Impact of Baseline Features and Risk Factor Control on Cognitive Function in the Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis Trial

Tanya N Turan; Sami Al Kasab; Alison Smock; George Cotsonis; David Bachman; Michael J Lynn; Azhar Nizam; Colin P Derdeyn; David Fiorella; Scott Janis; Bethany Lane; Jean Montgomery; Marc I Chimowitz

doi:10.1159/000497245

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Impact of Baseline Features and Risk Factor Control on Cognitive Function in the Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis Trial

Journal article

Peer reviewed

Impact of Baseline Features and Risk Factor Control on Cognitive Function in the Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis Trial

Tanya N Turan, Sami Al Kasab, Alison Smock, George Cotsonis, David Bachman, Michael J Lynn, Azhar Nizam, Colin P Derdeyn, David Fiorella, Scott Janis, …

Cerebrovascular diseases (Basel, Switzerland), Vol.47(1-2), pp.24-31

2019

DOI: 10.1159/000497245

PMCID: PMC9936320

PMID: 30763948

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Abstract

Cerebrovascular disease is an important cause of cognitive impairment. The aim of this study is to report the relationship between cognitive function and risk factors at baseline and during follow-up in the Stenting and Aggressive Medical Management for Preventing Recurrent stroke in Intracranial Stenosis (SAMMPRIS) trial.\nSubjects in the SAMMPRIS trial were included in this study. In order to have an assessment of cognitive function independent of stroke, patients with a stroke as a qualifying event whose deficits included aphasia or neglect were excluded from these analyses as were those with a cerebrovascular event during follow-up. The Montreal Cognitive Assessment (MoCA) score was used to assess cognitive impairment at baseline, 4 months, 12 months and closeout. Cognitive impairment was defined as MoCA < 26. A multivariate analysis was performed to determine what risk factors were independent predictors of cognitive function at baseline, 12 months and closeout. Among patients randomized to aggressive medical management only, the percentage of patients with cognitive impairment was compared between patients in versus out of target for each risk factor at 12 months and closeout.\nOf the 451 patients in SAMMPRIS, 371 patients met the inclusion criteria. MoCA < 26 was present in 55% at baseline. Older age and physical inactivity were associated with cognitive impairment at baseline. Older age, non-white race, lower baseline body mass index, and baseline cognitive impairment were associated with cognitive impairment at 12 months. In the aggressive medical management group, at 12 months, physical inactivity during follow-up was the strongest risk factor associated with cognitive impairment.\nCognitive impairment is common in patients with severe symptomatic intracranial atherosclerosis. Physical inactivity at baseline and during follow-up is a strong predictor of cognitive impairment.

Recurrence

United States - epidemiology

Prevalence

Age Factors

Stroke - diagnostic imaging

Constriction, Pathologic

Humans

Cognition

Exercise

Time Factors

Cognitive Dysfunction - epidemiology

Cognitive Dysfunction - psychology

Stroke - epidemiology

Cognitive Dysfunction - diagnosis

Intracranial Arteriosclerosis - diagnostic imaging

Stents

Angioplasty - instrumentation

Stroke - prevention & control

Risk Assessment

Stroke - psychology

Risk Factors

Treatment Outcome

Angioplasty - adverse effects

Intracranial Arteriosclerosis - epidemiology

Intracranial Arteriosclerosis - therapy

Sedentary Behavior

Details

Title: Subtitle: Impact of Baseline Features and Risk Factor Control on Cognitive Function in the Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis Trial
Creators: Tanya N Turan - Medical University of South Carolina, Charleston, South Carolina, USA
Sami Al Kasab - Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA, sami-alkasab@uiowa.edu
Alison Smock - Medical University of South Carolina, Charleston, South Carolina, USA
George Cotsonis - Department of Public Health, Emory University, Atlanta, Georgia, USA
David Bachman - Medical University of South Carolina, Charleston, South Carolina, USA
Michael J Lynn - Washington University, St. Louis, Michigan, USA
Azhar Nizam - Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
Colin P Derdeyn - Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
David Fiorella - Department of Neurosurgery, State University of New York at Stony Brook, Stony Brook, New York, USA
Scott Janis - National Institute of Neurological Disorders and Stroke, Bethesda, Maryland, USA
Bethany Lane - Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
Jean Montgomery - Department of Public Health, Emory University, Atlanta, Georgia, USA
Marc I Chimowitz - Medical University of South Carolina, Charleston, South Carolina, USA
Resource Type: Journal article
Publication Details: Cerebrovascular diseases (Basel, Switzerland), Vol.47(1-2), pp.24-31
DOI: 10.1159/000497245
PMID: 30763948
PMCID: PMC9936320
NLM abbreviation: Cerebrovasc Dis
ISSN: 1015-9770
eISSN: 1421-9786
Publisher: Switzerland
Language: English
Date published: 2019
Academic Unit: Neurology; Radiology; Iowa Neuroscience Institute; Neurosurgery
Record Identifier: 9984070123902771

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