Agrawal Sumedh S, Ampar Nikith, Prabhu Arvind N, Pai Aparna R
Department of Neurology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India.
Ann Neurosci. 2025 Jun 7:09727531251344712. doi: 10.1177/09727531251344712.
Stroke is a major cause of disability and mortality, often leading to both motor and cognitive impairments. Cognitive impairment is common among stroke survivors, with ischaemic strokes constituting the majority. While physical rehabilitation is emphasised, cognitive assessment remains underutilised in acute care.
This study aimed to assess cognitive impairment in patients with ischaemic stroke affecting the anterior circulation using the Montreal Cognitive Assessment (MoCA) scale, and to correlate clinical variables with cognitive outcomes.
This observational study was conducted over 18 months at a tertiary healthcare centre in coastal Karnataka, India. Patients with first-ever ischaemic stroke involving the middle cerebral artery (MCA) and anterior cerebral artery (ACA) territories were included. Cognitive impairment was assessed using the MoCA scale within 1 week of stroke onset and again at 90 days. Clinical data such as NIHSS and mRS scores, as well as stroke subtype (via TOAST classification), were also collected.
A total of 96 patients were included, with a mean age of 62.5 ± 10.3 years. At baseline, 55% of patients showed cognitive impairment, which improved at the 90-day follow-up (45% impaired). The most frequently affected domains were Attention (55%), Language (45%) and Executive function (50%). Factors such as older age, lower education level and higher NIHSS scores were associated with worse cognitive outcomes. Stroke aetiology (large-artery atherosclerosis and cardioembolism) was linked to more severe cognitive deficits. Aphasia was observed in 29 patients, and follow-up MoCA testing showed minimal cognitive improvement in this group.
Vascular cognitive impairment is a significant concern in ischaemic stroke patients. The MoCA scale is an effective tool for the early identification of cognitive impairment, even within the first week post-stroke. Age, education, NIHSS and mRS scores are critical predictors of post-stroke cognitive decline. Further studies are needed to refine cognitive assessment tools, especially for aphasic patients.
中风是导致残疾和死亡的主要原因，常引发运动和认知障碍。认知障碍在中风幸存者中很常见，其中缺血性中风占大多数。虽然强调身体康复，但在急性护理中认知评估仍未得到充分利用。
本研究旨在使用蒙特利尔认知评估（MoCA）量表评估影响前循环的缺血性中风患者的认知障碍，并将临床变量与认知结果相关联。
这项观察性研究在印度卡纳塔克邦沿海的一家三级医疗中心进行了18个月。纳入首次发生的累及大脑中动脉（MCA）和大脑前动脉（ACA）区域的缺血性中风患者。在中风发作后1周内使用MoCA量表评估认知障碍，并在90天时再次评估。还收集了诸如美国国立卫生研究院卒中量表（NIHSS）和改良Rankin量表（mRS）评分等临床数据，以及中风亚型（通过TOAST分类）。
共纳入96例患者，平均年龄为62.5±10.3岁。基线时，55%的患者存在认知障碍，在90天随访时有所改善（45%存在障碍）。最常受影响的领域是注意力（55%）、语言（45%）和执行功能（50%）。年龄较大、教育水平较低和NIHSS评分较高等因素与较差的认知结果相关。中风病因（大动脉粥样硬化和心源性栓塞）与更严重的认知缺陷有关。29例患者出现失语，随访MoCA测试显示该组认知改善甚微。
血管性认知障碍是缺血性中风患者的一个重要问题。MoCA量表是早期识别认知障碍的有效工具，即使在中风后的第一周内也是如此。年龄、教育程度、NIHSS和mRS评分是中风后认知下降的关键预测因素。需要进一步研究以完善认知评估工具，特别是针对失语患者。
