Cognitive Assessments in Randomized Controlled Trials of Acute or Secondary Prevention Stroke Treatments 2011 to 2024: A Scoping Review.

Background: Cognitive impairment after stroke is common and associated with poorer outcomes. However, cognition is rarely assessed in acute or secondary prevention randomized controlled trials (RCTs), and those that do have not been systematically synthesized. This review examines how often cognitive end points are used, specific assessments applied, domains tested, and rates of missing cognitive data.

Faster Thrombolysis Is Associated With Improved Cognitive Outcomes in Patients With Acute Ischemic Stroke Treated With Alteplase and Tenecteplase: A Substudy of the AcT Trial.

Background: Cognitive impairment after stroke is linked with poorer functional outcomes. Faster thrombolytic improves recanalization, 3-month functional recovery, and in-hospital survival. We examined whether faster treatment times from door-to-needle and symptom onset-to-needle (OTN) impacted cognition.

Adjunctive Intraarterial Thrombolysis after Thrombectomy in Large Vessel Occlusion Stroke: A Meta-Analysis of RCTs.

Background And Purpose: Adjunctive intraarterial (IA) thrombolysis after endovascular thrombectomy may improve clinical outcomes in patients with large vessel occlusion (LVO) stroke possibly due to improvement in microvascular reperfusion.

Methods: We conducted a meta-analysis of randomized controlled trials (RCTs) evaluating IA thrombolysis with tenecteplase, alteplase or urokinase in anterior or posterior circulation LVO stroke after successful reperfusion (modified Thrombolysis in Cerebral Infarction 2b-3). Efficacy outcomes were excellent functional outcome (modified Rankin Scale [mRS] 0-1), functional independence (mRS 0-2) and recovery without any disability (mRS 0) at 90 days.

Tiny-objective segmentation for spot signs on multi-phase CT angiography via contrastive learning with dynamic-updated positive-negative memory banks.

Background And Objective: Presence of spot sign on CT Angiography (CTA) is associated with hematoma growth in patients with intracerebral hemorrhage. Measuring spot sign volume over time may aid to predict hematoma expansion. Due to the difficulties that imaging characteristics of spot sign are similar with vein and calcification and spot signs are tiny appeared in CTA images to detect, our aim is to develop an automated method to pick up spot signs accurately.

Deep Learning based Collateral Scoring on Multi-Phase CTA in patients with acute ischemic stroke in MCA region.

Background And Purpose: Collateral circulation is a critical determinant of clinical outcomes in acute ischemic stroke (AIS) patients and plays a key role in patient selection for endovascular therapy. This study aimed to develop an automated method for assessing and quantifying collateral circulation on multi-phase CT angiography, aiming to reduce observer variability and improve diagnostic efficiency.

Materials And Methods: This retrospective study included mCTA images from 420 AIS patients within 14 hours of stroke symptom onset.

Management of Patients With Mild Cognitive Impairment in the Era of Anti-Amyloid Therapy: A Worldwide Neurology Survey.

Background And Objectives: The aim of this study was to explore practice patterns in managing mild cognitive impairment (MCI). The investigation and management of MCI is considered important because it offers the opportunity to potentially stave off conversion to dementia. However, there are few data on current practices/approaches in this area, especially worldwide; such data can help identify potential disparities and anticipate adoption of new therapies.

COSMOS: Interrater and Intrarater Reliability Study of a Novel Outcome Measure.

The vast majority of patients with minor stroke achieve what are considered good or excellent outcomes on the modified Rankin Scale (0-1/0-2), yet many are dissatisfied with their outcomes. There is a need for a functional outcome measure tailored for minor stroke that better reflects the spectrum of clinical outcomes within this population. We developed the Canadian Outcome Scale for Minor Stroke (COSMOS) and performed an interrater and intrarater reliability study.

The future of biomarkers for vascular contributions to cognitive impairment and dementia (VCID): proceedings of the 2025 annual workshop of the Albert research institute for white matter and cognition.

Advances in biomarkers and pathophysiology of vascular contributions to cognitive impairment and dementia (VCID) are expected to bring greater mechanistic insights, more targeted treatments, and potentially disease-modifying therapies. The 2025 Annual Workshop of the Albert Research Institute for White Matter and Cognition, sponsored by the Leo and Anne Albert Charitable Trust since 2015, focused on novel biomarkers for VCID. The meeting highlighted the complexity of dementia, emphasizing that the majority of cases involve multiple brain pathologies, with vascular pathology typically present.

Rural Field Consultation for Remote Acute Stroke Transport Decisions.

Background: The best prehospital transport strategy for patients with suspected stroke due to possible large vessel occlusion varies by jurisdiction and available resources. A foundational problem is the lack of a definitive diagnosis at the scene. Rural stroke presentations provide the most problematic triage destination decision-making.

Arterial brain calcium (ABC) volume - A novel radiological marker of atherosclerotic risk and future stroke risk on non-contrast CT.

Background And Purpose: Coronary calcium is a well-recognized marker of atherosclerotic risk. While intracranial carotid artery calcification has received some attention, calcific disease in other intracranial arteries is not well studied. In this pilot study, we sought to examine the whether the total volume of calcium in the intracranial arteries is associated with established markers of atherosclerosis and stroke risk.

Correlation of Depression and Anxiety Responses on the Mild Behavioral Impairment Checklist With the Cornell Scale for Depression in Dementia and Abbreviated Version of the Penn State Worry Questionnaire.

Introduction: Cognitive disorders are often accompanied by depression and anxiety. The Mild Behavioral Impairment Checklist (MBI-C) was developed to capture neuropsychiatric symptoms that predict risk for dementia and includes questions on mood, but has not been validated for identifying significant depression or anxiety symptoms. Our objective was to determine whether MBI-C mood domain scores predict responses on 2 previously validated scales: the Cornell Scale for Depression in Dementia (CSDD) and the Penn State Worry Questionnaire-Abbreviated version (PSWQ-A) scales.

Frailty and stroke: Global implications for assessment, research, and clinical care-A WSO scientific statement.

Frailty is common in stroke and has important disease- and treatment-modifying effects. The need to develop clinical practice and research for the impact of frailty on stroke is likely to increase in the coming decades as the global population ages, resulting in a higher burden of frailty that is likely to be borne disproportionately by lower- and middle-income countries.The global nature of frailty in stroke necessitates global action.

The Effect of Training and Certification for the NIHSS and the mRS on Rater Performance: A Systematic Review.

Background: Up-to-date certification of the National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS) is often required for clinical trials, representing a significant burden on clinical investigators globally.

Aims: This systematic review sought to determine if NIHSS or mRS training, re-training, certification or recertification led to improvements in the reliability or accuracy of ratings as well as other relevant user metrics (e.g.

Impact of Brain Frailty on Clinical Presentation and Neurologic Recovery in Acute Ischemic Stroke Patients Undergoing Thrombectomy.

Background And Objectives: Brain frailty impairs the ability to compensate for brain dysfunction and is linked to worse outcomes after stroke. Stroke severity at presentation is a key determinant of outcomes in acute ischemic stroke. This study aimed to examine the impact of brain frailty on initial stroke severity and recovery in acute ischemic stroke (AIS) patients undergoing endovascular thrombectomy (EVT).

Mitigating and Quantifying Cherry-Picking in Acute Stroke Trials.

Consecutive enrollment of eligible patients is fundamental to the internal and external validities of randomized controlled trials. The generalizability of trial results is greatly undermined when enrolled patients are not representative of the broader target population, which is especially likely if a large proportion of otherwise-eligible individuals receive treatment outside the trial. In this article, we discuss the problem that such selective recruitment or cherry-picking of patients poses to clinical trials.

Patient and Caregiver Perspectives on the Design and Execution of ACT-GLOBAL, a Stroke Adaptive Platform Trial: A Focus Group Study.

Introduction: Adaptive platform trials represent a paradigm shift in stroke research. We examined how patient-partners perceived the design and execution of an international platform trial in acute stroke, ACT-GLOBAL (A multi-faCtorial, mulTi-arm, multi-staGe, randomized, gLOBal Adaptive pLatform trial for stroke), through a series of focus groups with process evaluation methodology.

Methods: Participants were recruited from two comprehensive stroke centers one in Calgary, Canada and one in Sydney, Australia.

Comparing Early National Institutes of Health Stroke Scale Versus 90-Day Modified Rankin Scale Outcomes in Acute Ischemic Stroke Trials: A Systematic Review and Analysis.

Background: Early National Institutes of Health Stroke Scale (NIHSS) assessment may provide practical benefits over 90-day modified Rankin Scale (mRS), but it is unclear how it compares in adjudicating randomized clinical trial (RCT) results in acute ischemic stroke.

Methods And Results: We searched Ovid Medline (inception to April 1, 2023) and included RCTs of acute therapies for acute ischemic stroke with data for both 90-day mRS and NIHSS within 7 days. Primary outcome was agreement between trial results (classified as positive, negative, or neutral) based on 24-hour NIHSS and 90-day mRS scores.

Synchronous Image-Label Diffusion Probability Model With Application to Stroke Lesion Segmentation on Non-Contrast CT.

The stroke lesion volume is a key radiologic measurement for assessing the prognosis of acute ischemic stroke (AIS) patients, which is challenging to be automatically measured on noncontrast CT (NCCT) scans. Recent diffusion probabilistic models (DPMs) in the domain of image generation have shown potentials of being used for lesion volume segmentation on medical images. In this article, a novel synchronous image-label diffusion probability model (SDPM) is proposed for stroke lesion segmentation on NCCT using a dual-Markov diffusion process with shared noise.

Sex Differences in Outcomes After Tenecteplase for Minor Stroke: A Subanalysis of the TEMPO-2 Trial.

Background: In this subanalysis of the TEMPO-2 (Tenecteplase Versus Standard of Care for Minor Ischaemic Stroke With Proven Occlusion) trial, a randomized clinical trial comparing tenecteplase and nonthrombolytic control in patients with minor stroke and symptomatic intracranial occlusion, we investigated sex differences in the efficacy and safety of tenecteplase.

Methods: We compared outcomes after tenecteplase versus control, stratified by sex. We also compared outcomes in female versus male patients treated with tenecteplase.