Page 519

Karger_ESC London_2013

London, United Kingdom 2013 Small vessel stroke and white matter disease (PO 440 - 462) Poster Session Red Cerebrovasc Dis 2013; 35 (suppl 3)1-854 519 439 Behavioral disorders and post-stroke dementia Repeat cognitive screening (MoCA, MMSE & ACE-R, IQCODE) in a high risk post-stroke population: data from the ‘Prevention Of Decline in Cognition After Stroke Trial’ (POD-CAST) D.J. Blackburn1, L. Fox2, M. Mangoyana3, P.M.W. Bath4 Sheffield Institute for Translational Neuroscience, University of Sheffield, Sheffield, UNIT-ED KINGDOM1, Division of Stroke Medicine, University of Nottingham, Nottingham, UNIT-ED KINGDOM2, Division of Stroke Medicine, University of Nottingham, Nottingham, UNITED KINGDOM3, Division of Stroke Medicine, University of Nottingham, Nottingham, UNITED KINGDOM4 Background: Post stroke dementia (PSD) is very common, ranging from 15-30% depending on whether pre-existent dementia is excluded (Pendlebury et al 2009). Different cognitive tests have been used to screen for post stroke dementia. Methods: We studied patients enrolled into PODCAST, a trial of risk factor management post stroke. Inclusion criteria: age >70, 3-7 months post-event, mRS 0-2 and no dementia on telephone MMSE. To date, 134 people were screened with 60 recruited. All participants undertook the Addenbrooke’s Cognitive Examination-revised (ACE-R)- primary outcome, MMSE, Montreal Cognitive Assess-ment (MoCA) and the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE). Results: Of 35 participants with baseline and 6 months data (mean age 74.97 +/- 1.21, SD 7.16; 29 male and 6 female). Two developed dementia within 13 months of stroke, associated with sharp drops in ACE-R (17, 35) and MoCA (5, 12). The baseline MoCA was significantly different in those who developed dementia vs those who did not (18.5 +/- 2.5 vs 24 +/- 0.616 p=0.01). ACE-R, MMSE and IQCODE showed a non-significant difference (74.5 +/- 6.5 vs 85.9 +/- 1.43, p=0.07; 25 +/- 3 vs 27.82 +/- 0.39 p=0.12, and 3.62 +/- 0.08 vs 3.03 +/- 0.08, p=0.08) respectively. Using cutoffs from non-stroke populations, the percentage of people screened positive on the ACE-R (<88), MoCA (<26) and MMSE (<27) was 54.3%, 74.2% and 22.8% at baseline. At 6 months follow-up (9-13 months post-stroke) all cognitive tests showed significant differences be-tween those with and without dementia. Positive screens on ACE-R, MoCA and MMSE at 6-month follow-up were 57.1%, 71.4% and 31.4%. Many participants remained stable and several had marked improvements on cognitive screening. Discussion: Baseline screening tests may predict the development of PSD. However, conventional dementia screening cutoffs may not be relevant to post-stroke populations and it may take up to one year for stabilization of cognitive function. 440 Small vessel stroke and white matter disease The interplay of white matter integrity, cognitive decline and gait impairment in cerebral small vessel disease M. Duering1, A. Kern2, R. Schniepp3, M. Gonik4, C. Pradhan5, M. Wuehr6, S. Huth7, A. Gschwendtner8, E. Jouvent9, D. Hervé10, H. Chabriat11, M. Dichgans12, K. Jahn13 Institute for Stroke and Dementia Research, University of Munich, Munich, GERMANY1, In-stitute for Stroke and Dementia Research, University of Munich, Munich, GERMANY2, German Vertigo Center (IFB), University of Munich, Munich, GERMANY3, Institute for Stroke and Demen-tia Research, University of Munich, Munich, GERMANY4, German Vertigo Center (IFB), Universi-ty of Munich, Munich, GERMANY5, German Vertigo Center (IFB), University of Munich, Munich, GERMANY6, German Vertigo Center (IFB), University of Munich, Munich, GERMANY7, Institute for Stroke and Dementia Research, University of Munich, Paris, FRANCE8, Department of Neurol-ogy, CHU Lariboisière, APHP, Paris, FRANCE9, Department of Neurology, CHU Lariboisière, APHP, Paris, FRANCE10, Department of Neurology, CHU Lariboisière, APHP, Paris, FRANCE11, Institute for Stroke and Dementia Research, University of Munich, Munich, GERMANY12, German Vertigo Center (IFB), University of Munich, Munich, GERMANY13 Background: Impairment of gait and cognitive performance is common in cerebral small vessel dis-ease (SVD). Recent studies suggest that the decline of cognition and gait are related in SVD. We aimed to study the impact of white matter integrity on gait and cognitive performance in patients with pure SVD. Furthermore we set out to disentangle the interdependence between gait and cogni-tion in relation to the spatial distribution of white matter alterations. Methods: 33 patients with CADASIL (median age 54) underwent comprehensive quantitative gait analysis, magnetic resonance imaging and cognitive testing. Gait performance was compared with 162 healthy subjects. Fractional anisotropy (FA) was analyzed using tract-based spatial statistics. We calculated group comparisons between subjects with normal and impaired gait and regression mod-els incorporating FA, a gait score and a cognitive score. Results: Altered white matter integrity within numerous white matter tracts was related to lower gait performance and also with lower cognitive performance. Interestingly, most of these associations disappeared after correcting the analysis on gait for cognitive deficits and vice versa. Some regions showed specific associations with either gait (body of the corpus callosum and corticospinal tract) or cognitive decline (anterior thalamic radiation, forceps minor et major, fronto-occipital fasciculus and inferior longitudinal fasciculus). Conclusions: Gait and cognition rely on the integrity of both distinct and overlapping white matter tracts. Alterations within the corticospinal tract and central commissural fibers seem to be specifi-cally associated with gait impairment, while damage to long-range association, frontal or posterior commissural and frontal projection fibers are associated with cognitive decline.


Karger_ESC London_2013
To see the actual publication please follow the link above