Association of the ASCO classification with the executive function subscores of the Montreal cognitive assessment in patients with postischemic stroke

Kazuo Washida; Masafumi Ihara; Hisatsugu Tachibana; Kenji Sekiguchi; Hisatomo Kowa; Fumio Kanda; Tatsushi Toda

doi:10.1016/j.jstrokecerebrovasdis.2014.04.009

Association of the ASCO classification with the executive function subscores of the Montreal cognitive assessment in patients with postischemic stroke

J Stroke Cerebrovasc Dis. 2014 Oct;23(9):2250-5. doi: 10.1016/j.jstrokecerebrovasdis.2014.04.009. Epub 2014 Aug 27.

Authors

Kazuo Washida¹, Masafumi Ihara², Hisatsugu Tachibana³, Kenji Sekiguchi³, Hisatomo Kowa³, Fumio Kanda³, Tatsushi Toda³

Affiliations

¹ Division of Neurology, Graduate School of Medicine, Kobe University, Kobe, Japan. Electronic address: [email protected].
² Department of Neurology, The National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
³ Division of Neurology, Graduate School of Medicine, Kobe University, Kobe, Japan.

PMID: 25174562
DOI: 10.1016/j.jstrokecerebrovasdis.2014.04.009

Abstract

Background: The ASCO classification can evaluate the etiology and mechanisms of ischemic stroke more comprehensively and systematically than conventional stroke classification systems such as Trial of Org 10172 in Acute Stroke Treatment (TOAST). Simultaneously, risk factors for cognitive impairment such as arterial sclerosis, leukoaraiosis, and atrial fibrillation can also be gathered and graded using the ASCO classification.

Methods: Sixty patients with postischemic stroke underwent cognitive testing, including testing by the Japanese version of the Montreal cognitive assessment (MoCA-J) and the mini-mental state examination (MMSE). Ischemic strokes were categorized and graded by the ASCO classification. In this phenotype-based classification, every patient is characterized by the A-S-C-O system (A for Atherosclerosis, S for Small vessel disease, C for Cardiac source, and O for Other cause). Each of the 4 phenotypes is graded 0, 1, 2, or 3, according to severity. The conventional TOAST classification was also applied. Correlations between individual MoCA-J/MMSE scores and the ASCO scores were assessed.

Results: The total score of the ASCO classification significantly correlated with the total scores of MoCA-J and MMSE. This correlation was more apparent in MoCA-J than in MMSE, because MoCA-J scores were normally distributed, whereas MMSE scores were skewed toward the higher end of the range (ceiling effect). Results for individual subtests of MoCA-J and MMSE indicated that cognitive function for visuoexecutive, calculation, abstraction, and remote recall significantly correlated with ASCO score.

Conclusions: These results suggest that the ASCO phenotypic classification of stroke is useful not only for assessing the etiology of ischemic stroke but also for predicting cognitive decline after ischemic stroke.

Keywords: ASCO phenotypic classification; Montreal cognitive assessment; mini-mental state examination; poststroke cognitive impairment.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Aged
Aged, 80 and over
Brain Ischemia / classification*
Brain Ischemia / complications
Brain Ischemia / psychology*
Cognition*
Cognitive Dysfunction / etiology
Cognitive Dysfunction / psychology*
Disease Progression
Executive Function*
Female
Humans
Male
Middle Aged
Neuropsychological Tests
Risk Factors
Stroke / classification*
Stroke / complications
Stroke / psychology*
Treatment Outcome