title: Association of the ASCO classification with the executive function subscores of the Montreal cognitive assessment in patients with postischemic stroke.
abstract: BACKGROUND
  The ASCO classification can evaluate the etiology and mechanisms of ischemic stroke more comprehensively and systematically than conventional stroke classification systems such as Trial of Org 10172 in Acute Stroke Treatment (TOAST). Simultaneously, risk factors for cognitive impairment such as arterial sclerosis, leukoaraiosis, and atrial fibrillation can also be gathered and graded using the ASCO classification.
  
  
  METHODS
  Sixty patients with postischemic stroke underwent cognitive testing, including testing by the Japanese version of the Montreal cognitive assessment (MoCA-J) and the mini-mental state examination (MMSE). Ischemic strokes were categorized and graded by the ASCO classification. In this phenotype-based classification, every patient is characterized by the A-S-C-O system (A for Atherosclerosis, S for Small vessel disease, C for Cardiac source, and O for Other cause). Each of the 4 phenotypes is graded 0, 1, 2, or 3, according to severity. The conventional TOAST classification was also applied. Correlations between individual MoCA-J/MMSE scores and the ASCO scores were assessed.
  
  
  RESULTS
  The total score of the ASCO classification significantly correlated with the total scores of MoCA-J and MMSE. This correlation was more apparent in MoCA-J than in MMSE, because MoCA-J scores were normally distributed, whereas MMSE scores were skewed toward the higher end of the range (ceiling effect). Results for individual subtests of MoCA-J and MMSE indicated that cognitive function for visuoexecutive, calculation, abstraction, and remote recall significantly correlated with ASCO score.
  
  
  CONCLUSIONS
  These results suggest that the ASCO phenotypic classification of stroke is useful not only for assessing the etiology of ischemic stroke but also for predicting cognitive decline after ischemic stroke.
authors.affiliation: Division of Neurology, Graduate School of Medicine, Kobe University, Kobe, Japan. Electronic address: washida@med.kobe-u.ac.jp.
authors.forename: Kazuo
authors.initials: K
authors.lastname: Washida
authors.affiliation: Department of Neurology, The National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
authors.forename: Masafumi
authors.initials: M
authors.lastname: Ihara
authors.affiliation: Division of Neurology, Graduate School of Medicine, Kobe University, Kobe, Japan.
authors.forename: Hisatsugu
authors.initials: H
authors.lastname: Tachibana
authors.affiliation: Division of Neurology, Graduate School of Medicine, Kobe University, Kobe, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Sekiguchi
authors.affiliation: Division of Neurology, Graduate School of Medicine, Kobe University, Kobe, Japan.
authors.forename: Hisatomo
authors.initials: H
authors.lastname: Kowa
authors.affiliation: Division of Neurology, Graduate School of Medicine, Kobe University, Kobe, Japan.
authors.forename: Fumio
authors.initials: F
authors.lastname: Kanda
authors.affiliation: Division of Neurology, Graduate School of Medicine, Kobe University, Kobe, Japan.
authors.forename: Tatsushi
authors.initials: T
authors.lastname: Toda
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000145:classification* / Q000150:complications / Q000523:psychology*; D003071:Cognition; D060825:Cognitive Dysfunction / Q000209:etiology / Q000523:psychology*; D018450:Disease Progression; D056344:Executive Function; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D012307:Risk Factors; D020521:Stroke / Q000145:classification* / Q000150:complications / Q000523:psychology*; D016896:Treatment Outcome
keywords: ASCO phenotypic classification; Montreal cognitive assessment; mini-mental state examination; poststroke cognitive impairment