Giovanna Zamboni1, Ludovica Griffanti2, Mark Jenkinson2, Sara Mazzucco2, Linxin Li2, Wilhelm Küker2, Sarah T Pendlebury2, Peter M Rothwell2. 1. From the Stroke Prevention Research Unit, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital (G.Z., L.G., S.M., L.L., W.K., S.T.P., P.M.R.) and Oxford Centre for Functional MRI of the Brain (FMRIB) (M.J.), Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom. Giovanna.zamboni@ndcn.ox.ac.uk. 2. From the Stroke Prevention Research Unit, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital (G.Z., L.G., S.M., L.L., W.K., S.T.P., P.M.R.) and Oxford Centre for Functional MRI of the Brain (FMRIB) (M.J.), Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom.
Abstract
BACKGROUND AND PURPOSE: Among screening tools for cognitive impairment in large cohorts, the Montreal Cognitive Assessment (MoCA) seems to be more sensitive to early cognitive impairment than the Mini-Mental State Examination (MMSE), particularly after transient ischemic attack or minor stroke. We reasoned that if MoCA-detected early cognitive impairment is pathologically significant, then it should be specifically associated with the presence of white matter hyperintensities (WMHs) and reduced fractional anisotropy (FA) on magnetic resonance imaging. METHODS: Consecutive eligible patients with transient ischemic attack or minor stroke (Oxford Vascular Study) underwent magnetic resonance imaging and cognitive assessment. We correlated MoCA and MMSE scores with WMH and FA, then specifically studied patients with low MoCA and normal MMSE. RESULTS: Among 400 patients, MoCA and MMSE scores were significantly correlated (all P<0.001) with WMH volumes (rMoCA=-0.336; rMMSE=-0.297) and FA (rMoCA=0.409; rMMSE=0.369) and-on voxel-wise analyses-with WMH in frontal white matter and reduced FA in almost all white matter tracts. However, only the MoCA was independently correlated with WMH volumes (r=-0.183; P<0.001), average FA values (r=0.218; P<0.001), and voxel-wise reduced FA in anterior tracts after controlling for the MMSE. In addition, patients with low MoCA but normal MMSE (n=57) had higher WMH volumes (t=3.1; P=0.002), lower average FA (t=-4.0; P<0.001), and lower voxel-wise FA in almost all white matter tracts than those with normal MoCA and MMSE (n=238). CONCLUSIONS: In patients with transient ischemic attack or minor stroke, early cognitive impairment detected with the MoCA but not with the MMSE was independently associated with white matter damage on magnetic resonance imaging, particularly reduced FA.
BACKGROUND AND PURPOSE: Among screening tools for cognitive impairment in large cohorts, the Montreal Cognitive Assessment (MoCA) seems to be more sensitive to early cognitive impairment than the Mini-Mental State Examination (MMSE), particularly after transient ischemic attack or minor stroke. We reasoned that if MoCA-detected early cognitive impairment is pathologically significant, then it should be specifically associated with the presence of white matter hyperintensities (WMHs) and reduced fractional anisotropy (FA) on magnetic resonance imaging. METHODS: Consecutive eligible patients with transient ischemic attack or minor stroke (Oxford Vascular Study) underwent magnetic resonance imaging and cognitive assessment. We correlated MoCA and MMSE scores with WMH and FA, then specifically studied patients with low MoCA and normal MMSE. RESULTS: Among 400 patients, MoCA and MMSE scores were significantly correlated (all P<0.001) with WMH volumes (rMoCA=-0.336; rMMSE=-0.297) and FA (rMoCA=0.409; rMMSE=0.369) and-on voxel-wise analyses-with WMH in frontal white matter and reduced FA in almost all white matter tracts. However, only the MoCA was independently correlated with WMH volumes (r=-0.183; P<0.001), average FA values (r=0.218; P<0.001), and voxel-wise reduced FA in anterior tracts after controlling for the MMSE. In addition, patients with low MoCA but normal MMSE (n=57) had higher WMH volumes (t=3.1; P=0.002), lower average FA (t=-4.0; P<0.001), and lower voxel-wise FA in almost all white matter tracts than those with normal MoCA and MMSE (n=238). CONCLUSIONS: In patients with transient ischemic attack or minor stroke, early cognitive impairment detected with the MoCA but not with the MMSE was independently associated with white matter damage on magnetic resonance imaging, particularly reduced FA.
Authors: Linshu Wang; Kiran Chaudhari; Ali Winters; Yuanhong Sun; Raymond Berry; Christina Tang; Shao-Hua Yang; Ran Liu Journal: Transl Stroke Res Date: 2022-07-22 Impact factor: 6.800
Authors: Giovanna Zamboni; Ludovica Griffanti; Sara Mazzucco; Sarah T Pendlebury; Peter M Rothwell Journal: Neurology Date: 2019-06-14 Impact factor: 9.910
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Authors: Vaanathi Sundaresan; Giovanna Zamboni; Campbell Le Heron; Peter M Rothwell; Masud Husain; Marco Battaglini; Nicola De Stefano; Mark Jenkinson; Ludovica Griffanti Journal: Neuroimage Date: 2019-07-31 Impact factor: 6.556