Objectives: Cognitive impairment, anxiety, depression, fatigue, and dependence in instrumental activities of daily living (ADL) are common after stroke; however, little is known about how these outcomes may differ following treatment with endovascular clot retrieval (ECR), intravenous tissue plasminogen activator (t-PA), or conservative management.Methods: Patients were recruited after acute treatment and invited to participate in an outcome assessment 90-120 days post-stroke. The assessment included a cognitive test battery and several questionnaires. The COVID-19 pandemic led to significant disruptions in recruitment and data collection, and the t-PA and conservative management groups were combined into a standard medical care (SMC) group.Results: Sixty-two participants were included in the study (ECR = 31, SMC = 31). Mean age was 66.5 (20-86) years, and 35 (56.5%) participants were male. Participants treated with ECR had significantly higher National Institutes of Health Stroke Scale scores at presentation and significantly lower education. After adjusting for stroke severity, premorbid intellectual ability, and age, treatment with ECR was associated with significantly better performances on measures of cognitive screening, visual working memory, and verbal learning and memory. Participants treated with ECR also experienced less fatigue and were more likely to achieve independence in basic and instrumental ADLs. Despite this, cognitive impairment and fatigue were still common among participants treated with ECR and anxiety and depression symptoms were experienced similarly by both groups.Conclusions: Cognitive impairment and fatigue were less common but still prevalent following treatment with ECR. This has important practical implications for stroke rehabilitation, and routine assessment of cognition, emotion, and fatigue is recommended for all stroke survivors regardless of stroke treatment and functional outcome.

Background Little is known regarding cognitive outcomes following treatment with endovascular clot retrieval (ECR) and intravenous tissue plasminogen activator (t-PA). We aimed to determine if there were any differences on a measure of cognitive screening between patients treated with ECR, t-PA, and those who were managed conservatively. Methods The medical records of ischaemic stroke patients admitted to Monash Medical Centre between January 2019 and December 2019 were retrospectively reviewed. Information extracted from medical records included age, sex, National Institutes of Health Stroke Scale at presentation, location of occlusion, treatment type, medical history, and cognitive screening performance measured by the Montreal Cognitive Assessment (MoCA). Results Eighty-two patients met the inclusion criteria (mean age = 66.5 ± 13.9; 49 male, 33 female). Patients treated with ECR performed significantly better on the MoCA (n = 36, 24.1 ± 4.3) compared to those who were managed conservatively (n = 26, 20.7 ± 5.5). Performance for patients treated with t-PA (n = 20, 23.9 ± 3.5) fell between the ECR and conservative management groups, but they did not significantly differ from either. Conclusion Our retrospective chart review found that ischaemic stroke patients treated with ECR appear to perform better on cognitive screening compared to patients who are managed conservatively. We also found that patients treated with ECR and t-PA appear to have similar cognitive screening performances in the acute stages following ischaemic stroke, although this finding is likely to have been impacted by group differences in stroke characteristics and may reflect the possibility that the ECR group performed better than expected based on their stroke severity.

Objectives Despite the rapid increase in research examining outcomes in Autoimmune Encephalitis (AE) patients, there are few cohort studies examining cognitive outcomes in this population. Here, we conducted a retrospective observational study to characterise the neuropsychological outcomes of these patients. We then examined demographic data, clinical features, and auxiliary examination variables to determine predictors of intact outcomes. Methods This retrospective observational study collected psychometric data from 59 patients across six secondary and tertiary referral centres in metropolitan hospitals in Victoria, Australia between January 2008 and July 2019. Data were collected on patient general demographics, antibody profile, clinical features, and paraclinical findings, treatments, and psychometric data. Psychometric data was standardised into age and education normative values Pattern analysis was employed to derive patterns of psychometric deficits in these patients. Univariable logistic regression was performed to examine predictors of 'intact' psychometric outcomes. Results Twenty-nine patterns of psychometric outcomes were observed, suggesting outcomes in AE are complex. Deficits in psychometric markers of executive dysfunction were the most commonly observed in this cohort, followed by deficits on tasks sensitive to memory. Half the cohort were classified as having psychometric impairments across at least two cognitive domains. None of the demographic data, clinical features, and auxiliary examination variables were predictors of 'intact' psychometric outcome. Conclusions Neuropsychological outcomes of AE are complex and the current paper highlights the need for ongoing individual management. Further detailed and standardised cognitive testing in combination with MRI volumetrics and serum/CSF biomarkers is required to provide rigorous assessments of disease outcomes.

Background and purpose Despite the rapid increase in research examining outcomes in autoimmune encephalitis (AE) patients, there are few cohort studies examining cognitive outcomes in this population. The current study aimed to characterise psychometric outcomes in this population, and explore variables that may predict psychometric outcomes. Methods This retrospective observational study collected psychometric data from 59 patients across six secondary and tertiary referral centres in metropolitan hospitals in Victoria, Australia between January 2008 and July 2019. Frequency and pattern analysis were employed to define and characterize psychometric outcomes. Univariable logistic regression was performed to examine predictors of intact and pathological psychometric outcomes. Results Deficits in psychometric markers of executive dysfunction were the most common finding in this cohort, followed by deficits on tasks sensitive to memory. A total of 54.2% of patients were classified as having psychometric impairments across at least two cognitive domains. Twenty-nine patterns were observed, suggesting outcomes in AE are complex. None of the demographic data, clinical features or auxiliary examination variables were predictors of psychometric outcome. Conclusions Cognitive outcomes in AE are complex. Further detailed and standardized cognitive testing, in combination with magnetic resonance imaging volumetrics and serum/cerebrospinal fluid biomarkers, is required to provide rigorous assessments of disease outcomes.

STUDY OBJECTIVES:Sleep disordered breathing (SDB) in children is associated with detrimental neurocognitive and behavioral consequences. The long term impact of treatment on these outcomes is unknown. This study examined the long-term effect of treatment of SDB on neurocognition, academic ability, and behavior in a cohort of school-aged children.DESIGN:Four-year longitudinal study. Children originally diagnosed with SDB and healthy non-snoring controls underwent repeat polysomnography and age-standardized neurocognitive and behavioral assessment 4y following initial testing.SETTING:Melbourne Children's Sleep Centre, Melbourne, Australia.PARTICIPANTS:Children 12-16 years of age, originally assessed at 7-12 years, were categorized into Treated (N = 12), Untreated (N = 26), and Control (N = 18) groups.INTERVENTIONS:Adenotonsillectomy, Tonsillectomy, Nasal Steroids. Decision to treat was independent of this study.MEASUREMENTS AND RESULTS:Changes in sleep and respiratory parameters over time were assessed. A decrease in obstructive apnea hypopnea index (OAHI) from Time 1 to Time 2 was seen in 63% and 100% of the Untreated and Treated groups, respectively. The predictive relationship between change in OAHI and standardized neurocognitive, academic, and behavioral scores over time was examined. Improvements in OAHI were predictive of improvements in Performance IQ, but not Verbal IQ or academic measures. Initial group differences in behavioral assessment on the Child Behavior Checklist did not change over time. Children with SDB at baseline continued to exhibit significantly poorer behavior than Controls at follow-up, irrespective of treatment.CONCLUSIONS:After four years, improvements in SDB are concomitant with improvements in some areas of neurocognition, but not academic ability or behavior in school-aged children.

BACKGROUND:Parents consistently report working memory deficits in children with sleep-disordered breathing (SDB); however, results from objective testing measures are inconsistent. This study aims to examine and compare working memory performance in children with various degrees of severity of SDB using both parent report and objective testing. METHODS:Subjects included 127 children aged 7-12 years (mean age 9.6 ± 1.6 y: 71 M/56 F). Overnight polysomnography classified subjects into four groups: control (N=34); primary snoring (PS: N=55), mild obstructive sleep apnoea (mild OSA: N=22) and moderate to severe OSA (MS OSA: N=16). The Behaviour Rating Inventory of Executive Function (BRIEF) was used as the parent reported measure of working memory. A computerised task involving immediate recognition of playing cards (CogHealth) was used as the objective measure. RESULTS:Results of the BRIEF revealed working memory deficits at all severities of SDB compared to controls. Results of CogHealth revealed no difference between SDB groups and controls; however, mild OSA performed significantly worse than PS. Comparison of the two measures revealed that parents of controls reported less deficits, and parents of PS reported more deficits, than were found on the objective measure of working memory. CONCLUSIONS:This study showed that parents of children with less severe SDB have a tendency to overestimate the level of working memory deficit in their children, possibly as a reflection of behaviour. This suggests that observation of deficits in working memory may be largely dependent on the assessment method and children with SDB may not be as impaired as previously thought.

Objective: Sleep disordered breathing (SOB) is common in children and ranges in severity from primary snoring (PS), to obstructive sleep apnea syndrome (OSAS). This study investigated everyday function (behavior, attention, executive skills) in children with varying degrees of SOB and control children with no history of SOB recruited from the community.Methods: One hundred thirty-six children aged 7-12 were studied. Routine overnight polysomnography (PSG) classified children into 4 groups: PS (n = 59), mild OSAS (n = 24), moderate/severe OSAS (n = 18), and controls (n = 35). Behavioral function and behavioral aspects of attention and executive function were assessed using the Child Behavior Checklist (CBCL) and the Behavior Rating Inventory of Executive Function (BRIEF).Results: Children with all seventies of SDB had significantly higher rates of total, internalizing and externalizing behavioral problems compared to control children. increased rates of behavioral executive dysfunction were also found across the SOB spectrum.Conclusion: Our findings suggest that behavioral, attention, and executive function difficulties are present in children with PS as well as OSAS. These results have implications for the treatment of milder forms of SOB, particularly PS, which is commonly viewed as benign. (C) 2011 Elsevier B.V. All rights reserved.