Cognitive impairments such as memory impairments, word-finding difficulties, compromised orientation and perception are often observed in stroke patients. Low serum-mg-concentrations are associated with cognitive impairments in ischemic stroke patients one month after stroke onset. It is not clear, if cognitive impairments after stroke is caused by the mg-deficiency or by the stroke itself. Until now, no studies investigating the relationship between mg-concentration, stroke severity and cognition during treatment course are available. Thus, this study aimed to investigate the relationship between mg-concentration and cognition of stroke patients.
Stroke patients admitted to the stroke unit will be included. Initial mg-concentration in serum as well as stroke related measures (National Institutes of Health Stroke Scale, Scandinavian Stroke Scale, modified Rankin Scale) will be ealuated. Moreover, the cognitive abilities of the patient will be assessed within the first three days via the Kölner Neuropsychologische Screening for stroke patients as well as the Mini Mental Status Test. During stroke rehabilitation mg-level, stroke related measures (NIHSS,SSS,MRS) as well as the cognitive tests (MMST,KöpSS) will be re-assed after 4 weeks, 3 month as well as at study end, which is defined as discharge from the clinic (death, transfer to another hospital without return after 4 weeks, discharge to long-term nursing/ home/hospice). Attention-network of stroke patients are measeared if the patient undergo a MRi scan. In this study following questions will be assessed: 1. What is the incidence of cognitive impairments in stroke patients? 1. Are there differences between ischemic and hemorrhagic stroke patients? 2. Are there age and/or gender differences? 2. Are there differences regarding the mg-concentration at admission in comparison to the follow-up (week 4 after admission, 3 month after admission) and between patients with/without cognitive impairments? 3. Is there a correlation between the mg-concentration and the stroke severity? 4. Is there a correlation between the scores of the different cognitive tests (MMST and KöpSS)? 5. Is there an association between the stroke severity, the cognitive impairments (KöpSS) and the neuronal attention network?
Study Type
OBSERVATIONAL
Enrollment
80
The cognitive state of the patient is measure by the Kölner Neuropsychologische Screening (KöpSS) and by the Mini Mental Status Test (MMST). The MMST is a popular often used test, which makes comparisons to other international studies possible. However, even though this test was specifically designed for stroke patients, it has a limited sensibility. Thus the KöpSS is being used as an additional test demonstrating satisfactory sensibility and specificity. It is suitable for acute and subacute strokes and covers all stroke relevant domains.
Institute for Neurorehabilitation Research, BDH-Clinic Hessich Oldendorf
Hessisch Oldendorf, Lower Saxony, Germany
RECRUITINGSerum mg-concentration
This study defines a reference value ranging from 1,8 to 2,53 mg/dl.
Time frame: day 1
Change from Serum mg-concentration from admission at day 28
This study defines a reference value ranging from 1,8 to 2,53 mg/dl.
Time frame: day 28
Change from Serum mg-concentration from admission at day 72
This study defines a reference value ranging from 1,8 to 2,53 mg/dl.
Time frame: day 72
Change from Serum mg-concentration from admission at study end
This study defines a reference value ranging from 1,8 to 2,53 mg/dl.
Time frame: up to 6 month
Kölner Neuropsychologische Screening für Schlaganfall-Patienten (KöpSS)
The score ranges from 0 to 108 points. If all subtest can be performed, a score \<98 points identify an impaired cognition.
Time frame: day 3
Change from Kölner Neuropsychologische Screening für Schlaganfall-Patienten (KöpSS) at day 28
The score ranges from 0 to 108 points. If all subtest can be performed, a score \<98 points identify an impaired cognition.
Time frame: day 28
Change from Kölner Neuropsychologische Screening für Schlaganfall-Patienten (KöpSS) at day 72
The score ranges from 0 to 108 points. If all subtest can be performed, a score \<98 points identify an impaired cognition.
Time frame: day 72
Change from Kölner Neuropsychologische Screening für Schlaganfall-Patienten (KöpSS) at study end
The score ranges from 0 to 108 points. If all subtest can be performed, a score \<98 points identify an impaired cognition.
Time frame: up to 6 month
National Institutes of Health Stroke Scale
0-5 points: mild stroke; 6-14 points: moderate stroke; 15- 24 points: severe stroke; ≥25 points: very severe stroke
Time frame: day 1
Change from National Institutes of Health Stroke Scale at day 3
0-5 points: mild stroke; 6-14 points: moderate stroke; 15- 24 points: severe stroke; ≥25 points: very severe stroke
Time frame: day 3
Change from National Institutes of Health Stroke Scale at day 28
0-5 points: mild stroke; 6-14 points: moderate stroke; 15- 24 points: severe stroke; ≥25 points: very severe stroke
Time frame: day 28
Change from National Institutes of Health Stroke Scale at day 72
0-5 points: mild stroke; 6-14 points: moderate stroke; 15- 24 points: severe stroke; ≥25 points: very severe stroke
Time frame: day 72
Change from National Institutes of Health Stroke Scale at study end
0-5 points: mild stroke; 6-14 points: moderate stroke; 15- 24 points: severe stroke; ≥25 points: very severe stroke
Time frame: up to 6 month
Lenght of stay
Lenght of stay will be assesse at discharge.
Time frame: up to 6 month
Mini Mental State Test (MMST)
30 - 28 points no dementia; 27 - 25 points mild cognitive decline; 24 - 18 points mild dementia; 17 - 10 points moderate dementia; \< 10 points severe dementia
Time frame: day 3
Change from Mini Mental State Test (MMST) at day 28
30 - 28 points no dementia; 27 - 25 points mild cognitive decline; 24 - 18 points mild dementia; 17 - 10 points moderate dementia; \< 10 points severe dementia
Time frame: day 28
Change from Mini Mental State Test (MMST) at day 72
30 - 28 points no dementia; 27 - 25 points mild cognitive decline; 24 - 18 points mild dementia; 17 - 10 points moderate dementia; \< 10 points severe dementia
Time frame: day 72
Change from Mini Mental State Test (MMST) at study end
30 - 28 points no dementia; 27 - 25 points mild cognitive decline; 24 - 18 points mild dementia; 17 - 10 points moderate dementia; \< 10 points severe dementia
Time frame: up to 6 month
Modified Rankin Scale (MRS)
0 - No symptoms; 1 - No significant disability. Able to carry out all usual activities, despite some symptoms; 2 - Slight disability. Able to look after own affairs without assistance, but unable to carry out all previous activities; 3 - Moderate disability. Requires some help, but able to walk unassisted; 4 - Moderately severe disability. Unable to attend to own bodily needs without assistance, and unable to walk unassisted; 5 - Severe disability. Requires constant nursing care and attention, bedridden, incontinent; 6 - Dead.
Time frame: day 1
Change from Modified Rankin Scale (MRS) at day 3
0 - No symptoms; 1 - No significant disability. Able to carry out all usual activities, despite some symptoms; 2 - Slight disability. Able to look after own affairs without assistance, but unable to carry out all previous activities; 3 - Moderate disability. Requires some help, but able to walk unassisted; 4 - Moderately severe disability. Unable to attend to own bodily needs without assistance, and unable to walk unassisted; 5 - Severe disability. Requires constant nursing care and attention, bedridden, incontinent; 6 - Dead.
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Time frame: day 3
Change from Modified Rankin Scale (MRS) at day 28
0 - No symptoms; 1 - No significant disability. Able to carry out all usual activities, despite some symptoms; 2 - Slight disability. Able to look after own affairs without assistance, but unable to carry out all previous activities; 3 - Moderate disability. Requires some help, but able to walk unassisted; 4 - Moderately severe disability. Unable to attend to own bodily needs without assistance, and unable to walk unassisted; 5 - Severe disability. Requires constant nursing care and attention, bedridden, incontinent; 6 - Dead.
Time frame: day 28
Change from Modified Rankin Scale (MRS) at day 72
0 - No symptoms; 1 - No significant disability. Able to carry out all usual activities, despite some symptoms; 2 - Slight disability. Able to look after own affairs without assistance, but unable to carry out all previous activities; 3 - Moderate disability. Requires some help, but able to walk unassisted; 4 - Moderately severe disability. Unable to attend to own bodily needs without assistance, and unable to walk unassisted; 5 - Severe disability. Requires constant nursing care and attention, bedridden, incontinent; 6 - Dead.
Time frame: day 72
Change from Modified Rankin Scale (MRS) at study end
0 - No symptoms; 1 - No significant disability. Able to carry out all usual activities, despite some symptoms; 2 - Slight disability. Able to look after own affairs without assistance, but unable to carry out all previous activities; 3 - Moderate disability. Requires some help, but able to walk unassisted; 4 - Moderately severe disability. Unable to attend to own bodily needs without assistance, and unable to walk unassisted; 5 - Severe disability. Requires constant nursing care and attention, bedridden, incontinent; 6 - Dead.
Time frame: up to 6 month
Scandinavian Stroke Scale (SSS)
Sum score range from 0 to 58 in the edited version,with 0 indicating severe neurological deficits and 58 indicating no neurological deficits.
Time frame: day 1
Change from Scandinavian Stroke Scale (SSS) at day 3
Sum score range from 0 to 58 in the edited version,with 0 indicating severe neurological deficits and 58 indicating no neurological deficits.
Time frame: day 3
Change from Scandinavian Stroke Scale (SSS) at day 28
Sum score range from 0 to 58 in the edited version,with 0 indicating severe neurological deficits and 58 indicating no neurological deficits.
Time frame: day 28
Change from Scandinavian Stroke Scale (SSS) at day 72
Sum score range from 0 to 58 in the edited version,with 0 indicating severe neurological deficits and 58 indicating no neurological deficits.
Time frame: day 72
Change from Scandinavian Stroke Scale (SSS) at study end
Sum score range from 0 to 58 in the edited version,with 0 indicating severe neurological deficits and 58 indicating no neurological deficits.
Time frame: up to 6 month
Early Rehabilitation Barthel Index (ERBI)
Sum score range from -325 to 100 points,with 100 indicating independence in the activity of daily living.
Time frame: day 1
Change from Early Rehabilitation Barthel Index (ERBI) at day 3
Sum score range from -325 to 100 points,with 100 indicating independence in the activity of daily living.
Time frame: day 3
Change from Early Rehabilitation Barthel Index (ERBI) at day 28
Sum score range from -325 to 100 points,with 100 indicating independence in the activity of daily living.
Time frame: day 28
Change from Early Rehabilitation Barthel Index (ERBI) at day 72
Sum score range from -325 to 100 points,with 100 indicating independence in the activity of daily living.
Time frame: day 72
Change from Early Rehabilitation Barthel Index (ERBI) at study end
Sum score range from -325 to 100 points,with 100 indicating independence in the activity of daily living.
Time frame: up to 6 month
International Classification of Functioning Disability and Health (ICF) Assessment
A core set consisting of 20 ICF items is used. The severity of each item is scored with zero ("no impairment") to four ("complete impairment").
Time frame: day 1
Change from International Classification of Functioning Disability and Health (ICF) Assessment at day 28
A core set consisting of 20 ICF items is used. The severity of each item is scored with zero ("no impairment") to four ("complete impairment").
Time frame: day 28
Change from International Classification of Functioning Disability and Health (ICF) Assessment at day 72
A core set consisting of 20 ICF items is used. The severity of each item is scored with zero ("no impairment") to four ("complete impairment").
Time frame: day 72
Change from International Classification of Functioning Disability and Health (ICF) Assessment at study end
A core set consisting of 20 ICF items is used. The severity of each item is scored with zero ("no impairment") to four ("complete impairment").
Time frame: up to 6 month
Early Functional Abilities (EFA)
Sum score range from 20 to 100 points,with 100 indicating no impairement.
Time frame: day 1
Change from Early Functional Abilities (EFA) at day 28
Sum score range from 20 to 100 points,with 100 indicating no impairement.
Time frame: day 28
Change from Early Functional Abilities (EFA) at day 72
Sum score range from 20 to 100 points,with 100 indicating no impairement.
Time frame: day 72
Change from Early Functional Abilities (EFA) at study end
Sum score range from 20 to 100 points,with 100 indicating no impairement.
Time frame: up to 6 month
Adverse events and complications
All adverse events and complications will be documened.
Time frame: up to 6 month