Abstract TP442: Baseline Cognitive Impairment and Associated Risk Factors in Patients with Intracranial Stenosis in the SAMMPRIS Trial

Abstract

Background and Purpose: Cognitive impairment is an important outcome in stroke prevention trials. The Montreal Cognitive Assessment (MoCA) score is a cognitive measure used in the Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis (SAMMPRIS) trial due to its sensitivity in detecting cognitive impairment in stroke patients. We sought to determine the prevalence of low baseline MoCA scores and the baseline risk factors associated with lower MoCA scores in SAMMPRIS patients. Methods: The main entrance criteria in SAMMPRIS were a TIA or non-disabling stroke within 30 days prior to enrollment attributed to 70-99% intracranial atherosclerosis. Patients with stroke as the qualifying event who had an NIH Stroke Score indicating aphasia or neglect were excluded from these analyses. Low MoCA score was defined as <26, the standard value that has 90% sensitivity for detecting mild cognitive impairment. Baseline demographic, medical history, laboratory, and neuroimaging characteristics were compared between patients with low vs. normal MoCA scores in univariate and multivariate analyses. Results: The prevalence of low baseline MoCA scores was 207/377 (55%). Baseline features associated with low MoCA scores in the univariate analyses are shown in Table 1. In the multivariate analyses, older age (p<0.0001) and physical inactivity (p=0.0166) were associated with low MoCA scores. MoCA score was not related to other vascular risk factors, severity of stenosis, prior stroke, or white matter lesions on CT or MRI. Conclusions: SAMMPRIS patients had a high prevalence of cognitive impairment at baseline, which was not explained by the presence of vascular risk factors, such as hypertension and hypercholesterolemia. This finding suggests that cognitive impairment may be an important source of potential disability in patients with intracranial stenosis.