Cognitive impairment and memory dysfunction after a stroke diagnosis: a post-stroke memory assessment

Figures & data

Table 1 Classification of stroke

Classification of stroke and its subtypes		Definition
Ischemic stroke	Embolic	Blood flow blockage to the brain caused by the presence of blood clots in the arteries; the clots travel from the heart through the bloodstream to the brain.
	Thrombotic	Blood flow is impaired because of fat deposits, which cause blockage, on the wall of blood vessels.
Hemorrhagic stroke	Intracerebral	Bleeding within the brain tissues.
	Subarachnoid	Bleeding into the space between the inner and middle layers of the meninges.
Transient ischemic attacks		Attacks resulting from the temporary interruption of blood flow to the parts of the brain.

Figure 1 Risk factors and dementia.

Figure 2 Clinical evaluation.

Abbreviations: CT, computed tomography; ECG, electrocardiography; EEG, electroencephalography; MRI, magnetic resonance imaging.

Figure 3 Core and penumbra after stroke.

Note: Reprinted from Journal of Radiology Nursing, 30(3), Summers D, Malloy R, CT and MR imaging in the acute ischemic stroke patient: a nursing perspective,104–115, Copyright 2011, with permission from Elsevier.⁵⁶

Table 2 Stroke outcome due to vessel infarction

Brain artery infarction	Stroke outcome
Left middle cerebral artery	Aphasia Mutism Buccofacial apraxia Agraphia Acalculia Ideational apraxia Right/left confusion
Right middle cerebral artery	Neglect (personal, extrapersonal, and representational) Visuospatial failures and visuoconstructive disorders Aprosodia Language usage (pragmatic language) Disorders Anosognosia Anosodiaphoria
Posterior cerebral artery	Color agnosia Associative visual agnosia Alexia (hemianopic and pure) Facial agnosia Bálint’s syndrome Amnesia
Anterior cerebral artery	Deficits in planning, initiation, monitoring, concentration, and flexibility Contralateral leg weakness Sensory loss
Subcortical infarcts (include thalamic infarcts)	Impaired arousal, attention, motivation, initiation, and executive function Memory (verbal, visual, episodic declarative, anterograde, and retrograde)
Caudate infarcts	Impaired problem solving and attention Memory
Subcortical (infarcts of the inferior genu of the internal capsule)	Confusion Memory disturbance
Subarachnoid hemorrhage (anterior communicating artery aneurysm)	Amnesia Personality changes Confabulation Abulia due to damage to the mesial frontal cortex
Limbic and paralimbic lesion	Implicated in a failure to learn and retain new information Affective changes

Figure 4 Block diagram of vascular cognitive impairment spectrum.

Abbreviations: AD, Alzheimer’s disease; CVD, cerebral vascular disease; MCI, mild cognitive impairment; PSD, post-stroke dementia; VaD, vascular dementia; VCI, vascular cognitive impairment.

Table 3 Types of memory

Types of memory system		Anatomy (brain lobes storage)
Long-term memory	Episodic memory Semantic memory Procedural memory	Medial temporal lobe, diencephalon Inferior and lateral temporal lobe Basal ganglia, cerebellum
Short-term memory	Working memory	Prefrontal cortex

Table 4 Brain memory loss causes

Cause of memory loss	Subcases of memory loss	Memory loss type
Lifestyle factors	Medication	Learning
	Sleep pills, anti-histamine, anti-anxiety, schizophrenia medication, pain medication after surgery	Memory consolidationLTM
	Alcoholic and illicit drug use	Episodic memory
	Deficiency in vitamin B1, change in chemical memory
	Stress
	Emotional trauma (chronic or short-term stress)
	Sleep deprivation
	Stress, insomnia, sleep apnea
	Nutritional deficiencies
	Loss of vitamin B1, loss of vitamin B12
	Marijuana consumption
Brain injury	Acquired brain injury	LTM (episodic, semantic)
	Traumatic brain injury (assaults, road traffic accident, fall)
	Non-traumatic brain injury	STM
	Stroke (ischemic, hemorrhagic, TIA)	Working memory
	Tumors (pediatric glial, non-glial, recurrent, metastatic, others: cysts, neurofibromatosis, pseudotumor cerebri, tuberous sclerosis)	Procedural memory
	Metabolic disorder (liver disease, kidney disease, diabetes, ischemia, oxygen hypoxia to the brain, poison through ingestion or inhalation of toxic substance)
	Cognitive brain injury (present at birth)
	Brain cognition (dementia), multiple sclerosis, Parkinson’s disease
Infection	HIV, tuberculosis, syphilis, herpes, encephalitis, meningitis	STM LTM
Thyroid dysfunction	Underactive, overactive	STM Working memory
Aging	Dehydration, normal aging	Recall memory Ability to think
	Depression (common with aging)	Episodic memory Procedural memory Working memory
Mild cognitive impairment	Early stage of dementia	Working memory
Dementia	AD	Episodic memory
	Cortical amyloid plaques, neurofibrillary tangles	Semantic memory
	VaD	Working memory
	Stroke, deficiencies of (thyroid hormone, vitamin B12, folic acid), hydrocephalus, hypercalcemia	LTM STM
	Mixed (AD + VaD), Lewy body disease, Parkinson’s disease, frontotemporal, alcoholic

Abbreviations: AD, Alzheimer’s disease; HIV, human immunodeficiency virus; LTM, long-term memory; STM, short-term memory; TIA, transient ischemic attack; VaD, vascular dementia.

Table 5 Memory classification

Type		Test	Subtest	Brain lesion suspected location
Short-term memory		MMSE ACE-R MoCA WMS-IV RBMT	Orientation, registration Orientation, registration Orientation Orientation Orientation	Prefrontal cortex, Broca’s area, supplementary motor cortex, left posterior parietal cortex, right posterior parietal cortex
Working memory		MMSE	Attention and concentration (serial subtraction), verbal (repetition of sentences), visuo-spatial (2 pentagons drawing)	Prefrontal cortex, dorsolateral prefrontal cortex
		ACE-R	Attention and concentration (serial subtraction), verbal (language repetition), visuo-spatial (2 pentagons and cube drawing), perceptual ability (dot counting and letters identifying)
		MoCA	Attention and concentration (forward and backward list of digits), verbal (language repetition), visuo-spatial (cube drawing)
		TMT A and B	Attention and concentration
		Stroop test	Attention and concentration (color test)
		WCST	Executive function
		CDT	Visuospatial
		WMS-IV	Visual working memory (spatial addition, spatial span)
		WAIS-IV	Digit span (attention, concentration and mental control) Arithmetic (concentration while manipulating mental mathematical problems)
Long-term memory	Episodic memory	MMSE ACE-R MoCA WMS-IV RBMT	Recall three objects Recall three objects/anterograde, retrograde Delayed recall Delayed memory (logical memory II) Delayed recall	Medial temporal lobe, diencephalon
	Semantic memory	MMSE ACE-R MoCA FAB WMS-IV RBMT CVLT	Language repetition, naming, comprehension Verbal fluency, language repetition, naming, comprehension, reading, writing Verbal fluency, language repetition, naming Verbal fluency Verbal fluency Verbal fluency Verbal fluency	Inferior and lateral temporal lobe
	Procedural memory	RBMT		Basal ganglia, cerebellum

Abbreviations: ACE-R, Addenbrooke’s Cognitive Examination – Revised; CDT, Clock Drawing Test; CVLT, California Verbal Learning Test; FAB, Frontal Assessment Battery Scale; MMSE, Mini-Mental State Examination; MoCA, Montreal Cognitive Assessment; RBMT, Rivermead Behavioural Memory Test; TMT, Trail Making Test; WAIS, Wechsler Adult Intelligence Scale; WCST, Wisconsin Card Sorting Test; WMS-IV, Wechsler Memory Scale – 4th edition.

Table 6 Neuropsychological assessment characteristics

Assessments	Items	Subtests	Maximum score	Characteristics
MMSE	Orientation Registration Calculation/WORLD Memory recall Language naming Language comprehension Language writing Language repetition Visuo-spatial abilities MMSE total score	Orientation to place and time Repeat “ball, flag, tree” Serial 7 subtraction/WORLD backward Recall “ball, flag, tree” Name of two objects (a watch and a pen) “Close your eyes,” “Pick up the paper in your right hand, fold it in half, and set it on the floor” Write a sentence Repeat “No ifs, ands, or buts” Draw two pentagons	10 3 5 3 2 3 1 1 1 30	Time 10 minutes
ACE-R	Orientation* Registration* Calculation/WORLD* Recall* Anterograde Retrograde memory Letter fluency** Category fluency Comprehension* Writing* Repetition* Naming* Picture comprehension Reading Visuoexecutive* Visuoperceptual Address recall Address recognition ACE-R total score	Orientation to place and time Repeat “lemon, key, ball” Serial 7 subtraction/WORLD backward Recall “apple, table, penny” Repeat name and address, best of three trials Current prime minister, last prime minister, current US president, last US president No of words in 1 minute No of animals in 1 minute Obey written instruction “close your eyes,” perform three-step command Write a sentence Repeat “hippopotamus, eccentricity, unintelligible, statistician,” “above, beyond, and below,” and “no ifs, ands, or buts” Confrontation naming (12 line drawings) For example, “point to the object with a nautical connection” Read list of five words Intersecting pentagons, cube, and clock drawing Dot counting without pointing, recognition of fragmented letters Recall of name and address learned earlier Recognition of name and address items (if not recalled spontaneously)	10 3 5 3 7 4 7 7 4 1 4 12 4 1 8 8 7 5 100	Time 15–20 minutes
MoCA	Visuoexecutive*	Trail B test, cube copy, clock drawing	5	Time 10–15 minutes
	Naming*	Confrontation naming (lion, hippo, camel)	3
	Digit span	Forward (five digits), backward (three digits)	2
	Attention	Tapping at the letter A in letter list	1
	Calculation*	Serial 7 subtractions	3
	Repetition*	Repetition of two complex sentences	2
	Verbal fluency**	>11 words beginning with the letter F in 1 minute	1
	Abstraction	Similarities (eg, train and bicycle = transport)	2
	Recall*	Recall a list of five words	5
	Orientation*	Date, month, year, day, place, city	6
	MoCA total score		30
FAB	Similarities	Conceptualization	3	Time 10–15 minutes
	Lexical fluency**	Mental flexibility	3
	Motor series	Programming	3
	Conflicting instructions	Sensitivity to interference	3
	Go-No-Go	Inhibitory control	3
	Prehension behavior	Environmental autonomy	3
	FAB total score		18

Notes:

* ACE-R and MoCA contain MMSE items

** MoCA and FAB same item.

Abbreviations: ACE-R, Addenbrooke’s Cognitive Examination – Revised; FAB, Frontal Assessment Battery Scale; MMSE, Mini-Mental State Examination; MoCA, Montreal Cognitive Assessment.

SummersDMalloyRCT and MR imaging in the acute ischemic stroke patient: a nursing perspectiveJ Radiol Nurs2011303104115

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