Sein Cho
At the Bayview Stroke Intervention Clinic (BaSIC), patients are seen for follow-up at 1, 6, and 12-months post-infarct. Many of these patients have relatively small strokes, as shown on the right image in these brain MRI scans. Patients with a stroke of this size typically lack major motor and language impairments and can appear as though they are fine. However, during their clinic visits, patients with these “small” strokes often express feeling very fatigued, inattentive, unable to concentrate, cognitively slow, etc. While they may not have a visible disability, they still struggle to return to work and normal life due to this cognitive dysfunction.
In order to investigate cognition post-stroke, patients with relatively small strokes were enrolled in the “Recovery Study” at their first clinic visit. At each visit, the patient underwent a battery of cognitive testing that evaluated six domains, including: verbal memory, spatial memory, motor speed, processing speed, executive function, and global cognition.
We use the MoCA as part of our cognitive battery. The extended battery used for the recovery study is longer and more in-depth.
*Montreal Cognitive Assessment (MoCA)
The Montreal Cognitive Assessment (MoCA) was designed as a rapid screening instrument for mild cognitive dysfunction. It assesses different cognitive domains: attention and concentration, executive functions, memory, language, visuoconstructional skills, conceptual thinking, calculations, and orientation.
The total possible score is 30, a score of 26 or above is considered normal.

This study found that cognitive impairment across multiple domains is common at 1-month following a minor stroke, regardless of location in the brain. These results suggest there is some sort of global cognitive network, and a minor stroke can cause a generalized disruption of that network.
These results also demonstrated that the average scores in every domain improved from the 1-month to 6-month follow-ups; however, while some patients continue to improve from 6- to 12-months, some patients’ scores plateau and even decrease. The lab is currently investigating that discrepancy, to identify the possible factors that drive continued improvement and potentially the factors that predict long-term decline.


Examples of MRI images with stroke (mechanism not specified)
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