Ragnar Åstrand

INTRODUCTION: Lumbar puncture (LP) is increasingly performed in memory clinics. We investigated patient-acceptance of LP, incidence of and risk factors for post-LP complications in memory clinic populations. METHODS: We prospectively enrolled 3868 patients (50% women, age 66 ± 11 years, mini mental state examination 25 ± 5) at 23 memory clinics. We used logistic regression analysis using generalized estimated equations to investigate risk factors for post-LP complications, such as typical postlumbar puncture headache (PLPH) and back pain. RESULTS: A total of 1065 patients (31%) reported post-LP complaints; 589 patients (17%) reported back pain, 649 (19%) headache, of which 296 (9%) reported typical PLPH. Only few patients needed medical intervention: 11 (0.3%) received a blood patch, 23 (0.7%) were hospitalized. The most important risk factor for PLPH was medical history of headache. An atraumatic needle and age >65 years were preventive. Gender, rest after LP, or volume of cerebrospinal fluid had no effect. DISCUSSIONS: The overall risk of complications is relatively low. If risk factors shown in this study are taken into account, LPs can be safely performed in memory clinics.

OBJECTIVES: We examined cognitive functions before and in acute phase of stroke studying frequency and profile of cognitive impairment and relationships between cognitive status. METHODS: Seventy-four patients with early phase after stroke and 49 healthy controls were included and examined using the Mini-Mental State Examination (MMSE) and a battery of neuropsychological tests. Cognitive status before stroke-onset was investigated using Cognitive Impairment Questionnaire. RESULTS: Cognitive impairments were present in 96% of patients after stroke onset using the battery of neuropsychological tests and in 39% of patients using the MMSE, but in only 9% of controls. Seventy-six percent exhibited reduced executive function and 75% reduced psychomotor tempo. Cognitive dysfunction was present in 52% before stroke onset without any impact on the frequency of impairment in the various cognitive areas in early phase after stroke. CONCLUSIONS: Cognitive impairment is frequent before the onset of stroke among older people and may partially explain the very high frequency of cognitive impairment observed after stroke onset.

OBJECTIVE: The Cognitive Impairment Questionnaire (CIMP-QUEST) is an instrument based on information obtained by key informants to identify symptoms of dementia and dementia-like disorders. The questionnaire consists of three subscales reflecting impairment in parietal-temporal (PT), frontal (F) and subcortical (SC) brain regions. The questionnaire includes a memory scale and lists non-cognitive symptoms. The reliability and validity of the questionnaire were examined in 131 patients with mild cognitive impairment (MCI) or mild dementia at a university-based memory unit. METHODS/RESULTS: Cronbach alpha for all subscales was calculated at r = 0.90. Factor analysis supported the tri-dimensionality of CIMP-QUEST's brain region-oriented construct. Test-retest reliability for a subgroup of cognitively stable MCI-patients (n = 25) was found to be r = 0.83 (P = 0.0005). The correlation between the score on the cognitive subscales (PT + F + M) and Informant Questionnaire on Cognitive Decline in the Elderly was r = 0.83 (P = 0.0005, n = 123). The memory subscale correlated significantly with episodic memory tests, the PT subscale with visuospatial and language-oriented tests, and the SC and F subscales with tests of attention, psychomotor tempo and executive function. CONCLUSIONS: CIMP-QUEST has high reliability and validity, and provides information about cognitive impairment and brain region-oriented symptomatology in patients with MCI and mild dementia.

Lumbar puncture (LP) is increasingly used as ancillary investigation in memory clinics. The invasive nature of this procedure is however hampering widespread implementation. We aimed to investigate patient-acceptance of LP, and the incidence of and risk factors for post-LP complications in memory clinic populations across Europe. All patients presenting at the memory clinic were prospectively included, whenever an LP was considered. Patients were included from November 2010 until March 2014 in twenty-three memory clinics across Europe. We included 3868 patients (50% women, mean age 66±11 years, mean MMSE 25±5). Three hundred ten patients (8%) refused to undergo LP and 102 patients (3%) could not be contacted for follow-up. Prior to LP various patient and LP procedure characteristics were recorded. Within two weeks after LP patients were asked about their complaints. Main outcome measures were typical post-LP headache (PLPH) and local back pain. Logistic regression analysis using generalized estimated equations was used to investigate risk factors for post-LP complications. In total, 1065 patients (31%) reported complaints of any kind after the LP; 589 patients (17%) reported back pain, 649 (19%) headache, of which 296 (9%) reported typical PLPH. There were only few complications needing medical intervention; 11 patients (0.3%) received a blood patch, 23 (0.7%) were hospitalized. The most important risk factor for PLPH was history of headache (OR [95%CI] 1.8 [1.2-2.6] for mild headache; 2.7 [1.9-3.7] for chronic/severe headache). An atraumatic needle (OR [95%CI] 0.4 [0.2-0.8]) and age >65 years (OR [95%CI] 0.7 [0.5-1.0]) were preventive. A small needle diameter was associated with less severe headache (OR [95%CI] 0·6 [0·4-0·9]). The most important risk factor for post-LP back pain was number of LP attempts (OR [95%CI] 2.1 [1.7-2.7] for 2-4 attempts; 5.4 [2.9-10.2] for >4 attempts). There was no effect of gender, rest after LP or volume of CSF withdrawn. LPs can be safely performed in memory clinics. Complaints were mostly mild in nature; complications needing medical intervention were rare. Risk factors should be taken into account and if possible modified when performing LPs.