Poststroke Montreal Cognitive Assessment and Recurrent Stroke in Patients With Symptomatic Intracranial Atherosclerosis

• Authors: Shadi Yaghi, NYU Langone Health; George Cotsonis, Emory University; Adam de Havenon, The University of Utah; Shyam Prahbakaran, The University of Chicago; Jose G Romano, University of Miami Leonard M. Miller School of Medicine; Ronald M Lazar, The University of Alabama at Birmingham; Randolph S Marshall, Columbia University Irving Medical Center; Edward Feldmann, Baystate Medical Center; David S Liebeskind, University of California, Los Angeles
• Journal Title: Journal of Stroke and Cerebrovascular Diseases
• Volume: Volume 29, Number 4
• Publisher: (publisher) | 2020-04-01, Pages 104663-104663
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1016/j.jstrokecerebrovasdis.2020.104663
• Subjects: Health Sciences, Public Health
• Keywords: Intracranial atherosclerosis; MOCA; cognitive impairment; stroke; Aged; Cognition; Cognitive Dysfunction; Female; Humans; Intracranial Arteriosclerosis; Male; Mental Status and Dementia Tests; Middle Aged; Predictive Value of Tests; Prognosis; Randomized Controlled Trials as Topic; Recurrence; Retrospective Studies; Risk Assessment; Risk Factors; Stroke; Time Factors

Abstract

Background and Purpose: Cognitive impairment occurs in 20%-40% of stroke patients and is a predictor of long-term morbidity and mortality. In this study, we aim to determine the association between poststroke cognitive impairment and stroke recurrence risk, in patients with anterior versus posterior circulation intracranial stenosis. Methods: This is a post-hoc analysis of the Stenting and Aggressive Medical Therapy for Preventing Recurrent Stroke in Intracranial Stenosis (SAMMPRIS) trial. The primary predictor was poststroke cognitive function measured by Montreal Cognitive Assessment (MOCA) at 3-6 months and the primary outcome was recurrent ischemic stroke. We used univariate and multivariable cox-regression models to determine the associations between MOCA at 3-6 months and recurrent stroke. Results: Of the 451 patients enrolled in SAMMPRIS, 393 patients met the inclusion criteria. The mean age of the sample (in years) was 59.5 ± 11.3, 62.6% (246 of 393) were men. Fifty patients (12.7%) had recurrent ischemic stroke during a mean follow up of 2.7 years. The 3-6 month MOCA score was performed on 351 patients. In prespecified multivariable models, there was an association between 3 and 6 month MOCA and recurrent stroke (hazard ratio [HR] per point increase .93 95% confidence interval [CI] .88-.99, P = .040). This effect was present in anterior circulation stenosis (adjusted HR per point increase .92 95% CI .85-0.99, P = .022) but not in posterior circulation artery stenosis (adjusted HR per point increase 1.00 95% .86-1.16, P = .983). Conclusions: Overall, we found weak associations and trends between MoCA at 3-6 months and stroke recurrence but more notable and stronger associations in certain subgroups. Since our study is underpowered, larger studies are needed to validate our findings and determine the mechanism(s) behind this association.