White matter imaging correlates of early cognitive impairment detected by the MoCA after TIA and minor stroke

Zamboni, G; Griffanti, L; Jenkinson, M; Mazzucco, S; Li, L; Kuker, W; Pendlebury, S; Rothwell, P

Neuroscience & Neuroimaging Research Collection

Journal article

White matter imaging correlates of early cognitive impairment detected by the MoCA after TIA and minor stroke

Abstract:: Background and Purpose

Among screening tools for cognitive impairment in large cohorts, the Montreal Cognitive assessment (MoCA) appears to be more sensitive to early cognitive impairment than the Mini-Mental State Examination (MMSE), particularly after transient ischemic attack (TIA) or minor stroke. We reasoned that if MoCA-detected early cognitive impairment is pathologically significant, then it should be specifically associated with the presence of white matter hyperintensities (WMH) and reduced fractional anisotropy (FA) on MRI.

Methods

Consecutive eligible patients with TIA or minor stroke (Oxford Vascular Study) underwent MRI and cognitive assessment. We correlated MoCA and MMSE scores with WMH and FA, then specifically studied patients with low MoCA and normal MMSE.

Results

Among 400 patients, MoCA and MMSE scores were significantly correlated (all p<0.001) with WMH volumes (rMoCA=-0.336, rMMSE=-0.297) and FA (rMoCA=0.409, rMMSE=0.369), and -on voxel-wise analyses- with WMH in frontal white matter and reduced FA in almost all white matter tracts. However, only the MoCA was independently correlated with WMH volumes (r=-0.183, p<0.001), average FA values (r=0.218, p<0.001), and voxel-wise reduced FA in anterior tracts after controlling for the MMSE. In addition, patients with low MoCA but normal MMSE (N=57) had higher WMH volumes (t=3.1,p=0.002), lower average FA (t=-4.0,p<0.001), and lower voxel-wise FA in almost all white matter tracts than those with normal MoCA and MMSE (N=238).

Conclusions

In patients with TIA or minor stroke, early cognitive impairment detected with the MoCA but not with the MMSE was independently associated with white matter damage on MRI, particularly reduced FA.

Publication status:: Published

Peer review status:: Peer reviewed

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APA Style

Zamboni, G., Griffanti, L., Jenkinson, M., Mazzucco, S., Li, L., Kuker, W., Pendlebury, S., & Rothwell, P. (2017). White matter imaging correlates of early cognitive impairment detected by the MoCA after TIA and minor stroke. Stroke, 48, 1539–1547.

MLA Style

Zamboni, G, et al. “White Matter Imaging Correlates of Early Cognitive Impairment Detected by the MoCA after TIA and Minor Stroke.” Stroke, vol. 48, 2017, pp. 1539–47.

Chicago Style

Zamboni, G, L Griffanti, M Jenkinson, et al. 2017. “White Matter Imaging Correlates of Early Cognitive Impairment Detected by the MoCA after TIA and Minor Stroke.” Stroke 48: 1539–47.
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