Risultati per: Gestione delle complicanze psichiatriche e cognitive nel Parkinson

Stroke, Volume 56, Issue Suppl_1, Page AWP175-AWP175, February 1, 2025. Background:Post-stroke cognitive impairment (PSCI) is a condition characterized by cognitive decline that occurs after a stroke. PSCI affects up to 60% of stroke survivors. Early detection of those at high risk for PSCI is essential for timely intervention and personalized care. Electronic health records (EHRs) contain valuable data that can be leveraged by machine learning to predict PSCI, potentially enhancing patient outcomes. This study focuses on developing and validating machine learning models to predict PSCI, aiming to enable earlier diagnosis and improve post-stroke care.Methods:7956 all-type stroke patients (including Ischemic&Hemorrhagic stroke) treated between 2012 and 2021 were extracted from Emory Healthcare system. We employed multiple methods to predict PSCI, using ICD codes and prescribed medications that were available up to the discharge of index strokes. First, we utilized traditional machine learning methods, including Logistic Regression, Support Vector Machine, and Random Forest to develop models. Then, we developed hypergraph models to enhance prediction performance. Unlike traditional graphs that only capture pair-wise relationships between pairs of entities, hypergraphs can model the more complex higher-order relationships among multiple entities, by allowing a hyperedge (encounter) to connect multiple vertices (ICD and medications) simultaneously among patient visits and EHR medical features. Finally, we compared the performance across different methods and selected the best one for the PSCI prediction task. We compared their performance on four metrics: ACC (Accuracy, the proportion of correct predictions), AUC (Area Under the ROC Curve, measuring the model’s ability to distinguish between classes), AUPR (Area Under the Precision-Recall Curve, a comprehensive measure considering both precision and recall), and Macro-F1 (a balanced measure calculated by the harmonic mean of precision and recall).Results:We included 7956 all-type stroke patients (50% female, 56% non-white) in this analysis, where 1797 (23%) had diagnostic codes often used by clinicians at Emory to document PSCI. According to the performance, the hypergraph model was associated with higher ACC, AUC, AUPR, and Macro-F1 than other models.Conclusion:By comparing the results of various machine learning methods, we found that hypergraph model approaches outperform traditional machine learning methods in utilizing EHRs for predicting PSCI after a stroke.

Stroke, Volume 56, Issue Suppl_1, Page ATP369-ATP369, February 1, 2025. Introduction:The cholinergic anti-inflammatory pathway regulates immune responses through the alpha7 nicotinic acetylcholine receptor (α7nAChR), found in neurons, macrophages, and monocytes. α7nAChR activation via agonists or Vagus nerve stimulation (VNS) reduces pro-inflammatory cytokines in disease models. In young mice, pharmacological activation or stimulation of the Vagus nerve has been shown to mitigate ischemic stroke injury by reducing brain and peripheral inflammation and oxidative stress. However, the role of α7nAChR in long-term stroke outcomes remains unclear.Methods:Young (8-12 weeks) male wild-type (WT) and α7nAChR knockout (KO) mice underwent middle cerebral artery occlusion (MCAO) for 60 minutes. After 24 hours, brain acetylcholine levels and α7nAChR expression were assessed by mass spectrometry and western blot respectively. Microglia, macrophage counts, and TNF-α expression were evaluated using flow cytometry. Long-term behavioral tests included the Barnes maze (days 7 and 30), novel object recognition (day 10), and object location tests on day 20. A second cohort was euthanized on day 7 for brain-infiltrated immune cell analysis.Results:At 24 hours post-MCAO, brain α7nAChR expression decreased significantly without changes in acetylcholine levels. WT MCAO mice showed reduced microglia, increased microglial TNF-α expression, and fewer α7nAChR-positive microglia compared to shams (p

Stroke, Volume 56, Issue Suppl_1, Page ATP362-ATP362, February 1, 2025. Introduction:Menopause increases the risk and severity of ischemic stroke (IS), while endogenous 17β-estradiol (E2) naturally protects premenopausal women against IS. The female sex hormone E2 is a potent neuro- and cognitive-protective agent. Studies have shown that periodic E2 or estrogen receptor subtype-beta (ER-β) agonist pre-treatments every 48 hours before an ischemic episode ameliorated ischemic brain damage in young ovariectomized or reproductively senescent (RS) aged female rats. The current study investigates the underlying mechanism of ER-β agonist-mediated neuroprotection.Methods:Retired breeder (9–10 months) Sprague–Dawley female rats were considered RS after remaining in constant diestrus phase for more than a month. The RS rats were exposed to transient middle cerebral artery occlusion (tMCAO; 90 mins) and treated with either ER-β agonist (beta 2, 3-bis(4-hydroxyphenyl) propionitrile; DPN; 1 mg/kg; s.c.) or DMSO vehicle at 4.5 hours after induction of tMCAO. Subsequently, rats were treated with either ER-β agonist or DMSO vehicle every 48 hours (48-h) for ten injections. Forty-eight hours after the last treatment, animals were tested for cognitive deficits via the Morris water maze. At 1-month post-tMCAO, brains were collected for histopathological analysis. A second cohort of RS rats underwent DPN or DMSO treatment for a month; 48-h after last injection, brains were collected for unbiased global metabolomic analysis (conducted by Metabolon Inc.). The metabolomic study was complemented with western blot analysis and enzyme activity measurements of key altered pathways.Results:Data showed significant (p

Stroke, Volume 56, Issue Suppl_1, Page ATP349-ATP349, February 1, 2025. Background:Inflammation, a key player in both acute and chronic cerebral ischemia, is activated in brain tissues by bilateral carotid stenosis (BCAS)- induced chronic cerebral hypoperfusion. Our study aimed to investigate whether the deletion of the NLRP3inflammasome could abolish the deleterious effects of BCAS-induced chronic hypoperfusion in an experimental model of VCID.Methods:Microcoil-induced BCAS was used to induce chronic hypoperfusion. Middle-young (8-10 mice per group,4-5 months old, male) NLRP3WT and NLRP3KO were randomly assigned to BCAS-induced chronic hypoperfusion for four weeks. Cerebral blood flow was measured by laser speckle contrast imaging (LCSI) and CBF-ASL perfusion by MRI, and novel object recognition (NOR) and wire-hanging tests were also measured. Biochemical and histopathological staining was also assessed on the brain tissues.Results:At four weeks, there was a significant increase in CBF by LSCI and CBF-ASL perfusion by MRI in NLRP3KO mice compared to NLRP3WT groups. More importantly, the cognitive and motor function, as measured by NOR and wire-hanging tests, showed a remarkable improvement in NLRP3KO mice compared to WT.Conclusions:The findings suggest that deletion of NLRP3 inflammasome not only mitigates the cognitive impairment and motor effects of chronic hypoperfusion but also significantly improves cerebral blood flow. This indicates that targeting the NLRP3 inflammasome may be a new therapeutic approach against VCID.

Stroke, Volume 56, Issue Suppl_1, Page ATP363-ATP363, February 1, 2025. Introduction:IL-6 is a pro-inflammatory cytokine typically low in healthy young individuals but elevated after stroke, correlating with worse outcomes. IL-6 binds to soluble IL-6 receptors, which then interact with the glycoprotein gp130, initiating pro-inflammatory trans-signaling. In young mice, gp130Fc administration showed dose-dependent benefits. To test this in older individuals, gp130Fc (0.5 mg/kg, intraperitoneally) was given to aged mice 4 hours after middle cerebral artery occlusion. This dose caused 80% mortality in aged males within 72 hours, while all females survived. A lower dose (0.25 mg/kg) improved survival to 70% in aged males. Aged females had higher baseline plasma IL-6, which may explain their higher dose tolerance. Aging is associated with cognitive decline, leading us to hypothesize that inhibiting IL-6 trans-signaling could improve cognitive function in older animals.Methods:Aged (18-19 months) C57BL/6 male and female mice were used to assess cognitive deficits following gp130Fc treatment. The mice received either saline or gp130Fc at doses of 0.25 mg/kg (for males) and 0.5 mg/kg (for females) via intraperitoneal injection a week before behavioral testing and at day 14. Cognitive function was evaluated using several tests: Y-Maze on day 7, Novel Object Recognition Test (NORT) on day 14, and Object Location (OL) on day 21. From days 22-26, mice underwent training on the Barnes Maze, with testing on day 27. Mice were euthanized on day 28.Results:Older animals exhibited similar deficits in short-term memory as assessed on the Y maze, NORT, and OL task regardless of sex, but aged females showed worse long-term memory retention compared to age-matched males, as assessed by the Barnes Maze. Female mice took longer to escape and made more incorrect entries (P

Stroke, Volume 56, Issue Suppl_1, Page ATP106-ATP106, February 1, 2025. Background:Post-stroke cognitive impairment is especially devastating for young adult patients, who are in their most productive years. Despite its significant impact, this remains under-studied in this growing and clinically distinct patient group.Methods:We systematically searched PubMed, Embase, Scopus, and Cochrane CENTRAL for studies including ischemic stroke patients aged 18-50 years from January 2000 to July 2024. This meta-analysis evaluated the pooled prevalence of post-stroke cognitive impairment (CogI) and specific cognitive domains, as well as the associations between baseline characteristics and CogI.Results:A total of 4 studies with 1060 patients were included in this systematic review and meta-analysis. Overall, 35.9% (95% CI 27.2-45.5; Figure 1) of patients experienced post-stroke CogI with a mean follow-up time of 11.7 months (95% CI 8.00-15.4). One study was not included in the meta-analysis of proportions of overall cognition as this information was not available. The prevalence for individual domains was: visuospatial construction (23.1%; 95% CI 14.7-34.4), episodic memory (18.5%; 95% CI 9.7- 32.5), delayed memory (16.0%; 95% CI 13.5-18.9), working memory (18.8%; 95%CI 11.8-28.6), and attention (9.3%; 95%CI 3.2-24.0) with a mean follow-up time of 8.11 months (95% CI 3.50-12.7). Male patients had significantly higher odds of CogI (OR 1.58, 95% CI 1.05-2.38, p=0.030; Figure 2). Hypertension, diabetes mellitus, current smoking and dyslipidaemia were not significantly associated with CogI.Conclusions:A significant proportion of young adult ischemic stroke survivors experience CogI. Longitudinal prospective cohort studies are needed to better characterise the post-stroke cognitive trajectory in this important group of patients.

Stroke, Volume 56, Issue Suppl_1, Page ATMP119-ATMP119, February 1, 2025. Background:Vascular cognitive impairment (VCI) is the second most frequent subtype of dementia following Alzheimer’s disease. However, the underlying mechanism has not been fully understood and there is no effective treatment for VCI. MicroRNAs (miRNAs) play critical roles in the pathologies of cerebral ischemia and dementia. This study aims to identify key miRNAs that may mediate cognitive outcomes using multiple microinfarction (MMI), a VCI model.Methods:MMI was induced by the administration of cholesterol crystals (70-100µm) into the internal carotid artery. Male Wistar rats (10-12 month) subjected to MMI or sham operation were euthanized 28 days after MMI (n=8/group). Total RNAs were isolated from the striatal tissues and miRNA-sequencing was performed. AAV-PHP.Eb carrying miR-145-5p sponge was delivered by the Intracerebroventricular injection at 2 days prior to MMI to knockdown miR-145-5p. The mNSS (modified Neurological Severity Score) and cognition tests were examined at 2 weeks after MMI.Results:MiRNA-sequencing analysis showed that compared to sham rats, MMI significantly up- and down-regulated 4 and 9 miRNAs respectively. Bioinformatics analysis revealed that these miRNAs were highly associated with the oligodendrocytes/myelination (miR-210 and miR-125), BBB (miR-665 and miR-29), and inflammation (miR-322), etc. Amongst them, miR-145 was the top upregulated miRNA in the striatum after MMI. In situ hybridization demonstrated that miR-145 expression was highly upregulated in the smooth muscle cells, which was negatively correlated with the decrease of contraction marker of smooth muscle cells (SMCs). Treatment of MMI rats with AAV-miR-145 sponge significantly reduced sensorimotor deficits assayed by lower mNSS score. Furthermore, MMI rats administered AAV-miR-145 spent less time on the closed arm in the EPM (AAV-miR-145 VS control AAV: 182±28 VS 263±9 (s), P=0.01) and showed less freezing time in the OFT (AAV-miR-145 VS control AAV: 205±9 VS 246±11 (s), P=0.015), compared with those treated with control AAV. These data indicate that inhibition of miR-145 reduces depression-like behavior and cognitive deficit induced by MMI.Conclusion:Our results uncovered the deregulated miRNAs associated with myelination, white matter and vascular damage after MMI. Also, our data suggest that miR-145 could be a potential therapeutic target by the regulation of SMCs against VCI. Thus, our data provides new insights into the molecular mechanisms underlying VCI.

Stroke, Volume 56, Issue Suppl_1, Page ATMP116-ATMP116, February 1, 2025. Background and Purpose:Gut microbiota dysfunction is associated with diabetic cognitive impairment (DCI). However, the mechanisms underlying the interaction of gut microbiota dysbiosis and DCI remain poorly understood. We tested the hypothesis that extracellular vesicles generated by diabetic gut microbiota exacerbate DCI by promoting the impairment of cerebral vascular function.Methods:Gut-EVs from the stools of male non-diabetic dm (dm-gut-EVs) and diabetic (db/db mice) with DCI (db-gut-EVs) mice at 20 weeks of age (20W) were isolated and characterized by means of ultracentrifugation and 16S rRNA sequencing, respectively. Given that db/db mice develop cognitive deficits at 20W, prediabetic db/db mice at 8 weeks of age (8W) were treated with gut-EVs at a dose of 1x1010particles/injection intravenously twice a week for 12 weeks. Cognitive performance was assessed using a battery of behavioral tests.Results:16S rRNA analysis revealed significant alterations in the microbiota composition of db-gut-EVs derived from 20W db/db mice with DCI compared to dm-gut-EVs (n=5/group). Db/db mice treated with db-gut-EVs extracted at 20W, but not with dm-gut-EVs, exhibited a significant decline in learning and memory function, as assayed by the Novel object recognition, Social recognition memory, and Morris water maze assay, starting at 16W and worsening at 20W, compared to db/db mice treated with saline (n=10/group). Additionally, db/db mice treated with db-gut-EVs exhibited increased cerebral vascular thrombosis (18±2 vs 11±2 Fibrin+ vessels/mm2in saline, p

Stroke, Volume 56, Issue Suppl_1, Page A27-A27, February 1, 2025. Introduction:The combination of verbal and non-verbal cognitive dysfunction in post-stroke aphasia (PSA) patients may ultimately affect social interactions. However, the underlying neural mechanisms of both verbal and non-verbal cognitive impairment remain unclear. This study aimed to investigate the activity and functional abnormalities of local and remote brain regions and their relationship with cognitive behaviour, to provide more effective guidance in future clinical therapy.Methods:We recruited 46 PSA patients and 40 normal controls(NCs) matched for general characteristics in this study and evaluated their verbal and non-verbal cognitive functions. Functional magnetic resonance imaging(fMRI) was used to examine the fractional amplitude of low-frequency fluctuations(fALFF), regional homogeneity(ReHo), and functional connectivity(FC) in PSA patients. Independent two-sample t-tests were used to identify differences in these measures between two groups. Moreover, partial correlation analyses were performed to determine the correlation between FC from the affected brain regions and language and cognitive performance in PSA patients.Results:This study revealed that PSA patients presented significantly lower fALFF and ReHo values in right cerebellum superior (CRBL.Superior.R), left thalamus(THA.L), and left middle frontal gyrus(MFG.L). Moreover, the FC in the MFG.L-left inferior frontal gyrus, orbital part was significantly lower among PSA patients and was positively correlated with language and cognitive performance(p< 0.05). The CRBL. Superior. R-left caudate nucleus and right lenticular nucleus FC were also decreased and were associated with cognitive function(p< 0.05). In addition, PSA patients were further divided into fluent and nonfluent groups. The results revealed that nonfluent patients performed worse in verbal and non-verbal cognitive performance(p< 0.05) and had weaker performance in the THA.L and left supplementary motor area FC(p< 0.001).Conclusions:This study provides new evidence that abnormal neural activity and functional connectivity within specific brain regions may play crucial roles in language and cognitive processing. The underlying mechanisms of impaired linguistic function accompanied by decline in cognition may be a partial overlap between language and cognitive-related brain networks. In future, combining cognitive and linguistic functions and designing a comprehensive treatment plan will be the focus of rehabilitation.

Stroke, Volume 56, Issue Suppl_1, Page ATP378-ATP378, February 1, 2025. Introduction:The molecular and metabolic changes that occur after acute ischemic stroke (AIS) are not fully understood. One mechanism known to trigger systemic inflammatory responses and neuronal death during ischemic stroke cascades the rapid increase in Reactive Oxygen Species (ROS). Accumulation of oxidative stress has been shown to trigger the initiation and progression of cognitive deficits, including mild cognitive impairment (MCI) and Alzheimer’s Dementia (AD). One emerging biomarker able to reliably measure oxidative stress is Malondialdehyde (MDA), a reactive carbonyl compound originating from polyunsaturated fatty acid oxidation and lipid peroxidation. Due to its composition, MDA readily reacts with lipid membranes, making it a sensitive oxidative stress biomarker. This study assessed MDA levels in the plasma of AIS patients to evaluate its ability to predict cognitive impairment and long-term functional outcomes.Hypothesis:We hypothesized that oxidative stress correlates with long-term functional outcomes in AIS patients and varies based on non-modifiable risk factors such as sex and race.Methods:In this study, we used peripheral blood plasma from healthy volunteers (HV, N=24), and from ischemic stroke patients (N=27) at 3d and 7d post-stroke to capture the temporal profile of MDA after injury. Cognitive impairment was assessed during hospitalization with the Brief Neurocognitive Screening Test (BNST), with a score of 8 or below denoting cognitive impairment.Results:AIS patients had an increase in MDA levels compared to the control group, as seen in prior literature. There was a significant correlation with increase age of stroke patients and higher levels of MDA (p

Stroke, Volume 56, Issue Suppl_1, Page ATP147-ATP147, February 1, 2025. Background and Purpose:Pneumonia remains a common complication of stroke. A formal dysphagia screening is the first line of defense for these patients. This community Primary Stroke Center (PSC) identified the need to improve swallow screen compliance both at the hospital and in the county at large. Internal data review revealed that, over a one-year period, the administration of aspirin accounted for 62% of all swallow screen fallouts. This project was developed to increase compliance with the swallow screen protocol for all patients admitted for acute ischemic stroke at one community hospital.Methods:Alliteration is well-documented as a useful tool for recall and memory in the psychological literature. The stroke team wanted to assess if promoting the alliterative association between “aspirin” and “aspiration” could improve swallow screen compliance. This was done via a three-pronged approach. A reminder was placed on to the Pyxis cubie for aspirin that read, “Aspirin&Stroke Patients: Think Aspiration! Please complete your swallow screen.” The association was socialized via flyers and huddles. A stroke committee was formed, and stroke committee nurses reviewed this new project with their colleagues. Data was collected retroactively for 19 months; 12 months prior to the intervention and 7 months after.Results:Swallow screen compliance improved from 79% prior to the intervention to 90% after the intervention.Aspirin administration accounted for 62% of all fallouts prior to the intervention. This decreased to 33% after the intervention.Conclusions:Prevention of pneumonia is key to the clinical and financial success of an institution. This simple cognitive cue had an outsized impact on swallow screen compliance and the downstream improvements in patient care and expenditure. The success of this project underscores the importance of looking outside of nursing for inspiration and guidance.

Stroke, Volume 56, Issue Suppl_1, Page AWP62-AWP62, February 1, 2025. Introduction:Cerebrovascular diseases are the third leading cause of disability worldwide, which can occur due to the effects of Post-stroke Cognitive Impairment (PSCI) and Post-Stroke Depression (PSD). Higher morbidity and mortality are associated with both conditions following a stroke, but there is a lack of research on this topic in developing countries. We studied the prevalence of stroke and PSCI and PSD in a representative sample of the Brazilian population aged over 50 years, as well as the factors associated with both conditions.Methods:We performed a retrospective analysis of the ELSI-Brazil study, a nationally representative sample of adults aged 50 and over, including 9412 individuals. Individuals self-reported their sociodemographic characteristics, previous medical history, including prior stroke (transient ischemic attack, ischemic and hemorrhagic stroke), other chronic health conditions and disability in basic (b-ADL) and instrumental activities of daily living (i-ADL). Depression was defined as a score above 4 in the CESD-8 scale. Cognitive impairment was defined through a composite z-score including episodic memory, semantic memory, prospective memory, verbal fluency and orientation. After adjustments by age, sex and education, it was defined as a score below -1.0. Statistical analysis was performed using STATA/SE 17.0 software. Logistic regression was used to study the associated variables with PSD and PSCI.Results:From the total sample, 536 (5.3%) reported previous stroke. Of these, 58.6% had PSD and 31.8% had PSCI. Individuals who had a stroke were more likely to be older, male, of black race, have lower education, and more chronic health conditions. They also had higher disability in b-ADL and i-ADL, with higher depression and higher cognitive impairment. In the logistic regression, being a woman, having more chronic health conditions and higher disability in i-ADL were associated with PSD, while only being of black race was associated with PSCI.Conclusion:More than half of individuals with a previous stroke had depression and approximately a third had cognitive impairment. PSD was associated with being a woman, more chronic health conditions and higher disability in i-ADL. PSCI was associated with black race. Understanding the factors associated with PSD and PSCI is important to reduce stroke-related disability and promote better quality of life in individuals with previous stroke.

Stroke, Volume 56, Issue Suppl_1, Page A60-A60, February 1, 2025. Introduction:Over 70% of patients experience post-stroke cognitive impairment (PSCI), which can lead to functional decline. Outpatient stroke clinics often lack a consistent and validated cognitive assessment protocol for follow-ups. This increases the risk of missed diagnosis of PSCI, which is often determined based on the subjective assessment of cognitive functioning by patients or caregivers. Our goal was to assess the practice of unstructured PSCI screening at our stroke clinic and test if a cognitive screening protocol would improve PSCI detection in follow-up patients.Methods:We led a quality improvement project to identify root causes of the problem and plan interventions for introducing a feasible cognitive screening protocol. We performed a baseline chart review on 79 stroke patients seen at the clinic to assess documentation of discussion of cognitive symptoms during visits. We developed a pre-screening survey to assess educational level, post-stroke rehabilitation participation, and vascular risk factors. We enrolled 30 follow-up patients with either an ischemic or hemorrhagic stroke. An examiner conducted a short-form MoCA (MoCA-sf) test and a CLCE-24 questionnaire for subjective cognitive complaints (SCC) on each patient. We collected data from the electronic record on discharge mRS and NIHSS scores and measured time spent on screening to assess feasibility.Results:In baseline chart review, 65% of 79 patients did not have any discussion of cognitive symptoms documented during their visit before our intervention. In our initial screening results, 53% of patients screened positive for cognitive impairment (

Stroke, Volume 56, Issue Suppl_1, Page AWP57-AWP57, February 1, 2025. Introduction:Atrial fibrillation (AF) has been linked to cognitive impairment and dementia (CID) even among patients without clinically obvious stroke, but the mechanism is not established. In this study, we aim to clarify the relationship between the burden of AF and CID in a cohort of AF patients without any history of stroke. We hypothesized that a higher AF burden would be associated with CID, possibly through more pronounced cerebral hypoperfusion and covert infarcts.Methods:We included 843 patients with AF and without a history of clinical stroke or neurodegenerative disease, who underwent brain MRI at a tertiary center. Clinical data were collected through chart review, assisted with natural language processing algorithms to improve accuracy. Patients with a diagnosis of mild cognitive impairment or dementia were classified as having CID. AF load was categorized as low-burden (paroxysmal/persistent AF) or high-burden (longstanding persistent/permanent AF). A vascular neurologist extracted data on the brain atrophy score, Fazekas score, the presence of embolic and lacunar infarcts, cerebral microbleeds (CMB), and cortical superficial siderosis (cSS) from brain MRIs (FIGURE).Results:In total, 114 patients (13.7%) had CID, and they were older (78.4±7.6 vs 72.4±9.5 years, p < 0.001), and more likely to have a higher AF burden (44.7% vs 15.3%, p

Stroke, Volume 56, Issue Suppl_1, Page A152-A152, February 1, 2025. Cognitive and speech impairments are common after stroke, contributing to greater functional dependence and a diminished quality of life. Despite this, during acute stroke hospitalization, screening for these impairments using validated tools is rarely conducted beyond routine bedside examinations by medical providers.This quality improvement project aimed to enhance the early detection of speech and cognitive impairments in stroke patients. We hypothesized that there would be low concordance between provider perceptions of cognitive impairments and objective measures and that the referral rate for outpatient speech therapy would increase following the intervention.From 07/01/24 to 08/31/24, stroke patients were screened for cognitive and language function using Saint Louis University Mental Status (SLUMS) and Quick Aphasia Battery (QAB), respectively. Providers were also surveyed on their perceptions of the patients’ cognitive and language impairments and their intent to refer them for outpatient rehabilitation.Analysis revealed a significant association between QAB score and providers’ beliefs, χ2(2, N = 19) = 6.97, p = 0.031, suggesting that providers are more likely to recognize impairments as severity increases. Linear regression comparing provider scores and SLUMS scores showed R2= 0.13, indicating that provider ratings were unreliable. A significant difference was found in referral rates before and after the intervention compared to the same period in 2023, χ2(1, N = 77) = 4.52, p = 0.034.These findings indicate that mild and moderate cognitive impairments are frequently overlooked in acute stroke care. The discrepancy between provider assessments and standardized screening highlights the inadequacy of current bedside evaluations. Moreover, the significant increase in referrals following the implementation of validated screenings supports the effectiveness of this approach in promoting timely intervention for stroke survivors.

Stroke, Volume 56, Issue Suppl_1, Page AHUP15-AHUP15, February 1, 2025. Introduction:Late complications after stroke (LCAS), including cognitive symptoms, impact quality of life and recovery. It is not known if neighborhood-level measures of socioeconomic status (SES) influence LCAS. This study assessed associations between combinations of SES measures including neighborhood income inequality (Gini) and area deprivation index (ADI), and cognitive symptoms after acute ischemic stroke (AIS) in a hospital leveraging active surveillance of LCAS.Methods:This retrospective cohort study included 570 patients hospitalized at Tufts Medical Center with AIS and with subsequent follow-up in the Stroke Clinic where clinicians routinely screen for LCAS symptoms between 0-12 months. Using zip code data at the time of hospitalization, patients were characterized as low Gini (n = 224) and high ADI (n = 325) by national and state means, respectively. These variables were combined indicating patients who were living in both a low Gini and high ADI neighborhood (n = 154) to evaluate the effects of living in a homogeneously deprived area. The multifactorial analysis assessed the frequency of cognitive symptoms, adjusting for basic demographics, NIHSS, thrombolysis, active LCAS surveillance, and ADI-Gini combination.Results:There was no association between high ADI (OR: 0.74 – 1.70, p = 0.60) or low Gini (OR: 0.82 – 2.00, p = 0.26) alone and cognitive symptoms after AIS. However, the combined variable analysis demonstrated increased frequency of cognitive symptoms in the high ADI-low Gini group (OR: 1.01 – 2.60, p = 0.047). In this model, active surveillance of LCAS was significantly associated with a higher detection rate of cognitive symptoms (OR: 4.30 – 10.49, p < 0.001).Conclusion:This study suggests that individuals living in homogeneously deprived neighborhoods report higher frequencies of cognitive symptoms after AIS. Further studies with increased power are needed to investigate the underlying causes of these disparities and to develop interventions to reduce these complications.