XVII. European Stroke Conference
Nice, France
XVII. European Stroke Conference
Nice, France
Poster Session: Dementia and cognition
Session:
Poster Session I
Date:
Wednesday 14 May 2008
Time:
12:30 - 14:00
Room:
Agora 3
01
A prospective cognitive evaluation in post stroke/TIA patients using the Montreal Cognitive Assessment test (MoCA)
J.M.Boulanger
F. Boubaraoui
D. Racicot
Z. Nasreddine
L. Berger
Research Center, Charles-Lemoyne Hospital
Sherbrooke University
CANADA
Background : Prospective cognitive evaluation after cerebrovascular events is rarely described in the literature. The Montreal Cognitive Assessment test (MoCA) is a screening tool used to detect cognitive impairment but was studied mainly in Alzheimer’s disease. Methods: All patients presenting with a stroke or a transient ischemic attack (TIA) were seen and evaluated at baseline and 3 months after their events. A MoCA and a Mini Mental state (MMSE) were performed at 3 months. Scores < 26 were interpreted (according to previous validation studies) as significantly abnormal. Data were prospectively recorded. Results: From October 4th 2006 to June 15th 2007, 176 consecutive patients (mean age 69.7 years old) with a stroke or a TIA were evaluated at 3 months with a MoCA and a MMSE. One hundred thirty five patients had an ischemic stroke, 5 had an hemorrhagic stroke and 36 had a TIA. The mean MoCA and MMSE scores were respectively 21.8 and 26.3. One hundred twenty one patients (68.8%) had a MoCA score < 26 while 70 patients (39.7%) had a MMSE score < 26. Factors associated with a lower MoCA and MMSE scores were: age > 65 years old (MoCA 20.5 vs 24.6 ; p<0.0001; MMSE 20.5 vs 25.7; p= 0.003), baseline dementia (MoCA 8.8 vs 22.7; p<0.0001; MMSE 18.3 vs 26.8; <0.0001) and baseline National Institute of Health Stroke Score (NIHSS) > 8 (MoCA 16.2 vs 22.9; p<0.0001; MMSE 21.2 vs 27.1; p<0.0001). These factors remained significant after multivariate analysis except for the relationship between age>65 and MMSE (p=0.128). Factors considered but not statistically significant were: hypertension, diabetes, coronary artery disease, hyperlipemia, peripheral artery disease, past stroke, stroke vs TIA (index event), atrial fibrillation, glucose and stroke subtypes. Discussion: Cognitive impairment is frequent 3 months after a cerebrovascular event. A MoCA test is more sensitive to cognitive impairment than a MMSE in these patients. It is easy to administer and should be considered in all patients with a cerebrovascular event, especially in those with an ambiguous MMSE.
Session:
Poster Session I
Date:
Wednesday 14 May 2008
Time:
12:30 - 14:00
Room:
Agora 3
02
Cognitive-Impairment-No-Dementia (CIND) after stroke: a 4-year follow up study
F. Sciotto
M. Altieri
V . Di Piero
M. Gasparini
E. Vicenzini
I. Maestrini
B. Petolicchio
M. Toscano
A. Viganò
G.L.Lenzi
Clinica Neurologica A Sapienza University Rome
ITALY
Background and aims: Cognitive-Impairment-No-Dementia (CIND) is a diagnostic label applied to individuals presenting cognitive impairment that does not meet formal criteria for dementia. Since clinical criteria for CIND are still lacking, its frequency in stroke patients is wide, ranging from 35-71%. Patients with CIND seem to be at increased risk of developing post-stroke dementia (PSD). The aim of this study was to determine the incidence of CIND in a consecutive series of patients admitted to our stroke unit, to investigate the probable risk factors for CIND, and to estimate the rates of cognitive changes during a 4-year follow-up. Methods: Non-demented patients after 6 months from stroke onset were followed-up for 4 years. Patients were examined according to a standardized neurological and instrumental procedure, and underwent a complete neuropsychological (NP) assessment; CIND was defined as failure in at least one cognitive domain with a score below the sixth percentile in ? 50% of the tests exploring that domain. The same evaluation, including neuroimaging and NP tests, was annually repeated at each control. Results: 181 stroke patients (mean age 64.6 +/- 9.6 years; m/f 126/55) fulfilling the inclusion criteria were recruited. At the end of follow-up 46 (25.4%) patients developed CIND. The annual incidence was 6.4%. The incidence of CIND was higher in older patients (p= 0.047) and presenting silent infarcts (SIs) at baseline MRI (p=0.003). During the entire follow up 8.8% of CIND patients developed PSD, 13.3% remained stable, and 3.3% of patients returned cognitively normal. Conclusion: More than one-fourth of our patients developed CIND during a 4-year follow-up. In our patients CIND is mainly a stable condition and seems not increase the risk of developing PSD.
Session:
Poster Session I
Date:
Wednesday 14 May 2008
Time:
12:30 - 14:00
Room:
Agora 3
03
Preexisting dementia in patients with intra-cerebral haemorrhages: prevalence, associated factors and influence on short term outcomes
C. Cordonnier
D. Leys
M.P.Rutgers
F. Dumont
F. Pasquier
H. Hénon
Department of neurology and stroke unit, Lille University Hospital
FRANCE
Cerebrovascular diseases and dementia are closely linked. However, data available mainly concern ischaemic strokes. The relationships between intra-cerebral haemorrhages (ICH) and dementia should be even stronger than that between cerebral ischaemia and dementia because of the relationship between Alzheimer’s disease and amyloid angiopathy and hypertension. We aimed at determining the prevalence of pre-existing dementia in ICH patients, associated factors, and influence on short-term outcome. Methods. We evaluated the cognitive status before stroke with the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) in 265 consecutive patients (median age 68 years; interquartile range 54-78) admitted for a parenchymal haemorrhage, with a cut-off at 4 for a diagnosis of dementia. Results. Thirty-nine patients (15%; 95% confidence interval (CI): 11-19) were demented before ICH. Factors independently associated with preexisting dementia were female gender (OR 2.5; IC95% 1.1-10), previous stroke (OR 5.9; IC95% 2.3-15.4), cerebral atrophy score (OR 3.9: IC95% 1.9-7.9), leukoaraïosis score (OR 1.8; IC95% 1.1-2.9) and lobar location of ICH (OR 2.5; IC95% 1.01-6.01). Pre-existing dementia did not influence the short-term outcome. Discussion. The prevalence of 15% is close to that found in ischaemic stroke cohorts suggesting that the nature (ischaemic or haemorrhagic) of the vascular lesion may be less important in the pathogenesis of cognitive impairment than vascular risk factors. Patients with lobar ICH were more likely to have preexisting dementia. This finding is in line with the hypothesis that a frequent cause of lobar hemorrhage, cerebral amyloid angiopathy, is often associated with Alzheimer pathology.
Session:
Poster Session I
Date:
Wednesday 14 May 2008
Time:
12:30 - 14:00
Room:
Agora 3
04
Memory impairment caused by oxidative stress generation in the intraventricular area of rats
A. Ciobica
L. Hritcu
V. Artenie
Alexandru Ioan Cuza, University
ROMANIA
BACKGROUND: Impairments of cognitive performance have been observed in normal rats with beta-adrenergic and D1-dopamine receptors blockade, suggesting that these receptors have a facilitator role in learning and memory processes. In the present study, we examined whether oxidative stress contributes to the memory deficits induced by beta-adrenergic and D1-dopamine receptors blocked by means of pindolol and SCH 23390. METHODS Male Wistar rats were divided into three groups: 1. sham-operated; 2. Pindolol; 3. SCH 23390. All drugs were stereotaxically injected in the rat intraventricular area. Rats were treated 12 days. Learning and memory tests began 2 weeks after the operation, and the ability of the rats to acquire the operant task was studied by means of Y-maze task and radial arm-maze task, respectively. We evaluated the antioxidant enzymes activity. RESULTS Intrahippocampus injections of pindolol (10µg/µl, 4.5 µl/site) and SCH 23390 (0.3µg/µl, 4.5 µl/site) resulted in a significant impairment of both working and reference memory tested by means of radial arm-maze task, suggesting significant effects of spatial memory. Pindolol and SCH 23390 significantly decreased spontaneous alternation in Y-maze task, suggesting effects on spatial memory, especially on short-term memory. We observed that the levels of superoxide dismutase (SOD) and glutathione peroxidase (GPX) decreased in rats with beta-adrenergic (βAR) and D1-dopamine (D1R) receptors blockade by means of pindolol (10µg/µl, 4.5 µl/site) and SCH 23390 (0.3µg/µl, 4.5 µl/site), respectively, and the level of malondialdehyde (MDA) increase in same rats, compared with sham-operated rats. DISCUSSION Learning and memory processes are coordinated with different brain regions. Since the oxidative damage may play a role in the aging process, including the associated decline, age-related impairment in spatial learning and memory may be alleviated by antioxidant treatment. Our results suggest that oxidative stress damage of the brain induced impairment in spatial memory of rats.
Session:
Poster Session I
Date:
Wednesday 14 May 2008
Time:
12:30 - 14:00
Room:
Agora 3
05
MRI and risk factor assessment in TGA
U. Lex
R. Krendl
F. Schautzer
P. Kapeller
LKH Villach
AUSTRIA
Introduction: Transient global amnesia (TGA) is a so far benign disease affecting short term memory causing typical symptoms like making the patient asking repetitive questions. Lasting several hours symptoms cease spontaneously with only a small possibility of recurrence. Whilst vascular or epileptic factors combined with emotional stress dominates current discussions about its cause the definite mechanism about TGA`s pathophysiology is still undetermined. DWI may show tiny spots of enhanced diffusion in the hippocampus. Objectives: To determine the value of MRI and risk factor assessment in a clinically routine setting. Methods: We retrospectively evaluated brain MRI according to micro and macroangiopathy and checked on diffusion changes in the hippocampal region. In addition we assessed vascular risk factors (RR, cardiac disease, Diabetes, carotid ultrasound) and correlated with MRI findings. Results: 54 patients (mean age 67.2 yrs, 36m/18f) with TGA were retrospectively enclosed seen in 2006 and 2007. 23 received brain MRI (43%), 13 of which had additional DWI (24%). Microangiopathy evident as lacunes and white matter hyperintensities grade 2 (patchy) and 3 (confluent) was seen in 10 patients. Cardiovascular risk factors were seen in 8 (hypertension), 5 (diabetes) and 1 (angina pectoris) patient respectively. ACI stenosis ≥ 60% was seen in 1 patient. DWI positive lesions in the hippocampal area were evident in 3 individuals (23%). Emotional distress as possible trigger was present in 5 patients in the DWI group and in 22 in the overall group. Conclusions: Cardiovascular risk factors and emotional distress is frequent in patients suffering TGA. Non of the hippocampal lesions was diagnosed during routine scan reading. DWI scans enhance the diagnostic accuracy in TGA.
Session:
Poster Session I
Date:
Wednesday 14 May 2008
Time:
12:30 - 14:00
Room:
Agora 3
06
Angiotensin II type 1 receptor blocker telmisartan prevented cognitive decline in amyloid beta-injected mice
M. Masaki
J.-M.Li
K. Tsukuda
J. Iwanami
L.-J.Min
A. Sakata
T. Fujita
M. Iwai
M. Horiuchi
Ehime University Graduate School of Medicine
JAPAN
Poor cognitive performance induced by Alzheimer's disease significantly impairs social interaction and the quality of life of patients. In part, management of blood pressure with antihypertensive drugs is reported to be effective for prevention cognitive decline; however, little is known about the effects of antihypertensive drugs on Alzheimer's disease. Telmisartan, an angiotensin type 1 receptor blocker (ARB), has been reported to have a therapeutical effectiveness particularly in patients with metabolic syndrome with peroxisome proliferator-activated receptor (PPAR)-gamma agonistic effect. Here, we investigated the possible preventive effect of telmisartan on cognitive decline in Alzheimer's disease, using its acute mouse model induced by amyloid-beta (Agamma) injection in the brain. Cognitive function was evaluated as an avoidance rate of 20-trials by shuttle avoidance tests. We used non-hypotensive dose of telmisartan in ddY mice. A gamma 1-40 was intracerebroventricularly administrated with 200 pmol in 5gamma l phosphate buffer saline. After 2 weeks of Agamma injection, the mice showed a significant reduction of cognitive function. Pretreatment with telmisartan significantly inhibited such cognitive decline. Interestingly, co-treatment with GW9662, PPAR-gamma antagonist partially inhibited this telmisartan-mediated improvement of cognitive decline. Other ARB, losartan, which has less PPAR-gamma agonistic effect, also inhibited A gamma-injection-induced cognitive decline; however the effect was lower than that of telmisartan. Co-treatment with GW9662 did not affect losartan-mediated improvement of cognitive decline. These findings suggest that ARB has preventive effect on cognitive impairment in Alzheimer's disease and telmisartan could exert stronger effect with PPAR-gamma activation.
Session:
Poster Session I
Date:
Wednesday 14 May 2008
Time:
12:30 - 14:00
Room:
Agora 3
07
Elevated C-Reactive Protein (CRP) Levels Predict Poorer Cognitive Functions Among Patients with Preexisting Atherothrombotic Disease
G. Weinstein
U. Goldbourt
R. Schwartz
T. Phillips
D. Tanne
Sheba Medical Center & Tel Aviv University
ISRAEL
Background- Chronic low-grade inflammation may be a risk factor for dementia in elderly persons. Our aim was to test the hypothesis that elevated concentrations of CRP predict poorer cognitive function and in-particular executive function among patients with CHD. Methods- A subgroup of Coronary heart disease (CHD) patients who previously participated in a trial of lipid modification was assessed. CRP was measured by a high-sensitivity assay from thawed frozen (-700c) plasma samples collected at baseline. Cognitive scores were assessed ~15 years later, using the Mini Mental State Examination test, the clock drawing test and a validated set of computerized cognitive tests (Mindstreams Computerized Cognitive Battery; computing index scores summarizing performance in each cognitive domain and a global cognitive score). We compared means of cognitive scores between patients in the highest CRP tertile (CRP >/= 3.6mg/L) and patients in the lower tertiles. Results- Among 346 patients (mean age 72+/-6 yrs, 95% males, 19% diabetics) the mean clock drawing test score and the computerized global score (10.5+/-2.5 vs. 11.0+/-2.2; p=0.04 and 91.6+/-11.3 vs. 95.4+/-11.3; p=0.004, respectively) were lower among patients in the upper CRP tertile as compared to those in the lower two tertiles. The main domains affected were the executive and memory (93.3+/-11.5 vs. 97.9+/-12.4; p=0.001 and 84.8+/-15.4 vs. 89.7+/-15.0; p=0.007, respectively). These differences remained significant after adjustment for potential confounders. Discussion- Increased CRP levels are associated with cognitive impairment and with poorer executive and memory functions among CHD patients. These results support the hypothesis that chronic low-grade inflammation may be involved in vascular cognitive impairment.
Session:
Poster Session I
Date:
Wednesday 14 May 2008
Time:
12:30 - 14:00
Room:
Agora 3
08
Event Related Potential (ERP) P300 in Brain Infarction
U. Meenakshisundaram
C.U.Velmurugendran
Sri Ramachandra University
INDIA
Event Related Potentials(ERPs) are brain responses time-locked to some "event". This event may be a sensory stimulus, a mental event, or the omission of a stimulus. ERPs have been used as a tool for evaluation of cognitive functions of the brain. 20 patients were tested following ischemic stroke in the Acute Stroke Care Unit of Sri Ramachandra Medical Center, Sri Ramachandra University, Chennai. P300 auditory ERPs were recorded using Nicolet Viking NT-IV system. P1, N1, and P2 components were measured to standard stimuli, and P3 component to target and novel stimuli. The peak amplitude of each component was measured relative to the 200 msec prestimulus baseline. Inclusion and exclusion criteria for patient selection were strictly applied and the results obtained in these patients were compared with those obtained in age-matched controls. Results: 80% of patients with acute ischemic stroke showed prolongation of the novelty P3 amplitude while 50% showed reduced novelty P3 amplitude. Conclusions: There is a significant abnormality in the ERP P300 latency and amplitude following brain infarction. The abnormality in left hemispheric infarcts is greater than in right hemispheric infarcts. P300 abnormalities are also seen in vertebrobasilar territory infarction.
Session:
Poster Session I
Date:
Wednesday 14 May 2008
Time:
12:30 - 14:00
Room:
Agora 3
09
Patients undergoing left Carotid endarterectomy (CEA) have reported short-term improvement on Verbal Fluency
I. Rico Pons
M.A.Font Padros
A. Carvajal
M. Juncadella
C. Junque
J. Krupinski
Hospital Universitari de Bellvitge
SPAIN
Background: Carotid endarterectomy (CEA) has been shown to reduce the long-term risk of stroke in selected patients, but data concerning the changes in neuropsychological functions following CEA remains controversial. So far, published studies have reported opposing findings, with some reporting an apparent decrement in cognitive function and others reporting no effect or an apparent improvement. The aim of the present study was first, to examine the effect of CEA on cognitive function; and second to evaluate changes in hemispheric functions ipsilateral to the side of CEA in patients with unilateral high-grade stenosis in the left or right carotid artery. Methods: Thirteen right-handed patients undergoing CEA for symptomatic or asymptomatic high-grade unilateral carotid stenosis (aged 65 ± 8,5 yrs) without history of a major stroke (Rankin≤1) were assessed with an accurate neuropsychological battery of tests one day prior to CEA and three months after the intervention. Results: One patient was excluded after a postoperative stroke. The analyses of ipsilateral effects of CEA in cognition revealed a significant improvement in a verbal Fluency Task only in the left-operated patients on the follow-up assessment (p=0,011) and reaching scores of right-operated patients at three months. None of the tests scores showed significant improvement between the first and follow-up test in twelve remaining patients, but scores declined significantly on working memory function assessed by Digit Backward (6,67 +/- 2 vs. 4,17 +/- 1, p=0.014). Discussion: A decreased performance in working memory after CEA may be associated with ischemia from global hypoperfusion while removal of stenosis is associated with a restorative effect of cerebral blood flow and leads to an improvement in left-operated patients in a verbal fluency task.
Session:
Poster Session I
Date:
Wednesday 14 May 2008
Time:
12:30 - 14:00
Room:
Agora 3
10
Relationship of Methylenetetrahydrofolate Reductase C677T polymorphism and Vascular Dementia: preliminary study
O.J.Kim
D.G.Kim
S.H.Oh
Pochon CHA University, Kyunggi-do
SOUTH KOREA
Background & Objective : Recent studies have shown relationship between hyperhomocysteinemia and cognitive impairment. Methylenetetrahydrofolate reductase (MTHFR) is a key enzyme of homocysteine metabolism. The purpose of this study was to investigate the relations of MTHFR polymorphism and vascular dementia (VD). Methods : Between January 2005 and May 2007, 303 individuals underwent formed neuropsychological test and magnetic resonance image (MRI). We seleted 79(26%) subjects available MTHFR genotype screening. We compared the MTHFR polymorphism in 24 patients (5 men, 19 women, mean age 67.3) diagnosed as VD and 55 normal controls. VD was diagnosed by NINDS-AIREN criteria. Laboratory test including serum homocysteine, vitamine B12, folate, lipid profile was performed in all participants. Result : There was statistical difference in allelic frequency of MTHFR between VD and control (p=0.011). Frequency of MTHFR polymorphism (CC, CT, TT type) in VD patients were 22 (40%), 29 (52.7%), 4 (7.3%), respectively, in comparing with those in control (4 (16.7%), 14 (58.3%), 6 (25%)). The MMSE was significant lower in VD group than normal control. (p<0.01)There were non-significnant tendency of increased homocysteine level in TT type comparing with CC type in each group. The MMSE, vit B12, folate, and lipid profile were not different between two group, and among the MTHFR genotyping Conclusions : TT genotye of MTHFR may be associated with increased risk of vascular dementia. There was postiive tendency of increased homocysteine level in TT genotype, although it failed to reach statistical significance due to small sample size.. Further studywill be needed to clarify whether MTHFR polymorphism is associated w! ith icreased rsik of VD.
Session:
Poster Session I
Date:
Wednesday 14 May 2008
Time:
12:30 - 14:00
Room:
Agora 3
11
Apolipoprotein E ε4 allele frequency
in Korean Patients with Vascular Dementia
M.Y.Park
Yeungnam University Medical Center
SOUTH KOREA
Background : The clinical significance of the apolipoprotein E (Apo E) ε4 allele in vascular dementia (VaD) has been a subject of debate. VaD is the most common subtype of dementia in Korean population. Apo E allele frequencies were evaluated in Korean patients with VaD diagnosed by the Erkinjuntti criteria of subcortical vascular dementia and mini-mental-state examination (MMSE) in this study. Methods : Forty patients participated in the study. Twenty had a diagnosis of VaD, and twenty controls without dementia and risk factors of stroke who had absolutely normal brain MRI findings. The Apo E genotype was determined by the polymerase chain reaction (PCR) and allele specific hybridization using the Apo E typing test kit. Results : The Apo E ε4 allele frequency in the VaD group was 20％ and was not significantly different from those of normal controls (15％). The severity of dementia assessed by K-MMSE was not different between the VaD patients with Apo E ε4 allele and the VaD patients without Apo E ε4 allele. Conclusions : These results did not show neither increased frequency of Apo E ε4 allele in Korean VaD patients, nor any differences in trends compared to control subjects.
