Screening for cognitive impairment with the Montreal Cognitive Assessment in Spanish patients with minor stroke or transient ischaemic attack.

OBJECTIVE: The symptoms of minor stroke and transient ischemic attack (TIA) are temporary and mild. Despite the transient nature of the focal symptoms and the absence of visible brain lesions in some patients, many experience persistent cognitive problems subsequently. We aimed to establish the discriminant capacity of the Montreal Cognitive Assessment (MoCA) in screening for cognitive impairment (CI) within 90 days of TIA. METHODS: A total of 50 patients with minor stroke or TIA were recruited. Patients were administered the MoCA test and a formal neuropsychological test battery. CI was defined clinically according to neuropsychological test findings. RESULTS: The average age of recruited patients was 57.7±8.0 years; 70.0% were men; all patients had completed at least primary education. Thirty-seven patients (74.0%) presented CI. Receiver operating characteristic curve analysis obtained an optimal MoCA cut-off point of 25 for discriminating between patients with CI and those without, with an area under the curve of 0.835 (95% confidence interval [CI], 0.720-0.949), sensitivity of 78.4% (95% CI, 62.8%-88.6%), specificity of 76.9% (95% CI, 49.7%-91.8%), positive predictive value of 90.6% (95% CI, 81.0%-95.6%), and negative predictive value of 55.6% (95% CI, 39.5%-70.4%). CONCLUSIONS: More than half of the patients presented CI as determined by the formal battery of neuropsychological tests. A MoCA cut-off point of 25 is sufficiently sensitive and specific for detecting CI after minor stroke or TIA, and may be implemented as a screening technique in routine clinical practice.

Detección del deterioro cognitivo con la Evaluación Cognitiva de Montreal en pacientes españoles con ictus minor o ataque isquémico transitorio / Screening for cognitive impairment with the Montreal Cognitive Assessment in Spanish patients with minor stroke or transient ischaemic attack

Objetivo: Los síntomas de un ictus minor o un ataque isquémico transitorio (AIT) son leves y de corta duración. A pesar de la naturaleza pasajera de los síntomas focales y la ausencia de lesiones cerebrales visibles en algunos pacientes, muchos experimentan problemas cognitivos persistentes posteriormente. Nuestro objetivo es establecer el poder discriminativo del Montreal Cognitive Assessment (MoCA, «Evaluación Cognitiva de Montreal») en la detección del deterioro cognitivo (DC) dentro de los 90 días posteriores al AIT. Método: Se incluyeron un total de 50 pacientes con ictus minor y AIT. Se les aplicó la prueba MoCA y una batería neuropsicológica formal. El DC se definió clínicamente según los hallazgos de las pruebas neuropsicológicas. Resultados: La edad promedio de los pacientes seleccionados fue de 57,7 ± 8,0 años, siendo la mayoría de ellos varones (70,0%). Todos los pacientes tenían un nivel educativo igual o superior al primario. Treinta y siete (74,0%) sujetos presentaron DC. Mediante el análisis de la curva característica del receptor se obtuvo un punto de corte del test MoCA de 25 puntos para discriminar entre sujetos con y sin DC, siendo el área bajo la curva de 0,835 (intervalo de confianza del 95% [IC 95%] 0,720 a 0,949), la sensibilidad, del 78,4% (IC 95% 62,8-88,6%), la especificidad, del 76,9% (IC 95% 49,7-91,8%), el valor predictivo positivo, del 90,6% (IC 95% 81,0-95,6%) y el negativo, del 55,6% (IC 95% 39,5-70,4%). Conclusiones: Más de la mitad de la muestra presentaba DC según lo determinado por la batería formal de pruebas neuropsicológicas. Un punto de corte de 25 en el MoCA es lo suficientemente sensible y específico para detectar DC tras un ictus minor o AIT y podría implementarse en la práctica clínica como método de cribado. (AU)

Objective: The symptoms of minor stroke and transient ischemic attack (TIA) are temporary and mild. Despite the transient nature of the focal symptoms and the absence of visible brain lesions in some patients, many experience persistent cognitive problems subsequently. We aimed to establish the discriminant capacity of the Montreal Cognitive Assessment (MoCA) in screening for cognitive impairment (CI) within 90 days of TIA. Method: A total of 50 patients with minor stroke or TIA were recruited. Patients were administered the MoCA test and a formal neuropsychological test battery. CI was defined clinically according to neuropsychological test findings. Results: The average age of recruited patients was 57.7 ± 8.0 years; 70.0% were men; all patients had completed at least primary education. Thirty-seven patients (74.0%) presented CI. Receiver operating characteristic curve analysis obtained an optimal MoCA cut-off point of 25 for discriminating between patients with CI and those without, with an area under the curve of 0.835 (95% confidence interval [95% CI] 0.720-0.949), sensitivity of 78.4% (95% CI 62.8-88.6%), specificity of 76.9% (95% CI 49.7-91.8%), positive predictive value of 90.6% (95% CI 81.0-95.6%), and negative predictive value of 55.6% (95% CI 39.5-70.4%). Conclusions: More than half of the patients presented CI as determined by the formal battery of neuropsychological tests. A MoCA cut-off point of 25 is sufficiently sensitive and specific for detecting CI after minor stroke or TIA, and may be implemented as a screening technique in routine clinical practice. (AU)

Screening for cognitive impairment with the Montreal Cognitive Assessment in Spanish patients with minor stroke or transient ischaemic attack. / Detección del deterioro cognitivo con la Evaluación Cognitiva de Montreal en pacientes españoles con ictus minor o ataque isquémico transitorio.

OBJECTIVE: The symptoms of minor stroke and transient ischemic attack (TIA) are temporary and mild. Despite the transient nature of the focal symptoms and the absence of visible brain lesions in some patients, many experience persistent cognitive problems subsequently. We aimed to establish the discriminant capacity of the Montreal Cognitive Assessment (MoCA) in screening for cognitive impairment (CI) within 90 days of TIA. METHOD: A total of 50 patients with minor stroke or TIA were recruited. Patients were administered the MoCA test and a formal neuropsychological test battery. CI was defined clinically according to neuropsychological test findings. RESULTS: The average age of recruited patients was 57.7±8.0 years; 70.0% were men; all patients had completed at least primary education. Thirty-seven patients (74.0%) presented CI. Receiver operating characteristic curve analysis obtained an optimal MoCA cut-off point of 25 for discriminating between patients with CI and those without, with an area under the curve of 0.835 (95% confidence interval [95% CI] 0.720-0.949), sensitivity of 78.4% (95% CI 62.8-88.6%), specificity of 76.9% (95% CI 49.7-91.8%), positive predictive value of 90.6% (95% CI 81.0-95.6%), and negative predictive value of 55.6% (95% CI 39.5-70.4%). CONCLUSIONS: More than half of the patients presented CI as determined by the formal battery of neuropsychological tests. A MoCA cut-off point of 25 is sufficiently sensitive and specific for detecting CI after minor stroke or TIA, and may be implemented as a screening technique in routine clinical practice.

Retraso en la administración de tratamiento trombolítico en el ictus minor / Delayed administration of thrombolytic therapy in minor stroke

Introducción: Se considera ictus minor a aquel que se presenta con escasos síntomas; sin embargo, hasta un 40% presenta discapacidad a largo plazo. La tasa de trombólisis en estos pacientes también es inferior a la del resto de ictus. En este estudio se pretende explorar si existen diferencias en los tiempos de atención en la trombólisis intravenosa en los pacientes con ictus minor. Material y métodos. Revisión retrospectiva de los ictus tratados con trombólisis intravenosa en nuestro centro y análisis comparativo de los tiempos de asistencia entre ictus minor y el resto. Resultados: Se encontraron tiempos más alargados en los casos de ictus minor en cuanto al tiempo puerta-tomografía computarizada y puerta-aguja. No fue así, sin embargo, para el tiempo desde el inicio de los síntomas hasta la llegada al hospital. Conclusiones: La presencia de escasos síntomas en el ictus minor puede hacer difícil su reconocimiento y podría ser un motivo de retraso en el tratamiento. La formación entre el personal que atiende a estos pacientes es fundamental para mejorar este aspecto.(AU)

Introduction: Minor strokes are considered to be those that present with few symptoms, although up to 40% of them entail long-term disability. The rate of thrombolysis in these patients is also lower than in other strokes. The aim of this study is to explore whether there are any differences in intravenous thrombolysis care times in minor strokes. Patients and methods: We conducted a retrospective review of strokes treated with intravenous thrombolysis at our centre and a comparative analysis of the care times in minor strokes and in the other types. Results: Longer times were found in minor strokes in terms of door-to-CT scan and door-to-needle time. This was not the case, however, for the time from the onset of symptoms to arrival at the hospital. Conclusions: The presence of few symptoms in minor strokes can make them difficult to recognise and could be a reason for delaying treatment. Training among staff caring for these patients is essential to improve this aspect.(AU)