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

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

doi:10.1161/STROKEAHA.115.011507

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

Journal article

Open access

Peer reviewed

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

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

Stroke (1970), Vol.47(3), pp.726-731

2016-03

DOI: https://doi.org/10.1161/STROKEAHA.115.011507

PMID: 26846862

Abstract

Predictive Value of Tests

Prospective Studies

Stroke - psychology

Humans

Middle Aged

Stroke - diagnosis

Male

Diffusion Magnetic Resonance Imaging - trends

Ischemic Attack, Transient - diagnosis

Neuropsychological Tests

Cognition Disorders - diagnosis

Ischemic Attack, Transient - epidemiology

Ischemic Attack, Transient - psychology

Female

Stroke - epidemiology

Aged

Cognition Disorders - epidemiology

Longitudinal Studies

Cognition Disorders - psychology

Few studies have examined predictors of cognitive impairment after minor ischemic stroke and transient ischemic attack (TIA). We examined clinical and imaging features associated with worse cognitive performance at 90 days. TIA or patients with minor stroke underwent neuropsychological testing 90 days post event. Z scores were calculated for cognitive tests, and then grouped into domains of executive function (EF), psychomotor processing speed (PS), and memory. White matter hyperintensity and diffusion-weighted imaging volumes were measured on baseline magnetic resonance imaging. Ninety-day outcomes included modified Rankin Scale (mRS) and Centre for Epidemiological Studies Depression Scale (CES-D) score. Ninety-two patients were included, 76% male, 54% TIA, and mean age 65.1±12.0. Sixty-four percent were diffusion-weighted imaging positive. Median domain z scores were not significantly different from published norms (P>0.05): memory -0.03, EF -0.12, and PS -0.05. Patient performance ≥1 SD below normal was 20% on memory, 16% on PS, and 17% on EF. Cognitive scores did not differ by diagnosis (stroke versus TIA), stroke pathogenesis, presence of obstructive sleep apnea, and diffusion-weighted imaging or white matter hyperintensity volumes. In multivariable analyses, lower EF was associated with previous cortical infarct on magnetic resonance imaging (P=0.03), mRS score of >1; P=0.0003 and depressive symptoms (CES-D ≥16; P=0.03). Lower PS scores were associated with previous cortical infarct (P=0.02), acute bilateral positive diffusion-weighted imaging (P=0.02), mRS score of >1 (P=0.003), and CES-D ≥16 (P=0.03). Despite average-range cognitive performance in this TIA and population with minor stroke, we found associations of EF and PS with evidence of previous stroke, postevent disability, and depression.

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Collaboration types: Domestic collaboration; International collaboration
Citation topics: 1 Clinical & Life Sciences; 1.52 Neurodegenerative Diseases; 1.52.60 Dementia
Web Of Science research areas: Clinical Neurology; Peripheral Vascular Disease
ESI research areas: Neuroscience & Behavior

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Title: Imaging and Baseline Predictors of Cognitive Performance in Minor Ischemic Stroke and Patients With Transient Ischemic Attack at 90 Days
Creators: Jennifer L Mandzia - From the Calgary Stroke Program, Department of Clinical Neurosciences (J.L.M., E.E.S., M.H., P.A.B., C.G., E.D., N.A., S.P., S.B.C.), Department of Radiology (E.E.S., P.A.B., S.B.C.), Department of Medicine (P.H.), Department of Community Health Sciences (E.E.S., S.B.C.), Hotchkiss Brain Institute (E.E.S., P.H., P.A.B., S.B.C.), Seaman Family MR Centre (E.E.S., P.A.B., S.B.C.), and Sleep Centre, Foothills Medical Centre (P.H.), University of Calgary, Calgary, AB, Canada; Department of Clinical Neurological Sciences, London Health Sciences Center, Western University, London, ON, Canada (J.L.M.); and Department of Neurology, Miller School of Medicine, University of Miami, Coral Gables, FL (N.A.). jennifer.mandzia@lhsc.on.ca
Eric E Smith - From the Calgary Stroke Program, Department of Clinical Neurosciences (J.L.M., E.E.S., M.H., P.A.B., C.G., E.D., N.A., S.P., S.B.C.), Department of Radiology (E.E.S., P.A.B., S.B.C.), Department of Medicine (P.H.), Department of Community Health Sciences (E.E.S., S.B.C.), Hotchkiss Brain Institute (E.E.S., P.H., P.A.B., S.B.C.), Seaman Family MR Centre (E.E.S., P.A.B., S.B.C.), and Sleep Centre, Foothills Medical Centre (P.H.), University of Calgary, Calgary, AB, Canada; Department of Clinical Neurological Sciences, London Health Sciences Center, Western University, London, ON, Canada (J.L.M.); and Department of Neurology, Miller School of Medicine, University of Miami, Coral Gables, FL (N.A.)
Myles Horton - From the Calgary Stroke Program, Department of Clinical Neurosciences (J.L.M., E.E.S., M.H., P.A.B., C.G., E.D., N.A., S.P., S.B.C.), Department of Radiology (E.E.S., P.A.B., S.B.C.), Department of Medicine (P.H.), Department of Community Health Sciences (E.E.S., S.B.C.), Hotchkiss Brain Institute (E.E.S., P.H., P.A.B., S.B.C.), Seaman Family MR Centre (E.E.S., P.A.B., S.B.C.), and Sleep Centre, Foothills Medical Centre (P.H.), University of Calgary, Calgary, AB, Canada; Department of Clinical Neurological Sciences, London Health Sciences Center, Western University, London, ON, Canada (J.L.M.); and Department of Neurology, Miller School of Medicine, University of Miami, Coral Gables, FL (N.A.)
Patrick Hanly - From the Calgary Stroke Program, Department of Clinical Neurosciences (J.L.M., E.E.S., M.H., P.A.B., C.G., E.D., N.A., S.P., S.B.C.), Department of Radiology (E.E.S., P.A.B., S.B.C.), Department of Medicine (P.H.), Department of Community Health Sciences (E.E.S., S.B.C.), Hotchkiss Brain Institute (E.E.S., P.H., P.A.B., S.B.C.), Seaman Family MR Centre (E.E.S., P.A.B., S.B.C.), and Sleep Centre, Foothills Medical Centre (P.H.), University of Calgary, Calgary, AB, Canada; Department of Clinical Neurological Sciences, London Health Sciences Center, Western University, London, ON, Canada (J.L.M.); and Department of Neurology, Miller School of Medicine, University of Miami, Coral Gables, FL (N.A.)
Philip A Barber - From the Calgary Stroke Program, Department of Clinical Neurosciences (J.L.M., E.E.S., M.H., P.A.B., C.G., E.D., N.A., S.P., S.B.C.), Department of Radiology (E.E.S., P.A.B., S.B.C.), Department of Medicine (P.H.), Department of Community Health Sciences (E.E.S., S.B.C.), Hotchkiss Brain Institute (E.E.S., P.H., P.A.B., S.B.C.), Seaman Family MR Centre (E.E.S., P.A.B., S.B.C.), and Sleep Centre, Foothills Medical Centre (P.H.), University of Calgary, Calgary, AB, Canada; Department of Clinical Neurological Sciences, London Health Sciences Center, Western University, London, ON, Canada (J.L.M.); and Department of Neurology, Miller School of Medicine, University of Miami, Coral Gables, FL (N.A.)
Catherine Godzwon - From the Calgary Stroke Program, Department of Clinical Neurosciences (J.L.M., E.E.S., M.H., P.A.B., C.G., E.D., N.A., S.P., S.B.C.), Department of Radiology (E.E.S., P.A.B., S.B.C.), Department of Medicine (P.H.), Department of Community Health Sciences (E.E.S., S.B.C.), Hotchkiss Brain Institute (E.E.S., P.H., P.A.B., S.B.C.), Seaman Family MR Centre (E.E.S., P.A.B., S.B.C.), and Sleep Centre, Foothills Medical Centre (P.H.), University of Calgary, Calgary, AB, Canada; Department of Clinical Neurological Sciences, London Health Sciences Center, Western University, London, ON, Canada (J.L.M.); and Department of Neurology, Miller School of Medicine, University of Miami, Coral Gables, FL (N.A.)
Emily Donaldson - From the Calgary Stroke Program, Department of Clinical Neurosciences (J.L.M., E.E.S., M.H., P.A.B., C.G., E.D., N.A., S.P., S.B.C.), Department of Radiology (E.E.S., P.A.B., S.B.C.), Department of Medicine (P.H.), Department of Community Health Sciences (E.E.S., S.B.C.), Hotchkiss Brain Institute (E.E.S., P.H., P.A.B., S.B.C.), Seaman Family MR Centre (E.E.S., P.A.B., S.B.C.), and Sleep Centre, Foothills Medical Centre (P.H.), University of Calgary, Calgary, AB, Canada; Department of Clinical Neurological Sciences, London Health Sciences Center, Western University, London, ON, Canada (J.L.M.); and Department of Neurology, Miller School of Medicine, University of Miami, Coral Gables, FL (N.A.)
Negar Asdaghi - From the Calgary Stroke Program, Department of Clinical Neurosciences (J.L.M., E.E.S., M.H., P.A.B., C.G., E.D., N.A., S.P., S.B.C.), Department of Radiology (E.E.S., P.A.B., S.B.C.), Department of Medicine (P.H.), Department of Community Health Sciences (E.E.S., S.B.C.), Hotchkiss Brain Institute (E.E.S., P.H., P.A.B., S.B.C.), Seaman Family MR Centre (E.E.S., P.A.B., S.B.C.), and Sleep Centre, Foothills Medical Centre (P.H.), University of Calgary, Calgary, AB, Canada; Department of Clinical Neurological Sciences, London Health Sciences Center, Western University, London, ON, Canada (J.L.M.); and Department of Neurology, Miller School of Medicine, University of Miami, Coral Gables, FL (N.A.)
Shiel Patel - From the Calgary Stroke Program, Department of Clinical Neurosciences (J.L.M., E.E.S., M.H., P.A.B., C.G., E.D., N.A., S.P., S.B.C.), Department of Radiology (E.E.S., P.A.B., S.B.C.), Department of Medicine (P.H.), Department of Community Health Sciences (E.E.S., S.B.C.), Hotchkiss Brain Institute (E.E.S., P.H., P.A.B., S.B.C.), Seaman Family MR Centre (E.E.S., P.A.B., S.B.C.), and Sleep Centre, Foothills Medical Centre (P.H.), University of Calgary, Calgary, AB, Canada; Department of Clinical Neurological Sciences, London Health Sciences Center, Western University, London, ON, Canada (J.L.M.); and Department of Neurology, Miller School of Medicine, University of Miami, Coral Gables, FL (N.A.)
Shelagh B Coutts - From the Calgary Stroke Program, Department of Clinical Neurosciences (J.L.M., E.E.S., M.H., P.A.B., C.G., E.D., N.A., S.P., S.B.C.), Department of Radiology (E.E.S., P.A.B., S.B.C.), Department of Medicine (P.H.), Department of Community Health Sciences (E.E.S., S.B.C.), Hotchkiss Brain Institute (E.E.S., P.H., P.A.B., S.B.C.), Seaman Family MR Centre (E.E.S., P.A.B., S.B.C.), and Sleep Centre, Foothills Medical Centre (P.H.), University of Calgary, Calgary, AB, Canada; Department of Clinical Neurological Sciences, London Health Sciences Center, Western University, London, ON, Canada (J.L.M.); and Department of Neurology, Miller School of Medicine, University of Miami, Coral Gables, FL (N.A.)
Publication Details: Stroke (1970), Vol.47(3), pp.726-731
Publisher: United States
Academic Unit: Miller School of Medicine; UMMG Department of Neurology; UMMG Dept of Neurology - Stroke Div
Language: English
Resource Type: Journal article
PMID: 26846862
Record Identifier: 991031577167802976