the perspective of the fNIRS, the PSCI group had lower intra-right and interhemispheric functional connectivity (FC) than healthy controls (HC). In the PSCI group, specific brain areas, such as the somatosensory cortex and prefrontal cortex, had considerably lower FC (24). Interestingly, neither acute ischemic stroke (AIS) patients nor the HC group showed prefrontal cortex (PFC) activation throughout the test in another study by researchers. (25). Arenth et al. found substantial changes in deoxy-Hb levels between aphasic and non-aphasic groups, but no differences between HC and non-aphasic stroke patients (26, 27). fMRI is another non-invasive neuromonitoring technique for monitoring blood oxygenation. fNIRS and fMRI are closely related, and studies have shown a significant correlation between the hemodynamic response measured by fNIRS and the blood oxygen level-dependent (BOLD) response obtained by fMRI (28). One resting-state fMRI study demonstrated that stroke affected both the lesioned and contralesional hemispheres through functional connectivity analysis of fMRI findings (29). While another study found that although both static and dynamic functional network connectivity varied in patients with PSCI, only the mean dwell time (MDT) metric in dynamic functional network analysis correlated with patients’ MMSE scores.

Despite the variety of biomarker-based monitoring methods, EEG is becoming increasingly popular in the research community and clinical practice by virtue of its low cost, high usability, and ease of setup (30–32). Due to these advantages, EEG may have higher generalizability compared to fNIRS and fMRI, and has great potential for the universal identification of PSCI. Considering that there is currently no unfied criteria for classifying the stages of PSCI, this research attempts to divide PSCI into four stages from NC to server cognitive impairment, and tries to find the differences in EEG biomarker on these four levels of impairment, which on one hand, improves the framework of dividing the symptomatic stages of PSCI, and on the other hand, helps clinical workers to assess the stage of impairment of patients with PSCI, and facilitates individualized interventions and preventions for them.

Superior Global Cognition in Oldest-Old Is Associated with Resistance to Neurodegenerative Pathologies: Results from The 90+ Study

And what protocols does your doctors have to ensure you have superior global cognition? NOTHING? Then why are you seeing them? My Mom at 94 is still doing good with only a 6th grade education.

Take it yourself:

STANDARDIZED MINI-MENTAL STATE EXAMINATION (SMMSE)

Number 12 I still would fail at. In the hospital after three days in the ICU I failed knowing the date and day of the week and the name of the building and floor.

Superior Global Cognition in Oldest-Old Is Associated with Resistance to Neurodegenerative Pathologies: Results from The 90+ Study

Authors: Biswas, Roshni^{a; *} | Kawas, Claudia^{a; b} | Montine, Thomas J.^c | Bukhari, Syed A.^c | Jiang, Luohua^d | Corrada, Maria M.^{a; d; *}

Affiliations: [a] Department of Neurology, University of California, Irvine, CA, USA | [b] Department of Neurobiology and Behavior, University of California, Irvine, CA, USA | [c] Department of Pathology, Stanford University, Palo Alto, CA, USA | [d] Department of Epidemiology and Biostatistics, University of California, Irvine, CA, USA

Correspondence: [*] Correspondence to: Roshni Biswas, University of California, Irvine, Hewitt Hall Room 1515, Irvine, CA 92697, USA. Tel.: +1 949 824 9176; E-mail: roshni.biswas@uci.edu and Maria M. Corrada, University of California, Irvine, Hewitt Hall Room 1513, Irvine, CA 92697, USA. Tel.: +1 949 824 9109; E-mail: mcorrada@uci.edu.

Abstract:  

Background: 

Some oldest-old individuals can maintain superior cognition despite advanced age. Little is known about the neuropathological changes in the brains of oldest-old superior cognitive performers. 

Objective: 

Our objective was to examine the associations between Alzheimer’s disease (AD) and non-AD neuropathologic features in relation to superior cognitive performance in oldest-old individuals. Methods: 

We analyzed brain autopsy data from 102 participants with normal cognition from The 90+ Study. Superior global cognitive performers (SGCP) were defined as having Mini-Mental State Examination (MMSE) score ≥28 in the last visit 12 to 2 months before death. To examine the associations between individual and multiple comorbid neuropathologic features with SGCP status we used multiple logistic regression models adjusting for age, sex, and education. 

Results: 

Alzheimer’s disease neuropathological change (ADNC) and low levels of vascular pathologic change were not associated with superior cognition. In contrast, participants with limbic (OR = 8.37; 95% CI: 1.48–47.44) and neocortical (OR = 10.80;95% CI: 1.03–113.82) Lewy body disease (LBD), or with hippocampal sclerosis (HS) (OR = 5.28; 95% CI: 1.10–25.47) were more likely to be non-SGCP. High total burden of multiple comorbid neuropathologic features was associated with a lower likelihood of being SGCP. 

Conclusion: 

Oldest-old superior cognitive performers were resilient to ADNC and low levels of vascular pathologic change and were resistant to non-AD neurodegenerative changes and multiple comorbid neuropathologic features. Understanding the factors underlying the ability of superior cognitive performers to resist these changes might provide useful insights on maintenance of superior cognition despite advanced age.

Keywords: Alzheimer’s disease, cognitive aging, neurodegenerative disease, oldest-old, successful aging, vascular

DOI: 10.3233/JAD-221062

Journal: Journal of Alzheimer's Disease, vol. 93, no. 2, pp. 561-575, 2023

Accepted 8 March 2023

|

Published: 16 May 2023

Price: EUR 27.50

Silent Cerebral Infarctions During Revascularisation Procedures Associated With Worse Cognitive Impairment

This is why I think you really need to have a discussion with your doctor as to why this needs to be done. If your Circle of Willis is complete it would seem to make more sense to just close up the artery completely rather than risk more brain damage. My right carotid artery was completely closed for at least 10 years before collaterals appeared and I suffered no cognitive impairment from that lack of blood source.  Push your doctor hard on that question. Will they guarantee no adverse events from the procedure they do? 

Silent Cerebral Infarctions During Revascularisation Procedures Associated With Worse Cognitive Impairment

By Eric Ramos

BARCELONA, Spain -- January 26, 2020 -- Patients with new silent cerebral infarctions during revascularisation procedures for carotid artery disease appear to have worse cognitive impairment than patients who do not develop new lesions, according to a study presented here at The International Conference of the European Society of Cardiology (ESC) Council on Stroke.

Patients who developed new ischaemic lesions scored significantly worse on the Mini Mental State Examination (MMSE) at their follow-up visit, compared with MMSE scores taken right before and after the procedure.

“Patients undergoing carotid artery angioplasty and stenting have high risk of stroke or transient ischaemic attack intra-procedurally,” explained Alexandros Evangeliou, MD, Hippokration General Hospital, Thessaloniki, Greece. “Even though ischaemic brain lesions are detected on post-procedural imaging, most of these patients do not have neurological deficits.”

To clarify the association between intra-procedural ischaemic lesions and cognitive impairment, the researchers examined the neurological outcomes of 31 patients aged 56 to 78 years who successfully underwent carotid artery angioplasty and stenting for carotid artery disease.

All patients underwent a neurological clinical examination, and Mini-Mental-State-Examination (MMSE) and National Institutes of Health Stroke Scale (NIHSS) questionnaires were administered before and after surgery, and at the follow-up visit. Cerebral diffusion-weighted MRI was performed before and after revascularisation.

After a median follow-up time of 9 months, 8 (25.8%) patients showed new ischaemic lesions on MRI.

There were no differences in NIHSS scores before and after the procedure or at the follow-up visit. The authors noted that this was expected because the NIHSS score is used to quantify stroke severity in clinically evident strokes, not silent ones.

However, the MMSE score at the follow-up visit (24.7 ± 5) was significantly lower than scores recorded before the revascularisation procedure (27.2 ± 2.7; P = .049) and after (28.3 ± 1.53; P = .029).

“The MMSE score correlated with MRI imaging and can be used in this setting to assess prognosis,” said Dr. Evangeliou.

[Presentation title: Evaluation of Silent Cerebral Infarction Prognosis in Patients With Carotid Artery Disease Undergoing Carotid Artery Revascularization Procedure]

Effect of comprehensive rehabilitation training on prevention of post-stroke dementia: a randomized controlled trial

You will have to send your doctor after the protocol on this dementia prevention. You will need it.

1. A documented 33% dementia chance post-stroke from an Australian study?   May 2012.
2. Then this study came out and seems to have a range from 17-66%. December 2013.
3. A 20% chance in this research.   July 2013.

Effect of comprehensive rehabilitation training on prevention of post-stroke dementia: a randomized controlled trial

Yongbin Shi,1
, Zhanxing Zhang, 2
1
Department of Clinical Psychology, Hospital of Traditional Chinese and Western Medicine, Baoshan, Shanghai, China;
2
Department of Psychiatry, Mental Health Center, Baoshan, Shanghai, China
Received August 4
, 2016; Accepted September 22
, 2016; Epub May 15, 2017; Published May 30, 2017
Abstract:
To  evaluate  the  difference  in  the  prevention  of  cognitive  impairment  and  the  incidence  of  dementia  in  patients with initial stroke between comprehensive rehabilitation training (a combination of cognitive training, rehabilitation training  and  patient  education)  plus  medical  treatment  and  medical  treatment  alone.  A  total  of  200 patients  from  April  2013  to  April  2015  with  initial  onset  of  ischemic  stroke  were  included.  These  patients  were 
randomized into the experimental group (comprehensive rehabilitation training plus medical treatment) and control group (medical treatment alone) in a 1:1 ratio to receive treatment for 6 months and follow-up for 12 months. The proportion of patients with dementia, the changes from baseline of MMSE (Minimum Mental State Examination) and ADL (activities of daily living score) as well as the proportion of patients with anxiety and patient with depression were evaluated and compared between two groups. There was no significant difference in the proportion of patients with dementia between experimental group and control group at 3 months and 6 months. However, the proportion of patients with dementia in experimental group was significantly lower than control group at 12 months of follow-up
(7.70% vs. 19.20%, P=0.041). The changes from baseline of MMSE (1.67±0.34, 95% CI: 1.59-1.75 vs. 5.22±0.31, 95% CI: 5.15-5.29,P<0.001) and ADL (2.73±0.20, 95% CI: 2.69-2.77 vs. 3.45±0.27, 95% CI: 3.39-3.51, P<0.001) in experimental group were significantly decreased when compared to control group at 12th months. In addition, the proportion of patients with anxiety in the experimental group was significantly lower than control group (24.70% vs. 44.60%, P=0.007); whereas no significant difference was observed in the proportion of patients with depression between experimental group and control group (43.20% vs. 45.80%,
P=0.74). This study indicates that the comprehensive rehabilitation training reduces the incidence of post-stroke dementia as well as significantly prevents the cognitive function impairment, anxiety and improves activities of daily living in patients of stroke.

Cognitive screening in patients with stroke: a cross-sectional study

Useless because it gives no protocols on how to address these cognitive problems.  

Cognitive screening in patients with stroke: a cross-sectional study

Rastreio cognitivo em pacientes com acidente vascular cerebral: um estudo transversal.  Jornal Brasileiro de Psiquiatria , Volume 63(2) , Pgs. 90-103.

NARIC Accession Number: I243488.  What's this?
Author(s): Ana Amália Torres Souza Gandour Dantas; Sara Viviane de Souza Torres; Izabel Myckilane Alves de Farias; Suzane Beatriz Calixto de Lira Sant’Ana; Tania Fernandes Campos.
Publication Year: 2014.
Abstract: The aim of this cross-sectional study was to make a cognitive screening in patients with stroke in order to determine cutoff points according to age, education, and degree of neurological impairment. The study included 109 outpatients (61 men), mean age 59 years (± 11), 5 years of schooling (± 4) and 16 months sequel time (± 14). Patients were assessed by the Mini-Mental State Examination (MMSE) and the National Institute of Health Stroke Scale. Data were analyzed by multiple linear regression (stepwise forward). Results showed that the variable degree of neurological impairment, age, and education contributed significantly to the overall value of the MMSE and explained variance in cognitive status (adjusted R2 = 0.24). Each increase of neurological impairment represented a decrease of 0.456 in MMSE score. The greater the age, a decrease of 0.202 was evident. As the years of education decreased, there was a decrease in MMSE score of 0.190. The cutoffs ranged 14-22 according to the degree of neurological impairment, age, and education. The results showed that through positive screening for cognitive impairment, cutoffs associated with neurological impairment were found that need to be adjusted for age and education, suggesting that these associations preferably be taken into consideration in planning the neuropsychological rehabilitation of stroke patients.
Descriptor Terms: Assessment, Cognition, Stroke.
Language: Portuguese
Geographic Location(s): Brazil, South America.

Can this document be ordered through NARIC's document delivery service*?: Request Information.
Get this Document: http://www.scielo.br/pdf/jbpsiq/v63n2/0047-2085-jbpsiq-63-2-0098.pdf.

Citation: Ana Amália Torres Souza Gandour Dantas, Sara Viviane de Souza Torres, Izabel Myckilane Alves de Farias, Suzane Beatriz Calixto de Lira Sant’Ana, Tania Fernandes Campos. (2014). Cognitive screening in patients with stroke: a cross-sectional study.  Rastreio cognitivo em pacientes com acidente vascular cerebral: um estudo transversal.  Jornal Brasileiro de Psiquiatria , 63(2), Pgs. 90-103. Retrieved 9/10/2017, from REHABDATA database.

Association of subclinical carotid atherosclerosis with immediate memory and other cognitive functions

My right carotid artery is completely closed up and I don't think my cognitive functioning has slowed down one bit. 

Association of subclinical carotid atherosclerosis with immediate memory and other cognitive functions

Geriatrics and Gerontology International

Matsumoto L, et al.

sponsor

This study was meant to clarify if carotid atherosclerosis and its risk factors are associated with cognitive decline. Findings demonstrated that subclinical carotid atherosclerosis, defined as thickened intima-media thickness (IMT), could be a marker for early stages of cognitive impairment (CI), especially for immediate memory recall and the impairment was supposedly attributed to cerebral microvascular dysfunction in the frontal lobe.

Methods

• Researchers assessed 206 individuals who visited their center for health screening.
• They performed physical examinations, blood tests, intima–media thickness (IMT) measurement by carotid ultrasonography, brain magnetic resonance imaging scanning and cognitive function assessments.
• A total of 30 individuals, who had significant cerebrovascular lesions detected in magnetic resonance imaging scans, were excluded.(Cherry picking here, excluding the worst cases, like me)
• To detect early cognitive decline, researchers defined “cognitive impairment (CI)” when a patient satisfied at least one of three criteria.
• These were Mini–Mental State Examination score <24, clock–drawing test score <4 coexisting with forgetfulness and Wechsler Memory Scale–revised delayed recall score below the normal range for the duration of education (>16 years of education: ≥9, 10–15 years: ≥5, 0–9 years: ≥3).

Results

• Findings reported that among 176 individuals, 27 were placed in the CI group.
• Researchers observed that IMT was significantly higher in the CI group as compared with the non–CI group (mean ± SD: 2.0 ± 1.0 vs 1.7 ± 0.7, P = 0018 by Student's t–test).
• They also noted that other atherosclerotic risk factors, such as blood pressure, low–density lipoprotein cholesterol, and hemoglobin A1c, were not significantly different between the two groups.
• In multivariate analysis, it was highlighted that maximum IMT was associated with impaired immediate recall score on Wechsler Memory Scale–revised, independent of the presence of deep white matter hyperintensities on the magnetic resonance imaging scan.

Have Stroke Neurologists Entered the Arena of Stroke-Related Cognitive Dysfunctions?

Only evaluation and assessment NOT stroke protocols to correct such problems. Pretty much useless research.  

Why would you want neurologists in this?

Are Neurologists Respected? Read and weep.

 

Have Stroke Neurologists Entered the Arena of Stroke-Related Cognitive Dysfunctions?

Not Yet, but They Should!

Leonardo Pantoni

Download PDF

https://doi.org/10.1161/STROKEAHA.117.016869

Stroke. 2017;48:1441-1442

Originally published May 9, 2017

See related article, p 1539

In this issue of Stroke, Zamboni et al¹ reported the results of a study that explored whether early cognitive impairment was associated with the volume of white matter hyperintensities and with white matter damage on diffusion-weighted magnetic resonance imaging in patients with transient ischemic attack (TIA) or minor stroke. Cognitive evaluation was performed with the 2 currently most widely used screening tools, the Montreal Cognitive Assessment (MoCA) and the Mini Mental State Examination. Scores on both tests, 1 month after the event, were significantly correlated with volume of white matter hyperintensities and fractional anisotropy. However, only the MoCA was independently correlated with white matter hyperintensity volumes, average fractional anisotropy values, and reduced fractional anisotropy in anterior tracts after controlling for the Mini Mental State Examination.

This study reinforces the idea that the MoCA is better suited than the Mini Mental State Examination for the assessment of patients with cerebrovascular diseases.² These data are also in agreement with previous studies showing that the MoCA is more specifically associated with microstructural damage in white matter than the Mini Mental State Examination.³

Some issues, such as the appropriate normality cutoffs for these tests, remain open, but these studies, however, have the great merit of raising a series of relevant points concerning the cognitive costs of cerebrovascular diseases.

Cognition After Stroke: Magnitude of the Problem

Cognitive dysfunction is among the most common and severe consequence of stroke. For patients and their caregivers, cognition and related disturbances are among the top 10 priorities related to life after stroke.⁴

In hospital series, poststroke dementia prevalence can be as high as 40% depending on inclusion of recurrent strokes, time of evaluation after stroke, dementia criteria, and exclusion of aphasic patients.⁵ The magnitude of the problem is even larger considering that many stroke patients develop cognitive deficits that do not meet criteria for dementia (ie, mild cognitive impairment)⁶; this percentage can be as high as 80%.⁷ Finally, >90% of stroke survivors complain of subjective cognitive impairment.⁸ These complaints may benefit from objective testing.⁹

The presence of cognitive deficits has several consequences after stroke. Importantly, it may heavily affect rehabilitation strategies.¹⁰ Early poststroke cognitive dysfunction, together with stroke severity and prestroke functionality, is a significant and independent predictor of long-term functional poststroke outcome.¹¹

In this era where a great focus and vast efforts are placed on acute stroke and on the treatments available in this phase, it is interesting to compare the above-mentioned data with the figures of stroke patients subjected to thrombolysis. Estimates of alteplase treatment range from 3% to 5%,¹² with eligibility estimates approaching 10%. Optimistically, patients eligible for endovascular thrombectomy could be 7%,¹³ but current performance rates are significantly lower. Remarkably, all stroke patients can clearly benefit from admission to a dedicated stroke unit.

It is obvious that although the acute-phase therapies(Where are they?) are cornerstones of our care of stroke patients and, on an individual patient basis, they may change dramatically the outcome, the bulk of stroke problems remain in the chronic phase.

Stroke Neurologist Are Called to Assess Cognition

Despite the impressive data on the frequency of the stroke cognitive consequences, this topic has received scarce attention to date. One systematic review of published stroke trials pointed out that, out of almost 9000 studies, <5% included a cognitive measure.¹⁴

The evaluation of the patient’s cognitive abilities has always been part of the neurological examination, and neurologists had been skilled in this for years. However, this part of the neurological examination is complex, requires experience, and takes time. Today, we are frequently called to quickly visit stroke patients especially in specific settings such as in the acute phase when time-dependent decisions need to be made. Brief and time-convenient neurological scales have, therefore, been developed, the best example being the National Institute of Health Stroke Scale. The National Institute of Health Stroke Scale has great advantages such as the implementation of a standardized scoring measure and use of a common language among centers. These scales are so widely used in the stroke setting that there is a tendency for them to entirely replace the full neurological examination. There are clear hazards in such oversimplification. One is that these scales are heavily weighted on more easily evaluable deficits such as motor, whereas cognitive evaluation, besides language items, is minimalized.

Tools for the Evaluation of Cognition After Stroke

Thus, the evaluation of cognition should clearly become part of the neurological assessment of all stroke patients. Some of the open issues in this regard concern the time of the evaluation and the tools for it. A thorough cognitive assessment requires time as cognitive domains are various (language, memory, attention, executive function, visuospatial, etc).

Many cognitive instruments have been proposed for the evaluation of stroke patients.¹⁵ These tools should be selected according to the different intervals of assessment after stroke and the availability of time and personnel. In any case, we need tools to systematically assess cognition in stroke patients and instruments that are usable from the early phases.

The MoCA could be one of such tools.¹⁶ Its use for the assessment of cerebrovascular disease patients has been advocated because it evaluates many of the cognitive domains affected in these patients.¹⁷ The MoCA has been tested in several studies in the acute stroke setting where it is applicable and predictive of long-term outcome. The MoCA has advantages and limitations as does any other cognitive tool² under investigation for use in acute stroke. More important than the issue of the finding of the best tool (likely to be an impossible task) is attention to the evaluation of cognition in stroke patients.

Is It a TIA or a Cognitive Stroke?

One last interesting issue raised by the study by Zamboni et al¹ is the fact that some cognitive impairment was found in TIA patients 1 month after the event. TIA symptoms by definition must last <24 hours, so finding a clinical deficit at a time distant from onset could challenge the concept of TIAs being transient.

There are at least 2 possible explanations for such findings. The first is that the vascular event clinically diagnosed as TIA induces a cerebral damage that is transient in its noncognitive expression but that is sustained for cognition. Indeed, it is well documented that some TIAs are associated with permanent brain lesions.¹⁸ This damage might also happen at a microstructural level and be invisible on conventional neuroimaging. Alternatively, one may hypothesize that, in TIA patients, brain microstructural damage and functional dysfunction are present before the event. White matter damage as shown in the study by Zamboni et al could be one of the correlates of this cognitive decline. The answer to this question can come from longitudinal imaging studies, cognitively assessing subjects before the cerebrovascular event and then afterward. However, these are not easy to conduct.

Ten years after the call for vascular neurologists to enter the arena of poststroke cognition to fight the hard problem in daily life after a stroke,¹⁹ the consideration given to this aspect remains limited. We urge stroke clinicians to increase their attention toward the cognitive and long-term consequences of stroke.

The relationship between intracranial pressure and neurocognitive function before and after the repair of a skull injury

You probably want to know about this if you had a skull flap removed to reduce pressure.

The relationship between intracranial pressure and neurocognitive function before and after the repair of a skull injury

J. HE

1

, L.-L. CHEN

2

, D.-K. SUN

1

, H.-T. WANG

1

, J.-J. WANG

1

, X. ZHAI

3

1

Neurosurgery Ward 2, Linyi City Yishui Central Hospital, Linyi, Shandong, P.R. China

2

Clinical Laboratory, Linyi City Yishui Central Hospital, Linyi, Shandong, P.R. China

3

Department of Neurological Surgery Unit 1, the First Affiliated Hospital of Liaoning Medical

University, Jinzhou, Liaoning, P.R. China

Abstract.

–

OBJECTIVE:

This study examines the relationship between intracranial pressure (ICP) changes after skull injury repair and neurocognitive function before and after the repair.

PATIENTS AND METHODS:

Sixty patients undergoing skull injury repair participated in the study. A non-invasive detection analyzer was used to detect the ICP 2 days before operation, 10 days after the operation and one month after the operation in all patients. Additionally, the mean cerebral blood flow velocities (MV) in the internal carotid and the medial cerebral arteries were detected using a transcranial Doppler ultrasound (TCD). The neurological and cognitive functions were assessed using the NIHSS and the MMSE scales, respectively. And finally, an ELISA assay was used to detect the plasma insulin-like growth factor (IGF)-1 and β-amyloid peptide (Aβ

) levels.

RESULTS :

The results showed that all parameters studied improved significantly and continuously after surgery.

CONCLUSIONS:

We suggest that the improvement in the ICP values and the neurocognitive functions are related to the resulting decreased expression levels of IGF-1 and Aβ after the repair.

CCB Doesn't Help Cognition After Stroke MMSE scores no better with nimodipine than placebo after 6 months

Just because finding the solution to this is 'vexing' and complicated is no reason to give up.

CCB Doesn't Help Cognition After Stroke MMSE scores no better with nimodipine than placebo after 6 months

• by Kristina Fiore
  Associate Editor, MedPage Today February 23, 2017

HOUSTON -- Nimodipine didn't improve cognition when ischemic stroke patients with vascular mild cognitive impairment (MCI) started taking the calcium channel blocker within a week of their event, researchers reported here.
In a randomized controlled trial from 23 sites in China, patients had no differences in change in Mini-Mental State Exam (MMSE) scores at 6 months whether they were on the drug or placebo, Huaguang Zheng, MD, of Beijing Tiantan Hospital in China and colleagues reported at the International Stroke Conference meeting here.
"In our trial, we found that nimodipine didn't benefit vascular MCI patients, but it may have marginal positive effects on specific cognitive domains, such as executive function, and it won't increase the risk of stroke or other adverse events," Zheng said during a press briefing.
More than half of stroke patients develop vascular MCI during the first three months of follow-up, he explained, and about 30% to 50% will develop dementia within 5 years.
While there are currently no effective therapies for vascular MCI and dementia, some studies have suggested that nimodipine may have cognitive benefits, he said.
To assess whether that's the case, Zheng and colleagues randomized 654 patients to either placebo or to 30 mg nimodipine three times a day. The primary endpoint was the change in cognition function on the MMSE and on the Alzheimer's Disease Assessment Scale Cognitive Subscale (ADAS-Cog) over 6 months.
Overall, outcomes were similar between the two groups, with no significant advantage for nimodipine, Zheng said.
There was, however, an advantage for nimodipine in terms of the proportion of patients who had an ADAS-Cog score of 0 or greater at 6 months (34% versus 47%), and there was some indication that the drug may benefit specific brain areas, particularly executive function, he noted.
Zheng added that nimodipine didn't increase the risk of stroke and other adverse events.
He acknowledged that the study was limited because it didn't evaluate Global Cognitive Index scores, neurological outcome, or subcortical dementia, and the sample size was too small.
Mark Alberts, MD, of Hartford Healthcare, said it was "reasonable to investigate" nimodipine given that it's been shown to potentially have neuroprotective effects. But the problem of cognitive decline following stroke is a "vexing issue" because the pathophysiology is so complicated.
"If you have a stroke, and you develop dementia after the stroke, is that vascular dementia related to the stroke? Having a stroke, you take out millions of neurons," he told MedPage Today. "Most people, including myself, think it's a combination, that there's some underlying degenerative process, and vascular disease on top of that is just accelerating it perhaps."
Alberts said it's best to focus on risk factor control in patients with cognitive impairment after a stroke -- treating diabetes, hypertension, and hypercholesterolemia, for instance. For patients who progress to dementia, he offers rehabilitation programs or the cholinesterase inhibitor donepezil (Aricept).
Amytis Towfighi, MD, of the University of Southern California and director of neurological services at the Los Angeles County department of health, agreed that risk factor control is the main therapeutic strategy for cognitive impairment following stroke.
"Currently there are no proven treatments. We don't know if medications that have been tested in Alzheimer's would be effective," she told MedPage Today. "Generally we recommend lifestyle changes -- the same things you would recommend to prevent stroke. Prevention is the key."

The study was supported by the National Key Technology Research and Development Program of the Ministry of Science and Technology of China. Bayer provided additional support.
Zheng disclosed no financial relationships with industry.

• Primary Source

  International Stroke Conference

  Source Reference: Zheng H, et al "Efficacy and safety of nimodipine in vascular mild cognitive impairment: a randomized placebo controlled trial" ISC Meeting 2017; Abstract LB7.

Differences in cognitive profiles between traumatic brain injury and stroke: a comparison of the Montreal Cognitive Assessment and Mini-Mental State Examination

What is your doctor going to do with this to get you cognitively back to normal?

Differences in cognitive profiles between traumatic brain injury and stroke: a comparison of the Montreal Cognitive Assessment and Mini-Mental State Examination

• Hao Zhang^a,
• Xiao-Nian Zhang^a,
• Hui-Li Zhang^b,
• Qian-Qian Chi^a,
• Xin Zhang^a,
• Xiao-Ping Yun^{b, ,}

 Show more

doi:10.1016/j.cjtee.2015.03.007

Get rights and content

Open Access funded by Daping Hospital and the Research Institute of Surgery of the Third Military Medical University

Under a Creative Commons license

---

Abstract

Purpose

To investigate the profiles of cognitive impairment through Montreal Cognitive Assessment (MoCA) and Mini-Mental State Examination (MMSE) in patients with chronic traumatic brain injury (TBI) or stroke and to evaluate the sensitivity of the two scales in patients with TBI.

Methods

In this cohort study, a total of 230 patients were evaluated, including TBI group (n=103) and stroke group (n=127). The cognitive functions of two groups were evaluated by designated specialists using Moca (Beijing version) and MMSE (Chinese version).

Results

Compared with the patients with stroke, the patients with TBI received significantly lower score in orientation subtest and recall subtest in both tests. MoCA abnormal rates in the TBI group and stroke group were 94% and 87% respectively, while MMSE abnormal rates were 70% and 57%, respectively. In the TBI group, 87% patients with normal MMSE score had abnormal MoCA score and in the stroke group, about 70% patients with normal MMSE score had abnormal MoCA score. The diagnostic consistency of two scales in the TBI group and the stroke group were 72% and 69%, respectively.

Conclusion

In our rehabilitation center, patients with TBI may have more extensive and severe cognitive impairments than patients with stroke, prominently in orientation and recall domain. In screening post-TBI cognitive impairment, MoCA tends to be more sensitive than MMSE.

Interarm Blood Pressure Difference Associated With Higher Rates of Cognitive Decline

Would this have the same effect on stroke survivors? We'll never know because we have no strategy to update or a leader to go to. You're on your own.

Interarm Blood Pressure Difference Associated With Higher Rates of Cognitive Decline

 Higher systolic interarm difference (IAD) measurements in blood pressure are associated with an increased risk of cognitive decline and may alert health care practitioners of the need for preventive and therapeutic intervention in the elderly, according to a study presented here at the 26th Scientific Meeting of the European Society of Hypertension (ESH). Patients with elevated IAD in blood pressure also demonstrated higher mortality rates over a 9-year follow-up.
“Systolic IADs in blood pressure of 10 mm Hg are associated with increased cardiovascular disease and mortality. Both Alzheimer’s disease and vascular dementia include vascular disease in their aetiology,” explained John Campbell, MD, MBChB, University of Exeter Medical School, Exeter, United Kingdom, on June 12. “We hypothesised that an IAD may be prospectively associated with an increased risk of cognitive decline.”
Dr. Campbell and colleagues evaluated whether systolic IADs in blood pressure could identify people at risk for cognitive decline by use of the large database of the inChianti study. InChianti is a prospective study of ageing comprising detailed assessments of a random sample of older individuals with baseline assessments of sequential blood pressure measurements and cognitive assessment by the mini-mental state examination (MMSE).
The study enrolled >1,000 participants who were evaluated every 3 years during a 9-year follow-up. Associations between IAD and mortality, cognitive decline, and rate of change in MMSE over time were assessed by univariate cross-sectional and regression analyses adjusted for known cardiovascular and dementia risk factors.
A decline in MMSE score of ≥5 points was considered to be a clinically important substantial cognitive decline.
“The rate of change in cognitive scores may also be important in predicting risk of cognitive impairment,” noted Dr. Campbell.
Participants with IADs of ≥10 mm Hg showed a rate of decline in MMSE scores over time that was significantly greater than the rate in participants with no IAD in systolic blood pressure measurements. Participants with IAD demonstrated a decline at a rate of 0.51 MMSE points yearly, whereas participants without significant IAD showed a decline of 0.33 MMSE points per year (P = .024).
Individuals with IAD ≥10 mm Hg also demonstrated higher all-cause mortality rates at the 6- and 9-year follow-ups. The difference between participants with elevated IAD compared with those without IAD at 6 years (hazard ratio, 1.36; P = .04) was continued as a nonsignificant trend at 9 years.
“These results suggest a potential association of IAD with higher rates of cognitive decline that warrants further study using robust methods of measuring interarm blood pressure to clarify where detection of IAD can predict future cognitive decline,” concluded Dr. Campbell.
[Presentation title: Inter-Arm Blood Pressure Difference and Risk of Cognitive Decline: A 9-Year Prospective Cohort Study]

Who does well after a stroke? The Sydney stroke study.

Does your doctor 5 years after this research have any fucking clue what to look for to predict stroke recovery?  You can see from this that there was no objective looking at dead and damaged areas in the brain, anything else is subjective stupidity.

Who does well after a stroke? The Sydney stroke study.

Aging Ment Health. 2009 Sep;13(5):693-8. doi: 10.1080/13607860902845525.

Withall A¹, Brodaty H, Altendorf A, Sachdev PS.

Author information

Abstract

Research addressing positive outcomes one year after stroke has been limited. The sample comprised 125 participants with complete Activities of Daily Living (ADL), Instrumental Activities of Daily Living (IADL) and Mini-Mental State Examination (MMSE) scale scores at baseline ( approximately 4 months after ischaemic stroke) and at follow-up (1 year later), 31 persons were defined as having a favourable outcome (an MMSE score of >or=28/30 and combined ADL/IADL score equal to 14/14 at follow-up) and 94 as having a poorer outcome. Predictors of a favourable outcome following stroke included being younger, having higher premorbid IQ, no atrial fibrillation, no dementia, less apathy and fewer intercurrent cerebrovascular events. We conclude that people can have good outcomes in the year after stroke except if they experience further cerebrovascular events and/or have risk factors for cerebrovascular disease. Brain reserve appears to be protective.

PMID:

19882407

[PubMed - indexed for MEDLINE]

Hearing Aids Postpone Dementia for Seniors

Is your doctor testing you for hearing ability post-stroke?

Hearing Aids Postpone Dementia for Seniors

1. Hélène Amieva PhD^*,
2. Camille Ouvrard MSc,
3. Caroline Giulioli MSc,
4. Céline Meillon MSc,
5. Laetitia Rullier PhD and
6. Jean-François Dartigues MD, PhD

Article first published online: 20 OCT 2015

DOI: 10.1111/jgs.13649

© 2015, Copyright the Authors Journal compilation © 2015, The American Geriatrics Society

Issue

Journal of the American Geriatrics Society

Volume 63, Issue 10, pages 2099–2104, October 2015

Additional Information(Show All)

How to CiteAuthor InformationPublication HistoryFunding Information

SEARCH

Search Scope

Search String

• Advanced >
• Saved Searches >

ARTICLE TOOLS

• Get PDF (86K)
• Save to My Profile
• E-mail Link to this Article
• Export Citation for this Article
• Get Citation Alerts
• Request Permissions

More Sharing ServicesShare|Share on citeulikeShare on facebookShare on deliciousShare on www.mendeley.comShare on twitter

• Abstract
• Article
• References
• Cited By

View Full Article (HTML) Enhanced Article (HTML) Get PDF (86K)

Keywords:

• hearing loss;
• hearing aids;
• cognitive decline;
• elderly

Objectives

To investigate the association between hearing loss, hearing aid use, and cognitive decline.

Design

Prospective population-based study.

Setting

Data gathered from the Personnes Agées QUID study, a cohort study begun in 1989–90.

Participants

Individuals aged 65 and older (N = 3,670).

Measurements

At baseline, hearing loss was determined using a questionnaire assessing self-perceived hearing loss; 137 subjects reported major hearing loss, 1,139 reported moderate problems (difficulty following the conversation when several persons talk at the same time or in a noisy background), and 2,394 reported no hearing trouble. Cognitive decline was measured using the Mini-Mental State Examination (MMSE), administered at follow-up visits over 25 years.

Results

Self-reported hearing loss was significantly associated with lower baseline MMSE score (β = −0.69, P < .001) and greater decline during the 25-year follow-up period (β = −0.04, P = .01) independent of age, sex, and education. A difference in the rate of change in MMSE score over the 25-year follow-up was observed between participants with hearing loss not using hearing aids and controls (β = −0.06, P < .001). In contrast, subjects with hearing loss using a hearing aid had no difference in cognitive decline (β = 0.07, P = .08) from controls.

Conclusion

Self-reported hearing loss is associated with accelerated cognitive decline in older adults; hearing aid use attenuates such decline.