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Authors: Chander, Russell Jude | Lim, Levinia | Handa, Sagarika | Hiu, Shaun | Choong, Angeline | Lin, Xuling | Singh, Rajinder | Oh, Daniel | Kandiah, Nagaendran

Article Type: Research Article

Abstract: Background: While atrial fibrillation (AF) is an important risk factor for ischemic strokes and mild cognitive impairment (MCI) in Alzheimer’s disease, the association between AF and post-stroke cognitive impairment (PSCI), and the factors mediating this association, is unclear. Objective: To investigate the role of AF in PSCI, especially in relation to other markers of cerebrovascular disease. Methods: 445 subjects with mild ischemic stroke without pre-stroke cognitive decline were assessed 3–6 months post-stroke for cognitive deficits. MRIs were reviewed by trained raters for acute infarct characteristics, global cortical atrophy, white matter hyperintensities, cerebral microbleeds, and intracranial stenosis. Logistic regression analysis was …used to identify factors independently associated with PSCI. Subjects were also categorized according to paroxysmal (pAF) or persistent/chronic AF (p/cAF), and presence or absence of AF or large cortical infarcts (LCI) to study cognitive trends. Results: 80 (18.0%) subjects had AF. 76.3% of AF subjects and 42.7% of subjects without AF had PSCI. The odds ratio (OR) of AF in developing PSCI was 2.31 (95% CI: 1.12–4.75; p  = 0.035), after correcting for other risk factors. pAF subjects and AF subjects with LCIs had higher ORs for PSCI. AF subjects performed worse in neuropsychological tasks associated with global cognition, episodic memory, and executive function. Conclusion: AF is a significant risk factor for PSCI, even after correcting for AF-related infarcts. Other mechanisms, such as hypoperfusion, microhemorrhages, and neuroinflammation, may be at play. All stroke patients with AF, regardless of the type of infarction, should be closely monitored for PSCI. Show more

Keywords: Atrial fibrillation, cognitive impairments, ischemic stroke, magnetic resonance imaging, risk factors

DOI: 10.3233/JAD-170313

Citation: Journal of Alzheimer's Disease, vol. 60, no. 3, pp. 867-875, 2017

Authors: Kandiah, Nagaendran | Wang, Vivian | Lin, Xuling | Nyu, Mei Mei | Lim, Linda | Ng, Adeline | Hameed, Shahul | Wee, Hwee Lin

Article Type: Research Article

Abstract: Background: Young onset dementia (YOD) presents in individuals who are economically productive and socially active. While the cost related to dementia in the elderly has been widely studied, the cost related to YOD is largely unknown. Objective: To study the economic burden of community dwelling YOD in relation to late onset dementia (LOD) and cost of YOD based on etiology. Methods: In this prospective cross-sectional study of 255 patients attending a tertiary neurology center, data on economic burden, clinical features, and caregiver burden were collected using structured financial questionnaire, standard cognitive and neuropsychiatric measures, and Zarit caregiver burden scale. Cost …components were grouped into those relating to direct medical costs, direct non-medical costs, and those related to indirect costs. Cost was also categorized based on etiology of YOD. Results: The mean age at symptom onset in the YOD and LOD cohort was 57.0 (SD 5.1) and 75.0 (SD 5.9) years, respectively. The median annual cost for patients with YOD was almost twice that of LOD (USD 15,815 versus USD 8,396). Indirect cost contributed heavily to cost related to YOD. Even when grouped by dementia etiology, YOD patients with Alzheimer’s disease, frontotemporal dementia (FTD), and vascular dementia had higher cost compared to their elderly counterparts. Young onset FTD had the highest cost. 43.2% of YOD reported loss of employment due to dementia, which was significantly higher than that in LOD (2.4%). Conclusion: Patients with YOD have a high economic burden. Young patients with FTD have the highest cost followed by vascular dementia and Alzheimer’s disease. Show more

Keywords: Alzheimer’s disease, economic burden, frontotemporal dementia, young-onset dementia

DOI: 10.3233/JAD-150471

Citation: Journal of Alzheimer's Disease, vol. 49, no. 2, pp. 277-285, 2016

Authors: Kandiah, Nagaendran | Chander, Russell Jude | Lin, Xuling | Ng, Aloysius | Poh, Yen Yeong | Cheong, Chin Yee | Cenina, Alvin Rae | Assam, Pryseley Nkouibert

Article Type: Research Article

Abstract: Background: Post stroke cognitive impairment (PSCI), an important complication of strokes, has numerous risk factors. A scale adequately classifying risk of cognitive impairment 3–6 months after mild stroke will be useful for clinicians. Objective: To develop a risk score based on clinical and neuroimaging variables that will be useful in identifying mild ischemic stroke patients at high risk for PSCI. Methods: The risk score development cohort comprised of a retrospective dataset of 209 mild stroke patients with MRI confirmed infarcts, without pre-stroke cognitive impairment, and evaluated within 6 months post-stroke for PSCI. Logistic regression identified factors predictive of PSCI and …a risk score was developed based on regression coefficients. The risk score was checked for stability using 10-fold cross-validation and validated in an independent prospective cohort of 185 ischemic mild stroke patients. Results: Within 6 months post-stroke, 37.32% developed PSCI in the retrospective dataset. A 15-point risk score based on age, education, acute cortical infarcts, white matter hyperintensity, chronic lacunes, global cortical atrophy, and intracranial large vessel stenosis was highly predictive of PSCI with an AUC of 0.829. 10.11% with low scores, 52.69% with moderate scores, and 74.07% with high scores developed PSCI. In the prospective validation cohort, the model had an AUC of 0.776, and exhibited similar accuracy and stability statistics at both 6 and 12 months. Conclusion: The seven item risk score adequately identified mild stroke patients who are at an increased risk of developing PSCI. Show more

Keywords: Cognitive impairment, ischemic stroke, magnetic resonance imaging, prognosis, risk score

DOI: 10.3233/JAD-150736

Citation: Journal of Alzheimer's Disease, vol. 49, no. 4, pp. 1169-1177, 2016