K P Divya1, Ramshekhar N Menon2, Ravi Prasad Varma3, P N Sylaja4, Bejoy Thomas5, C Kesavadas5, J Sunitha1, V S Lekha1, S Deepak1. 1. Cognition and Behavioural Neurology Section, Department of Neurology, SreeChitraTirunal Institute for Medical Sciences and Technology, Trivandrum 695011, India. 2. Cognition and Behavioural Neurology Section, Department of Neurology, SreeChitraTirunal Institute for Medical Sciences and Technology, Trivandrum 695011, India. Electronic address: rsnmenon@sctimst.ac.in. 3. Department of Biostatistics, Sree ChitraTirunal Institute for Medical Sciences and Technology, Trivandrum 695011, India. 4. Comprehensive Stroke Care Centre, Department of Neurology, SreeChitraTirunal Institute for Medical Sciences and Technology, Trivandrum 695011, India. 5. Department of Imaging Sciences and Interventional Radiology, SreeChitraTirunal Institute for Medical Sciences and Technology, Trivandrum 695011, India.
Abstract
PURPOSE: To elucidate the cognitive profiles of post-stroke vascular mild cognitive impairment (VaMCI) in comparison to MCI of non-vascular etiology and cognitively normal healthy controls at a tertiary-care hospital in southern India. RESULTS: Logistic regression analysis adjusted for age and sex comparing VaMCI [N=50] with controls [N=27] revealed significant impairment in visual, verbal learning-recall and executive function scores. As compared to the MCI group [N=36], VaMCI had significantly higher scores on Weschler's Memory Scale (WMS) verbal subset delayed recall scores (p=0.045, odds ratio [OR]=2.62, 95% CI=1.02-6.76) with lower scores on WMS-visual immediate learning scores (p=0.042, OR=0.35, 95% CI=0.13-0.96), Rey Auditory Verbal Learning Test (RAVLT) total learning scores (p=0.001, OR=0.17, 95% CI=0.06-0.48) and 20 minute recall (p=0.026, OR=0.33, 95% CI=0.12-0.88), Delayed Matching to Sample test (DMS-48) abstract immediate (p=0.002, OR=0.20, 95% CI=0.07-0.56), abstract delayed recognition sub-sets (p=0.014, OR=0.28, 95% CI=0.10-0.78) and made more total errors on Wisconsin Card Sorting Test (WCST; p=0.040, OR=2.70, 95% CI=1.05-7.14) while the MCI group significantly had more commission errors on RAVLT (p≤0.001, OR=0.13, 95% CI=0.05-0.38) and WCST - perseverative errors (p=0.036, OR=0.30, 95% CI=0.10-0.93). Significant differences were noted in word-list learning-recall (p=0.012) and WMS verbal delayed recall (p=0.014) between VaMCI with mild versus moderate to severe deep white matter hyperintensities on neuroimaging. CONCLUSIONS: Cognitive impairment following minor stroke involves episodic verbal and visual memory over and above executive function in comparison to MCI of non-vascular etiology. Close cognitive followup is warranted with adequate risk stratification and management especially in the presence of sub-cortical leukoaraiosis which is contributory to cognitive decline in this group of patients.
PURPOSE: To elucidate the cognitive profiles of post-stroke vascular mild cognitive impairment (VaMCI) in comparison to MCI of non-vascular etiology and cognitively normal healthy controls at a tertiary-care hospital in southern India. RESULTS: Logistic regression analysis adjusted for age and sex comparing VaMCI [N=50] with controls [N=27] revealed significant impairment in visual, verbal learning-recall and executive function scores. As compared to the MCI group [N=36], VaMCI had significantly higher scores on Weschler's Memory Scale (WMS) verbal subset delayed recall scores (p=0.045, odds ratio [OR]=2.62, 95% CI=1.02-6.76) with lower scores on WMS-visual immediate learning scores (p=0.042, OR=0.35, 95% CI=0.13-0.96), Rey Auditory Verbal Learning Test (RAVLT) total learning scores (p=0.001, OR=0.17, 95% CI=0.06-0.48) and 20 minute recall (p=0.026, OR=0.33, 95% CI=0.12-0.88), Delayed Matching to Sample test (DMS-48) abstract immediate (p=0.002, OR=0.20, 95% CI=0.07-0.56), abstract delayed recognition sub-sets (p=0.014, OR=0.28, 95% CI=0.10-0.78) and made more total errors on Wisconsin Card Sorting Test (WCST; p=0.040, OR=2.70, 95% CI=1.05-7.14) while the MCI group significantly had more commission errors on RAVLT (p≤0.001, OR=0.13, 95% CI=0.05-0.38) and WCST - perseverative errors (p=0.036, OR=0.30, 95% CI=0.10-0.93). Significant differences were noted in word-list learning-recall (p=0.012) and WMS verbal delayed recall (p=0.014) between VaMCI with mild versus moderate to severe deep white matter hyperintensities on neuroimaging. CONCLUSIONS:Cognitive impairment following minor stroke involves episodic verbal and visual memory over and above executive function in comparison to MCI of non-vascular etiology. Close cognitive followup is warranted with adequate risk stratification and management especially in the presence of sub-cortical leukoaraiosis which is contributory to cognitive decline in this group of patients.
Authors: Harsimarpreet Kaur; Ashima Nehra; Sakshi Chopra; Hemchandra Sati; Rohit Bhatia; Senthil S Kumaran; R M Pandey; M V Padma Srivastava Journal: Ann Indian Acad Neurol Date: 2020-09-25 Impact factor: 1.383