Changes in congintive functions in patients with acute cerebrovascular event who tested by Mini-Mental State Examination and the Clock Drawing Test

Czech version

Authors: D. Školoudík ^1,2; T. Fadrná ¹; M.sedláková ¹; P. Ressner ²; M. Bar ¹; O. Zapletalová ¹; D.šaňák; R. Herzig ²; P. Kaňovský ²
Authors‘ workplace: Neurologická klinika FNsP, Ostrava ¹; Neurologická klinika LF UP a FN, Olomouc ²
Published in: Cesk Slov Neurol N 2007; 70/103(4): 382-387
Category: Original Paper

Výsledky studie byly prezentovány formou přednášky na Third international congress on vascular dementia, Praha, 25. 10. 2003 a XXXI. Slovensko-českém neurovaskulárním sympoziu, Bratislava, Slovenská republika, 10. 10. 2 003.

Overview

Introduction:
The objective of the study was to evaluate changes in testing cognitive functions by Mini-Mental State Examination (MMSE) and the Clock Drawing Test (CDT) in patients with acute cerebrovascular eventu (CVE) in the first 3 months from the occurrence of symptoms.

Method:
The study enrolled patients with acute CVE admitted to the hospital within 6 hours from the onset of symptoms. The control group (CG) consisted of patients with acute coronary syndrome without symptoms of affection of the central nervous system. MMSE and CDT tests were performed in all patients on the 2nd, 30th and 90th day. The influence of the monitored factors on the results of cognitive function tests was evaluated statistically.

Results:
A total of 30 patients with CVE were enrolled in the study (of which 57 % men of mean age 69.0 ± ± 11.3 years). The control group consisted of 15 patients (66.7 % of men of mean age 69.8 years ± 11.5 years). The percentage of CVE patients for whom pathological values were recorded in at least one of the performed tests was 73.3 % and 20.8 % on the 2nd and 90th day, respectively. In the control group, pathological findings were diagnosed in only 27 % and 7 % of patients on the 2nd and the 90th day, respectively (p < 0.01). A significant improvement was recorded between the results of the first and the second cognitive test (p<0.05). Significantly worse results in cognitive tests were recorded in patients at a higher age, in patients with a speech disturbance, with infection, and in patients with major neurological damage (p < 0.05). Correlation of the MMSE and CDT results was statistically significant (p < 0.01), with Pearson correlation coefficient r = 0.79.

Conclusion:
Using MMSE and CDT, cognitive function impairment can be detected in 73.3 % of patients in the acute phase of CVE. In addition to brain lesions, the results of the cognitive function tests were influenced by acute stress, higher age, speech disturbance, infection and the burden of neurological affection.

Key words:
cerebrovascular event – cognitive functions – risk factors – Mini-Mental State Examination – Clock Drawing Test

Sources

1. Jirák R, Dušková J, Malá E, Neubauer K, Obenberger J. Demence. Praha: Maxdorf 1999: 140-6.

2. Czepiel W, Lesniak M, Seniow J, Czlonkowska A. Characteristics and prevalence of cognitive impairment two weeks and a year after stroke onset. Book of abstracts of the Third International Congress on Vascular Dementia 2003: 26 [abstract].

3. Folstein MF, Folstein SE, McHugh PR. Mini-mental state. J Psychiatr Res 1975; 12: 189-198.

4. Dal-Pan G, Stern Y, Sano M, Mayeux R. Clock-drawing in neurological disorders. Behavioral Neurol 1989; 2: 39–48.

5. Hendriksen Ch, Meier D, Klitzing W, Krebs M, Ermini-Funfschilling D, Stahelin HB. Early Dementia and the clock drawing test. Memory Clinic. Geriatric University Clinic, Basel: Internal Press 1993.

6. Ressner P, Ressnerová E. Test hodin, přehledná informace a zhodnocení škál dle Shulmana, Sunderlanda a Hendriksena. Neurol pro praxi 2002; 6: 316-322.

7. Censori B, Manara O, Agostinis C, Camerlingo M, Casto L, Galavotti B et al. Dementia after first stroke. Stroke 1996; 27: 1205-1210.

8. Lin JH, Lin RT, Tai CT, Hsieh CL, Hsiao SF, Liu CK. Prediction of poststroke dementia. Neurology 2003; 61: 343-348.

9. Desmond DW, Moroney JT, Paik MC, Sano M, Mohr JP, Aboumatar S et al. Frequency and clinical determinants of dementia after ischemic stroke. Neurology 2000; 54: 1124-1131.

10. Pohjasvaara T, Erkinjuntti T, Vataja R, Kaste M. Dementia Three Months After Stroke. Baseline Frequency and Effect of Different Definitions of Dementia in the Helsinki Stroke Aging Memory Study (SAM) Cohort. Stroke 1997; 28: 785-792.

11. Hénon H, Durieu I, Guerouaou D, Lebert F, Pasquier F, Leys D. Poststroke dementia. Incidence and relationship to prestroke cognitive decline. Neurology 2001; 57: 1216-1222.

12. Roman GC. Facts, myths, and controversies in vascular dementia. J Neurol Sci 2004; 226: 49-52.

13. Roman GC. Vascular Dementia Prevention: A Risk Factor Analysis. Cerebrovasc Dis 2005; 20(Suppl 2): 91-100.

14. Barba R, Martínez-Espinosa S, Rodríguez-García E, Pondal M, Vivancos J, Del Ser T. Poststroke Dementia. Clinical Features and Risk Factors. Stroke 2000; 31: 1494-1501.

15. Gupta A, Pansari K, Shetty H. Post-stroke depression. Int J Clin Pract 2002; 56: 531-537.

16. Desmond DW, Moroney JT, Sano M, Stern Y. Mortality in patients with dementia after ischemic stroke. Neurology 2002; 59: 537-543.

17. Tatemichi TK, Paik M, Bagiella M, Desmond DW, Pirro M, Hanzawa LK. Dementia after stroke is a predictor of long-term survival. Stroke 1994; 25: 1915-1919.

18. Erkinjuntti T, Roman G, Gauthier S, Feldman H, Rockwood K. Emerging therapies for vascular dementia and vascular cognitive impairment. Stroke 2004; 35: 1010-1017.

19. Skoog I. Status of risk factors for vascular dementia. Neuroepidemiology 1998; 17: 2-9.

20. Schmidt R, Schmidt H, Fazekas F. Vascular risk factors in dementia. J Neurol 2000; 247: 81-87.

21. Skoog I. Risk factors for vascular dementia: a review. Dementia 1994; 5: 137-144.

22. Hassing LB, Johansson B, Nilsson SE, Berg S, Pedersen NL, Gatz M et al. Diabetes mellitus is a risk factor for vascular dementia, but not for Alzheimer’s disease: a population-based study of the oldest old. Int Psychogeriatr 2002; 14: 239-248.

23. del Ser T, Barba R, Morin MM, Domingo J, Cemillan C, Pondal M et al. Evolution of Cognitive Impairment After Stroke and Risk Factors for Delayed Progression. Stroke 2005; 36: 2670-2675.