Neuropsychological screening in the acute phase of cerebrovascular diseases.

INTRODUCTION Cognitive impairment is a common and disabling consequence of stroke. Its prevalence, the best way to screen for it in the acute setting, and its relation with pre-morbid status have not been thoroughly clarified. MATERIALS AND METHODS Ischemic and hemorrhagic stroke patients admitted to our stroke unit underwent a baseline assessment that included a clinical and neuroimaging assessment, 2 cognitive tests (Clock Drawing Test, CDT; Montreal Cognitive Assessment-Basic, MoCA-B) and measures of pre-morbid function (including the Clinical Dementia Rating Scale, CDR). A follow-up examination was repeated 3-to-4 months after the acute event. RESULTS 223 patients (52.5% women, mean age ±SD 75.8 years ±12.3) were evaluated. Pre-stroke cognitive impairment was present in 91 patients (40.8%). At follow-up, the prevalence of cognitive impairment was 49%, while its incidence among patients who did not have any pre-stroke cognitive impairment was 38.8%. Of the originally admitted 223 patients (71 were lost to follow up) only 60 (26.9%) were still cognitively intact at follow-up. On regression analysis, age and baseline CDT were associated with worsening of cognitive status at follow-up. In patients without cognitive impairment at baseline, a cut-off of 23 for MoCA-B and of 8.7 for CDT scores predicted the diagnosis of post-stroke cognitive impairment with sufficient accuracy. DISCUSSION AND CONCLUSION Pre- and post-stroke cognitive impairment affect a large proportion of patients with stroke. Our findings suggest that a neuropsychological screening during the acute phase might be predictive of the development of post-stroke cognitive impairment.