Olivier Godefroy1, Hugo Yaïche2, Hervé Taillia2, Flavie Bompaire2, Claudine Nédélec-Ciceri2, Camille Bonnin2, Jérôme Varvat2, Françoise Vincent-Grangette2, Momar Diouf2, Jean-Louis Mas2, Sandrine Canaple2, Chantal Lamy2, Audrey Arnoux2, Claire Leclercq2, Sophie Tasseel-Ponche2, Martine Roussel2, Mélanie Barbay2. 1. From the Department of Neurology (O.G., H.Y., S.C., C.L., A.A., C.L., M.R., M.B.), Amiens University Hospital; Laboratory of Functional Neurosciences (O.G., H.Y., J.S.C., C.L., A.A., C.L., M.R., M.B.) (EA 4559), Department of Biostatistics (M.D.), and Department of Rehabilitation (S.T.-P.), Jules Verne University of Picardie, Amiens; Department of Neurology (H.T., F.B.), Val-de-Grâce Hospital, Paris; Department of Neurology (C.N.-C. C.B.), La Rochelle Hospital; Department of Neurology (J.V., F.V.-G.), Saint-Étienne University Hospital; and Department of Neurology (J.-L.M.), Saint Anne Hospital, Paris, France. godefroy.olivier@chu-amiens.fr. 2. From the Department of Neurology (O.G., H.Y., S.C., C.L., A.A., C.L., M.R., M.B.), Amiens University Hospital; Laboratory of Functional Neurosciences (O.G., H.Y., J.S.C., C.L., A.A., C.L., M.R., M.B.) (EA 4559), Department of Biostatistics (M.D.), and Department of Rehabilitation (S.T.-P.), Jules Verne University of Picardie, Amiens; Department of Neurology (H.T., F.B.), Val-de-Grâce Hospital, Paris; Department of Neurology (C.N.-C. C.B.), La Rochelle Hospital; Department of Neurology (J.V., F.V.-G.), Saint-Étienne University Hospital; and Department of Neurology (J.-L.M.), Saint Anne Hospital, Paris, France.
Abstract
OBJECTIVE: To validate the ability of a specifically developed cognitive risk score to identify patients at risk of poststroke neurocognitive disorders (NCDs) who are eligible for a comprehensive cognitive assessment. METHODS: After assessing 404 patients (infarct 91.3%) in the Groupe de Réflexion pour l'Evaluation Cognitive VASCulaire (GRECogVASC) cross-sectional study with the National Institute of Neurological Disorders and Stroke-Canadian Stroke Network battery 6 months after stroke, we used multivariable logistic regression and bootstrap analyses to determine factors associated with NCDs. Independent, internally validated factors were included in a cognitive risk score. RESULTS: Cognitive impairment was present in 170 of the 320 patients with a Rankin Scale score ≥1. The backward logistic regression selected 4 factors (≥73% of the permutations): NIH Stroke Scale score on admission ≥7 (odds ratio [OR] 2.73, 95% confidence interval [CI] 1.29-4.3, p = 0.005), multiple strokes (OR 3.78, 95% CI 1.6-8, p = 0.002), adjusted Mini-Mental State Examination (MMSEadj) score ≤27 (OR 6.69, 95% CI 3.9-11.6, p = 0.0001), and Fazekas score ≥2 (OR 2.34, 95% CI 1.3-4.2, p = 0.004). The cognitive risk score computed with these 4 factors provided good calibration, discrimination (overoptimism-corrected C = 0.793), and goodness of fit (Hosmer-Lemeshow test p = 0.99). A combination of Rankin Scale score ≥1, cognitive risk score ≥1, and MMSEadj score ≥21 selected 230 (56.9%) of the 404 patients for a comprehensive assessment. This procedure yielded good sensitivity (96.5%) and moderate specificity (43%; positive predictive value 0.66, negative predictive value 0.91) and was more accurate (p ≤ 0.03 for all) than the sole use of screening tests (MMSE or Montréal Cognitive Assessment). CONCLUSION: The GRECogVASC cognitive risk score comprises 4 easily documented factors; this procedure helps to identify patients at risk of poststroke NCDs who must therefore undergo a comprehensive assessment. CLINICALTRIALSGOV IDENTIFIER: NCT01339195.
OBJECTIVE: To validate the ability of a specifically developed cognitive risk score to identify patients at risk of poststroke neurocognitive disorders (NCDs) who are eligible for a comprehensive cognitive assessment. METHODS: After assessing 404 patients (infarct 91.3%) in the Groupe de Réflexion pour l'Evaluation Cognitive VASCulaire (GRECogVASC) cross-sectional study with the National Institute of Neurological Disorders and Stroke-Canadian Stroke Network battery 6 months after stroke, we used multivariable logistic regression and bootstrap analyses to determine factors associated with NCDs. Independent, internally validated factors were included in a cognitive risk score. RESULTS: Cognitive impairment was present in 170 of the 320 patients with a Rankin Scale score ≥1. The backward logistic regression selected 4 factors (≥73% of the permutations): NIH Stroke Scale score on admission ≥7 (odds ratio [OR] 2.73, 95% confidence interval [CI] 1.29-4.3, p = 0.005), multiple strokes (OR 3.78, 95% CI 1.6-8, p = 0.002), adjusted Mini-Mental State Examination (MMSEadj) score ≤27 (OR 6.69, 95% CI 3.9-11.6, p = 0.0001), and Fazekas score ≥2 (OR 2.34, 95% CI 1.3-4.2, p = 0.004). The cognitive risk score computed with these 4 factors provided good calibration, discrimination (overoptimism-corrected C = 0.793), and goodness of fit (Hosmer-Lemeshow test p = 0.99). A combination of Rankin Scale score ≥1, cognitive risk score ≥1, and MMSEadj score ≥21 selected 230 (56.9%) of the 404 patients for a comprehensive assessment. This procedure yielded good sensitivity (96.5%) and moderate specificity (43%; positive predictive value 0.66, negative predictive value 0.91) and was more accurate (p ≤ 0.03 for all) than the sole use of screening tests (MMSE or Montréal Cognitive Assessment). CONCLUSION: The GRECogVASC cognitive risk score comprises 4 easily documented factors; this procedure helps to identify patients at risk of poststroke NCDs who must therefore undergo a comprehensive assessment. CLINICALTRIALSGOV IDENTIFIER: NCT01339195.
Authors: P Scheltens; D Leys; F Barkhof; D Huglo; H C Weinstein; P Vermersch; M Kuiper; M Steinling; E C Wolters; J Valk Journal: J Neurol Neurosurg Psychiatry Date: 1992-10 Impact factor: 10.154
Authors: Rosalind Lees; Johann Selvarajah; Candida Fenton; Sarah T Pendlebury; Peter Langhorne; David J Stott; Terence J Quinn Journal: Stroke Date: 2014-09-04 Impact factor: 7.914