Abstract Details

Title Patients with Mild Acute Ischemic Stroke and Transient Ischemic Attack Have Acute Cognitive Impairments

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P05 - (-)

Poster/Presentation
Number 223

Objective

Background BACKGROUND: Patients with mild acute ischemic stroke (AIS) are often not treated with t-PA because of the perception that they have minor deficits and good outcomes. We hypothesized that these patients have cognitive impairments and are actually more disabled than previously known.

Design/Methods DESIGN/METHODS: In this prospective study, previously healthy patients presenting with mild stroke (NIHSS ?5) or TIA were assessed within 24 hrs of symptom onset on various cognitive domains: Verbal learning and memory (CVLT), Visuospatial learning and memory (ROCF), Attention, working memory, and processing speed (Digit Span, Mental Control, SDMT, and Trails), Verbal fluency (FAS), and General cognition (MoCA). Tests were selected for ease of use at the bedside by personnel with little training required and well established normative data. We defined ? -1.5 standard deviations from the norm as abnormal.

Results RESULTS: Among 24 patients: 1 of 4 TIA (25%) and 19 of 20 mild AIS (95%) subjects had cognitive abnormalities. 83% of patients had at least 1 abnormal test; 63% had multiple abnormalities. No patient had neglect and only 1 patient had aphasia (expressive deficit only) on the NIHSS. Even among patients whose symptoms had resolved, 67% had cognitive abnormalities. Among the cognitive tests, the MoCA was the most frequently abnormal (58% of patients).

Conclusions CONCLUSIONS: Patients with mild stroke and TIA have a range of cognitive deficits undetectable on the NIHSS in the acute setting. The MoCA detected abnormalities more frequently than the other tests and may be well suited for bedside testing in acute stroke. We continue to enroll patients to improve our estimates of cognitive deficits in this patient population and are re-evaluating them at 90 days to determine if these cognitive impairments persist and have an impact on quality of life.

Authors/Disclosures
Andrew Bursaw, DO PRESENTER	No disclosure on file
	No disclosure on file
Sean I. Savitz, MD	Dr. Savitz has nothing to disclose.
Christopher C. LaGanke, MD (North Central Neurology Associates, PC)	Dr. LaGanke has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for EMD Serono. Dr. LaGanke has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Sanofi. Dr. LaGanke has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Biogen. Dr. LaGanke has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Sanofi. Dr. LaGanke has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Novartis. Dr. LaGanke has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for GSK. Dr. LaGanke has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Serono EMD. Dr. LaGanke has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Genentech. Dr. LaGanke has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Bristol Myers Squibb. Dr. LaGanke has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for TG Therapeutics.

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