title: Computer tomography for prediction of cognitive outcomes after ischemic cerebrovascular events.
abstract: BACKGROUND
  The aim of this study was to evaluate whether parameters noted on a single, acute computed tomographic (CT) scan, are associated with significant cognitive impairment (SCogI), and can help in the prediction of SCogI 3-6 months after stroke or transient ischemic attack (TIA).
  
  
  METHODS
  Patients with a recent (≤14 days) ischemic stroke or TIA, without preexisting dementia, underwent noncontrast CT scan within 24 hours of admission. A formal neuropsychologic battery was administered 3-6 months from index stroke. SCogI was defined as moderate cognitively impaired, not demented (CIND) (≥3 domains impaired), and dementia diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria. Logistic regression models were used to examine associations between CT parameters and SCogI. Receiver operating characteristic analysis with an area under the curve (AUC) was performed to assess discriminatory ability of radiological parameters for SCogI.
  
  
  RESULTS
  In all, 318 patients were included: 250 (78.6 %) with ischemic stroke and 68 (21.4%) with TIA; the mean age was 59.8 (±11.4) years. At 3-6 months, 76 (23.9 %) had SCogI (67 CIND moderate and 9 dementia). The presence of significant atrophy (P = .02) and chronic infarcts (P = .03) were associated with SCogI at 3-6 months. A significant increase in AUC was noted after addition of summarized CT results to a clinical score derived from age and baseline Montreal Cognitive Assessment (cutoff 21 of 22) for detection of SCogI: .83 (.78-.89) to .86 (.82-.91); P = .03.
  
  
  CONCLUSIONS
  CT parameters are independently associated with SCogI at 3-6 months after an ischemic cerebrovascular event and may be a clinically useful component in predicting for SCogI after stroke.
authors.affiliation: Department of Pharmacology, National University of Singapore, Singapore, Singapore; Department of Medicine, National University Hospital, National University Health System, Singapore, Singapore; Memory Aging and Cognition Centre, Departments of Pharmacology and Psychological Medicine, National University Health System, Singapore, Singapore.
authors.forename: Monica
authors.initials: M
authors.lastname: Saini
authors.affiliation: Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.
authors.forename: Chuen S
authors.initials: CS
authors.lastname: Tan
authors.affiliation: Department of Pharmacology, National University of Singapore, Singapore, Singapore; Memory Aging and Cognition Centre, Departments of Pharmacology and Psychological Medicine, National University Health System, Singapore, Singapore.
authors.forename: Saima
authors.initials: S
authors.lastname: Hilal
authors.affiliation: Department of Pharmacology, National University of Singapore, Singapore, Singapore; Memory Aging and Cognition Centre, Departments of Pharmacology and Psychological Medicine, National University Health System, Singapore, Singapore.
authors.forename: YanHong
authors.initials: Y
authors.lastname: Dong
authors.affiliation: Department of Diagnostic Imaging, National University Hospital, National University Health System, Singapore, Singapore.
authors.forename: Eric
authors.initials: E
authors.lastname: Ting
authors.affiliation: Memory Aging and Cognition Centre, Departments of Pharmacology and Psychological Medicine, National University Health System, Singapore, Singapore; Singapore Eye Research Institute, Singapore National Eye Center, Singapore, Singapore; Department of Ophthalmology, National University of Singapore, Singapore, Singapore.
authors.forename: Mohammad K
authors.initials: MK
authors.lastname: Ikram
authors.affiliation: Division of Neurology, Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore.
authors.forename: Vijay K
authors.initials: VK
authors.lastname: Sharma
authors.forename: Narayanaswamy
authors.initials: N
authors.lastname: Venketasubramanian
authors.affiliation: Department of Pharmacology, National University of Singapore, Singapore, Singapore; Memory Aging and Cognition Centre, Departments of Pharmacology and Psychological Medicine, National University Health System, Singapore, Singapore. Electronic address: phccclh@nus.edu.sg.
authors.forename: Christopher
authors.initials: C
authors.lastname: Chen
mesh_terms: D000368:Aged; D002545:Brain Ischemia / Q000175:diagnosis* / Q000523:psychology*; D003072:Cognition Disorders / Q000209:etiology* / Q000523:psychology*; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002546:Ischemic Attack, Transient / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D011237:Predictive Value of Tests; D020521:Stroke / Q000175:diagnosis; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome
keywords: Stroke; cognitive impairment; dementia; transient ischemic attack