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London, United Kingdom 2013 Poster Session Red Cerebrovasc Dis 2013; 35 (suppl 3)1-854 507 416 Behavioral disorders and post-stroke dementia Imaging and Baseline Predictors of cognitive performance in minor stroke and TIA patients at 90 days J.L. Mandzia1, E.E. Smith2, M. Horton3, P. Hanly4, P.A. Barber5, C. Godzwon6, E. Donaldson7, N. Asdaghi8, S. Patel9, J. Modi10, H. Aram11, S.B. Coutts12 Department of Clinical Neurosciences, Calgary Stroke Program, University of Calgary, Cal-gary, CANADA1, Department of Clinical Neurosciences, Calgary Stroke Program, University of Calgary, Calgary, CANADA2, Department of Clinical Neurosciences, Calgary Stroke Program, University of Calgary, Calgary, CANADA3, Department of Medicine, Division of Respirology, Uni-versity of Calgary, Calgary, CANADA4, Department of Clinical Neurosciences, Calgary Stroke Pro-gram, University of Calgary, Calgary, CANADA5, Department of Clinical Neurosciences, Calgary Stroke Program, University of Calgary, Calgary, CANADA6, Department of Clinical Neurosciences, Calgary Stroke Program, University of Calgary, Calgary, CANADA7, Division of Neurology, Uni-versity of British Columbia, Vancouver, CANADA8, Department or Diagnostic Imaging, University of Calgary, Calgary, CANADA9, Department of Diagnostic Imaging, University of Calgary, Calgary, CANADA10, Department of Clinical Neurosciences, Calgary Stroke Program, University of Calgary, Calgary, CANADA11, De-partment of Clinical Neurosciences, Calgary Stroke Program, University of Calgary, Calgary, CAN-ADA12 Background: Few studies have examined predictors of cognitive impairment following minor stroke and TIA. The goal of this study was to examine clinical and imaging features associated with poor cognitive outcome at 90 days. Methods: TIA or minor stroke (NIHSS<4) patients underwent de-tailed cognitive testing 90 days post event. DWI and white matter lesion volumes (WML) were mea-sured on baseline MRI. Patients with pre-event mRS>1 or dementia were excluded. Z-scores were calculated for cognitive tests based on normative data; tests were analyzed as domains of memory (CVLT long delay free recall), executive function (EF; average of COWAS test FAS and Trails B) and psychomotor speed (PS; average of Trails B and Digit Symbol Coding). Depression was as-sessed using the Center for Epidemiologic Studies Depression Scale (CES-D). Presence of obstruc-tive Sleep Apnea (OSA) was assessed using a Snoresat. Analyses were performed on the whole data set and then dichotomized based on cognitive score <1 SD below normal. A p value of ≤0.016 was chosen for significance, after Bonferroni correction for testing of 3 separate cognitive domains. Re-sults: 86 patients were included, 74% male, 55% TIA, mean age 65.2+12.2 and 14.2+3.3 years of education. 62% were DWI positive. 27.9% had moderate to severe OSA. Median Z-scores were: memory 0, EF -0.12 and PS +0.2. Mean CES-D was 7.9+8 (not depressed). Cognitive scores were not significantly different based on diagnosis, cause and risk factors of stroke, OSA, DWI or WML volumes. EF scores correlated with baseline NIHSS (p=0.005) and 90-day CES-D score (p=0.004), and were lower in patients with 90-day mRS >0 (p=.017). EF <1 SD was associated with baseline NIHSS (p=0.016) and 90-day CES-D (p=0.002). PS scores correlated with baseline NIHSS (p=0.01) and CES-D (p=0.001), and were lower in patients with 90-day mRS >0 (p=0.004). Conclusion: Stroke severity, disability and depression predict poor psychomotor and executive, but not memory test performance at 90 days. 417 Behavioral disorders and post-stroke dementia Stress, serotonin genetics and post-stroke dementia E. Ben Assayag1 Tel Aviv Sourasky Medical Center, Tel Aviv, ISRAEL1 Background Literature implicates the role of serotonin in the development and integrity of neural systems which subserve complex emotional and cognitive processing, as well as regulation of the hypothalamic-pi-tuitary- adrenal (HPA) axis. Animal studies indicate serotonin involvement in HPA activation, feed-back control and direct effect on hippocampal glucocorticoid receptors. Accumulating evidence suggests associations of the serotonin transporter-linked polymorphic region (5-HTTLPR) with HPA-axis reactivity to stress. Aims We investigated whether 5-HTTLPR genotype interacts with physiological stress to impact on cog-nitive function and hippocampal volume in post-stroke patients. Results Hippocampal volume from 308 patients correlated with cognitive scores: patients with smaller hip-pocampi had lower cognitive scores at admission 6, 12 and 24 months post-stroke (p<0.001). The 5-HTTLPR S allele was associated with lower hippocampal volume, normalized to total intra-cranial volume (p=0.036). After controlling for age, gender education and ApoE4 allele, a multiple regression confirmed this relationship (p=0.033). No associations were observed with amygdala vol-ume or frontal cortex. Carriers of the 5-HTT S allele had higher bedtime salivary cortisol at admission than non-carriers (p=0.047) and homozygous carriers displayed strong negative association of cortisol with hippocam-pal volume and with cognitive scores 6 months post-stroke (r=-0.356, p=0.031, r=-0.477, p=0.025, respectively). Conclusions Carriers of the S allele of the 5-HTTLPR had lower hippocampal volume as well as higher salivary cortisol and were more likely to suffer from post-stroke cognitive decline. The interactive effects of the S allele and cortisol levels on reduced hippocampal volume and low-er cognitive scores imply that the negative effect of the 5-HTTLPR on cognition involves the HPA axis. Serotonin receptors may provide a novel target for future anti-dementia therapeutics in stroke pa-tients.


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