Visually-Rated Medial Temporal Lobe Atrophy with Lower Educational History as a Quick Indicator of Amnestic Cognitive Impairment after Stroke

Article type: Research Article

Authors: Takahashi, Yukako^{a; b} | Saito, Satoshi^a | Yamamoto, Yumi^c | Uehara, Toshiyuki^{d; e} | Yokota, Chiaki^{d; e} | Sakai, Go^f | Nishida, Norifumi^f | Takahashi, Ryosuke^b | Kalaria, Raj N.^g | Toyoda, Kazunori^d | Nagatsuka, Kazuyuki^a | Ihara, Masafumi^{a; *}

Affiliations: [a] Department of Neurology, National Cerebral and Cardiovascular Center, Osaka, Japan | [b] Department of Neurology, Kyoto University Graduate School of Medicine, Osaka, Japan | [c] Department of Regenerative Medicine and Tissue Engineering, National Cerebral and Cardiovascular Center, Osaka, Japan | [d] Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan | [e] Department of Stroke Rehabilitation, National Cerebral and Cardiovascular Center, Osaka, Japan | [f] Department of Diagnostic Radiology, Osaka Saiseikai Nakatsu Hospital, Osaka, Japan | [g] Institute of Neuroscience, Newcastle University, Campus for Ageing and Vitality, Newcastle, UK

Correspondence: [*] Correspondence to: Masafumi Ihara, MD, PhD, FACP, Department of Neurology, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka 565-8565, Japan. Tel.: +81 6 6833 5012; Fax: +81 6 6872 7486; E-mail: ihara@ncvc.go.jp.

Abstract: Background: Time and resource limitations prevent cognitive assessment in acute-to-subacute settings, even in comprehensive stroke centers. Objective: To assess cognitive function in acute stroke patients undergoing routine clinical, laboratory, and radiological investigations, with a view to improving post-stroke care and treatment. Methods: Sixty-nine patients (72.6±11.1 years; 65% male) were prospectively enrolled within 14 days of acute ischemic stroke. Patients with altered consciousness, aphasia, or dysarthria were excluded. Clinical features including modified Rankin and NIH stroke scales, and vascular risk factors were assessed, as well as neuroimaging parameters by semi-quantitative evaluation of medial temporal lobe atrophy (MTLA) using MRA source images, FLAIR images for white matter changes (Fazekas scores), and T2∗ images for cerebral microbleeds. Neuropsychological screening was conducted using the Montreal Cognitive Assessment (MoCA) test. Univariate and multivariate analyses were used to evaluate the influence of variables on MoCA total and subscale scores. Results: Lower MoCA scores of 22 or less were associated with MTLA [OR (95% CI), 5.3 (1.0–27.5); p = 0.045], education years [OR (95% CI), 0.71 (0.55–0.91); p = 0.007], and modified Rankin scale at discharge [OR (95% CI), 2.4 (1.3–4.5); p = 0.007]. The delayed recall MoCA score was correlated with MTLA (r = – 0.452, p < 0.001), periventricular (r = – 0.273, p = 0.024), and deep (r = – 0.242, p = 0.046), white matter changes. Conclusions: MTLA, together with lower educational history, are quick indicators of amnestic cognitive impairment after stroke. The association between cognitive impairment and physical disability at discharge may signify the importance of earlier cognitive assessment.

Keywords: Comprehensive stroke center, dementia, medial temporal lobe atrophy, Montreal Cognitive Assessment, post-stroke dementia, stroke

DOI: 10.3233/JAD-180976

Journal: Journal of Alzheimer's Disease, vol. 67, no. 2, pp. 621-629, 2019