Welcome to the WSC 2022 Interactive Program

Background and Aims

Vascular Cognitive Impairment (VCI) is common after stroke. It is unclear if risk differs between ischaemic stroke subtypes. In this study, we aimed to compare the VCI feature in a large vessel disease (LVD) and small vessel disease (SVD) stroke at NBC Hospital in Indonesia.

Methods

We compared demographic and clinical data from post-stroke patients who are diagnosed with VCI based on their first comprehensive neurocognitive test (CERAD, MMSE, MOCA, Digit span, Trail Making Test (TMT)) within three months of the onset of ischemic stroke in NBC Hospital from January 2020 to December 2021. Data from localization of cerebrovascular disease and VCI were analyzed by bivariate analysis.

Results

A total of 89 patients (age 61,4±11,5 years; Male, 63%) with VCI after stroke met the inclusion criteria. Including 55 (62,5%) patients with SVD and 33 (37,5%) patients who had LVD. Cognitive domains that show impairment are the naming test (BNT), Memory (Delayed Recall), Executive Function (TMT A-B), and Visuospatial. While attention and fluency language tests remain good. There is no significant difference in the disturbing domain of cognitive impairment between the two. There was no correlation effect between the cerebrovascular lesion and the neurocognitive test, but the SVD stroke group showed more impaired TMT A-B scores.

Conclusions

Despite their small vascular size, lacunar strokes appear to be related to vascular cognitive impairment, suggesting that SVD may increase their impact more than LVD. No significant domain is involved in a small vessel and large vessel disease. More comprehensive studies on VCI with stroke subtyping are needed.

Background and Aims

Brain reserve (BR) has been suggested as protective factor against cognitive impairment, but the relationship between BR and executive function (EF) post-stroke remains unclear. We aimed to study whether the relationship between BR and EF during the first 3 months post-stroke differs in patients with and without acute EF-impairment on neuropsychological tests.

Methods

Individuals with supratentorial infarctions performed neuropsychological examination 3-7 days and 3 months post-stroke. The BR-measure total intracranial volume (TICV) was assessed at 3 months using MRI. Composite scores for EF at 3 months and change in EF-scores from 3-7 days to 3 months, were calculated based on selected neuropsychological tests. T-scores ≤ 35 in at least one test 3-7 days post-stroke indicated acute EF-impairment. We used multiple linear regression with interaction, and controlled for age, sex, education and stroke severity (NIH Stroke Scale; NIHSS).

Results

Of 79 patients [mean (M) age: 64.4±8.9; 32.9% female; NIHSS-score, 1 day after admission: M=2.6±2.5], 46 (58.2%) had impaired EF 3-7 days post-stroke. Better EF at 3 months and improvement in EF during the first 3 months post-stroke was related to higher TICV in patients without acute EF-impairment on neuropsychological tests, and to lower TICV in patients with acute EF-impairment (Bonferroni-correction, p ≤ .025).

Conclusions

Higher BR seems to be associated with EF during the first 3 months post-stroke only in patients without acute EF-impairment. Thus, the effect of BR on later EF post-stroke may differ between patients with and without impairment on EF-tests in the acute phase after ischemic stroke.

Background and Aims

Cognitive impairment is one of the most common post-stroke complications. Recently, more and more attention has been paid to the role of hemostasis in stroke, including post-stroke cognitive impairment. The aim of this study was to screen for early post-stroke cognitive impairment risk hemostasis biomarkers using dynamic thrombophotometry.

Methods

In 15 patients with no prestroke signs of cognitive impairment, a dynamic thrombophotometry test was performed on 14th day post-stroke. No patients had aphasia. Early symptoms of post-stroke cognitive impairment were tested using a Montreal Cognitive Assessment Test (MoCA) performed by an independent specialist. The Local Ethics Committee approved the study.

Results

Optical clot density measured on 14th day post stroke correlated with MoCA score (r = -0.579, p = 0.024). This was further confirmed in univariate linear regression model (regression coefficient -0.393, 95% CI from -0.724 to -0.062, p = 0.024 per 1000 relative unit of clot density).

Conclusions

Higher post-stroke clot density measured using dynamic thrombophotometry is associated with early development of post-stroke cognitive impairment and lower MoCA score. More studies with bigger sample size are needed to assess this relationship in detail. The study was funded by presidential grant SP-2404.2022.4.

Background and Aims

Vascular cognitive impairment (VCI) is a devastating condition that is both a risk factor for and a sequelae of stroke. The experiences of people with VCI and their caregivers across the continuum of care are not well defined. In collaboration with People with Lived Experience (PWLE), a VCI journey map was created to capture the lived experiences and critical needs from symptom onset to diagnosis, to management and living with VCI.

Methods

Data and inputs were sought using several qualitative approaches, including: an environmental scan, with a structured literature review of research on people’s experiences with VCI, review of existing journey maps, focus groups and consultations with PWLE and caregivers to PWLE with VCI. Qualitative theme analysis and validation with PWLE and health professionals were conducted.

Results

Distinct themes and stages of a VCI journey emerged. Stages began with symptom onset, through diagnosis, management, and living with VCI. Themes included symptoms, emotions and mental health, and navigating care. Unique elements were identified and plotted along the Map such as: ongoing adaptation to changing needs, grieving losses and changes and lack of age-appropriate services and information.

Conclusions

There are knowledge gaps related to the patient and caregiver experience of VCI; however, our Journey Map indicates that PWLE and caregivers identify distinct needs throughout the VCI journey. The Journey Map can inform and provide support and facilitate self-management and system navigation for PWLE and caregivers and foster person-centered care among healthcare professionals.

Further investigation of PWLE/caregiver needs, and strategies to support identified needs is needed.

Background and Aims

The STROKE-CARD Long-Term Follow-Up Trial (NCT04205006) took place between December 2019 and the November 2021 and aimed to re-evaluate the Post-Stroke disease-management program called STROKE-CARD. Invitation criteria for this trial was a prior participation in the STROKE-CARD trial, which assessed the recovery of patients suffering from an ischemic stroke or a transitoric ischemic attack (TIA) with an ABCD² Score ≥ 3 over a period of one year. For the STROKE-CARD (NCT02156778) trial all patients living in Tyrol who had suffered an ischemic stroke or TIA and were older than 18 years were eligible. Eclusion criteria were severe diseases with an estimated life expectancy <1 year, drug addiction, severe alcohol abuse, residence outside of Tyrol or a modified Rankin Scale (mRS) score of 5 at hospital discharge.

Methods

The cognitive abilities of the study subjects were tested at each outclinic examination using MoCA and MMSE, providing us with a progression of test scores from 231 patients 3-months to 6-years after the index event. In addition, cardiovascular risk factors and cardiovascular recurrent events of our patients were recorded.

Results

In our descriptive analysis, we found a small number of study participants who switched from the mild cognitive impairment group to the no cognitive impairment group in the first year after the index event and a increase in study participants with mild cognitive impairment 3 to 6 years after the index event.

Conclusions

Cognitive ability grading using MoCA and MMSE revealed that cognitive level initially remained stable and later worsened.

Background and Aims

High-sodium diets, widely spread all over the world, have been proposed as a leading cause of vascular cognitive impairment independently from their harmful effects on cardiovascular homeostasis. Indeed, high-sodium diets are associated with reductions in cerebral blood flow, via eNOS inhibition, leading to hypoperfusion and cognitive impairment (Faraco et al. 2018). Adult hippocampal neurogenesis is closely related to neurodegenerative diseases and age-associated cognitive decline (Hort et al. 2019, Moreno-Jimenez et al. 2019). The relationship between adult hippocampal neurogenesis and cerebrovascular pathology remains unclear. Therefore, we explored the possible role of neurogenesis in the VCI mediated by high sodium diets.

Methods

Eight-week-old male wild type C57Bl/6 mice were fed either a normal diet (ND, 0.4% NaCl) or a high sodium diet (HSD, 4% NaCl). After 3, 5 or 10 weeks, the hippocampal neurogenic niche population was studied by immunofluorescence. Neuroblasts, Quiescent Neural Progenitor cells (QNP), Amplifying Neural Progenitor cells (ANP) and astrocytes were counted and compared.

Results

Our results show that HSD reduces the number of ANPs cells after three weeks of diet while QNP maintained its numbers; however, after ten weeks of diet, HSD rodents recovered from this reduction and did not show any differences in ANP neither QNP compared to the ND group. Interestingly, astrocytes increased in the subgranular zone (SGZ) of the dentate gyrus of HSD animals, suggesting that HSD might have induced a change in cell fate.

Conclusions

Altogether, our data suggest that HSD leads to a hippocampal niche dynamics dysregulation that could compromise hippocampal function.

Background and Aims

In patients with vascular diseases, subclinical manifestations of cognitive dysfunction (CD) are observed. Quick questionnaire "Hexa-Code" of relatives about the previous CD of patient (certificate of registration No.110598 dated 12.28.2021), was created by us.

Aim: assessment of CD of patients with TIA, with "Hexa-Code".

Methods

48 patients with TIA were examined. The questionnaire consists of 29 questions, which are divided into 7 blocks. There are 6 "cognitive" blocks - memory, attention, abstract thinking, executive and visual-spatial functions, orientation in time and space, language; 1 block characterizing emotional state. Each question has three answer options: "YES" - 3 points, "POSSIBLE" - 2 points, "NO" - 1 point. After calculating the total number of points, results are interpreted: 29-43 points - absence of CD, 44-58 points - subclinical level of CD, 59-72 points - moderate CD, 72-87 points - major CD ("dementia"). The above gradation corresponds to the international criteria of CD.

Results

In 25% of cases, the assessment according to the "Hexa-Code"indicated the presence of patients with subclinical level CD (44-58 points), while the assessment according to MoCA didnt reveal any deviations (p<0.05). In 20.83% of cases, the evaluation according to the "Hexa-Code"revealed milder CD, namely a subclinical level of CD (44-58 points) in 12.5% and moderate CD (59 -72 points) in 8.33% than MoCA assessment (p<0.05). In another 54.17% of cases (n=26), the "Hexa-Code"and MoCA scores were interpreted as the same.

Conclusions

The implementation of "Hexa-Code", in order to assess the CD of patients contributes to detection of the earliest manifestations of pathology.

Background and Aims

Stroke is a leading cause of death and disability worldwide. Despite the prevalence

and associated burden of post-stroke cognitive impairment, there is uncertainty regarding

optimum interventions to improve cognitive function in people post-stroke. The aim of this

study is to explore the perspectives of key stakeholders on the design and development of a

multidisciplinary intervention to rehabilitate cognitive deficits in people post-stroke.

Methods

Audio-recorded, semi-structured interviews were employed with

people post-stroke, caregivers, healthcare professionals and academics. All transcribed

interviews were exported to NVivo software and analysed using reflexive thematic analysis.

Results

Thirty interviews were conducted across stakeholder groups including people poststroke

(n=10), caregivers (n=5), healthcare professionals (n=14) and academics (n=1). Four

themes relevant to the design and development of the intervention were identified (i)

engagement in the intervention must be meaningful, (ii) the point of readiness to engage, (iii)

a familiar but flexible setting is key (iv) pragmatics of intervention delivery.

Conclusions

These findings present new perspectives across stakeholder groups on the

design and delivery of an intervention to rehabilitate cognitive deficits in people post-stroke.

Taken together with existing quantitative evidence, these findings will inform the

development of a feasibility trial, examining patient and process outcomes, for cognitive

rehabilitation with people post-stroke.

Background and Aims

It is estimated that 30-50% of people with dementia (PWD) suffer from significant depression. This fact marks that in most PWD, depression coincides with cognitive decline. Several researchers explain that this happens because PWD can not run their daily activities independently and forget many essential things, such as family. It is also known that depression occurs more in highly educated people. Therefore, we conduct this research to find correlation between depression score and global cognitive score in mild-to moderate dementia.

Methods

Forty two PWD were assessed using the Montgomery-Asberg Depression Rating Scale (MADRS) to assess the symptoms of depression and the Mini-Mental State Examination (MMSE) to assess the global cognitive score. PWD included in this research restricted only those with MMSE scores between 17 and 23 (mild cognitive impairment) and MADRS scores below 34 (no depression, mild depression, and moderate depression).

Results

Of 42 subjects, depression occurred in 41 (97,6%) of 42 subjects, and the global cognitive score mean was 19,53. Depression score has a strong correlation with global cognitive score (r=0,647, p<0,001).

Conclusions

It is assumed that many PWD is aware of their declining cognitive ability, often making them feel not confident about their condition. Some PWD became disoriented, lost appetite, and experienced sleep disturbance. It is concluded that PWD with higher global cognitive scores also has higher depression scores.

Background and Aims

Post-stroke cognitive screening is widely recommended, yet few studies have investigated the predictive value of domain-specific function for longer-term cognitive outcome. This study sought to determine the prevalence of domain-specific cognitive impairment acutely and at 6 months, assess change in cognitive performance, and examine the predictive value of acute domain-specific screening.

Methods

A prospective cohort of 430 stroke survivors was assessed using the Oxford Cognitive Screen acutely (<2 weeks) and 6 months post-stroke. Cognitive impairment was defined as impairment in ≥1 domain, characterized by a deficit in ≥1 domain subtask relative to normative data. Demographic/clinical candidate predictor variables were collected acutely. Hierarchical regression analyses were performed to predict overall and domain-specific impairment at 6 months.

Results

Cognitive impairment in ≥1 domain was found in 423 (98%) patients acutely and 293 (68%) at 6 months. Attention and language impairments were most prevalent at both timepoints. Prevalence of impairment decreased across all domains from acute to 6 months. Proportion of recovery was highest in praxis and number processing, while impairments in language and memory were most persistent. Impairment at 6 months was best predicted by the addition of acute cognitive impairment (adjusted R²=0.298, p<0.0001) over conventional risk factors alone (adjusted R²=0.085, p<0.0001). Acute cognitive function (β=0.414, p<0.0001) was the strongest predictor of 6-month cognitive performance.

Conclusions

Cognitive impairment is highly prevalent following stroke in language, attention, memory, executive function, number processing and praxis, with varying trends towards recovery, stability and decline at 6 months. Overall and domain-specific cognition significantly contribute to predicting longer-term cognitive performance.