Serial montreal cognitive assessments demonstrate reversible cognitive impairment in patients with acute transient ischemic attack and minor stroke.
OBJECTIVE
Cognitive changes after ischemic stroke are often overlooked, particularly acutely and in patients with mild or transient deficits. We assessed patients with transient ischemic attack (TIA)/minor stroke with serial cognitive screening tests. We tested the hypothesis that mild acute deficits are transient and improve after TIA/minor stroke.


METHODS
Patients with acute TIA/minor ischemic stroke, without a history of cognitive impairment, presenting with a National Institute of Health Stroke Scale score ≤3 were assessed <72 hours of onset. Patients were administered the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA) at days 1, 7, 30, and 90. Cognitive impairment was defined as MoCA <26 and MMSE ≤26.


RESULTS
One hundred patients with a median (interquartile range) National Institute of Health Stroke Scale score of 1 (2) and median age of 68 (20) years were included. Baseline median MoCA score (26 [4]) was lower than the MMSE (29 [2]; P<0.0001). Cognitive impairment was detected in 54 of 100 patients (54%) with MoCA and 16 of 100 (16%; P=0.001) with MMSE. MoCA scores improved at day 7 (27 [5]), day 30 (28 [2]), and day 90 (28 [2]; P<0.0001). Resolution of cognitive deficits was because of resolution of recall deficits.


CONCLUSIONS
Acute temporary cognitive impairment after TIA/minor stroke is common. The MoCA is sensitive to these changes, but the MMSE is not. Routine cognitive assessment after TIA/minor stroke may be warranted and relevant to return to activities even when other neurological deficits are not evident.
From the Department of Medicine, Division of Neurology, University of Alberta, Edmonton, Alberta, Canada.
Leka
L
Sivakumar
From the Department of Medicine, Division of Neurology, University of Alberta, Edmonton, Alberta, Canada.
Mahesh
M
Kate
From the Department of Medicine, Division of Neurology, University of Alberta, Edmonton, Alberta, Canada.
Thomas
T
Jeerakathil
From the Department of Medicine, Division of Neurology, University of Alberta, Edmonton, Alberta, Canada.
Richard
R
Camicioli
From the Department of Medicine, Division of Neurology, University of Alberta, Edmonton, Alberta, Canada.
Brian
B
Buck
From the Department of Medicine, Division of Neurology, University of Alberta, Edmonton, Alberta, Canada. ken.butcher@ualberta.ca.
Ken
K
Butcher
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000150:complications / Q000503:physiopathology; D003071:Cognition; D003072:Cognition Disorders / Q000209:etiology / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020521:Stroke / Q000150:complications / Q000503:physiopathology
ischemic attack, transient; mild cognitive impairment