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Who should undergo a comprehensive cognitive assessment after a stroke? A cognitive risk score

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 Reflexion 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 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 Montreal 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. ClinicalTrials.gov identifier: NCT01339195.
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https://hal-u-picardie.archives-ouvertes.fr/hal-03606873
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Soumis le : samedi 12 mars 2022 - 14:19:13
Dernière modification le : mercredi 4 mai 2022 - 16:14:02

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Olivier Godefroy, Hugo Yaiche, Herve Taillia, Flavie Bompaire, Claudine Nedelec-Ciceri, et al.. Who should undergo a comprehensive cognitive assessment after a stroke? A cognitive risk score. Neurology, 2018, 91 (21), pp.E1979-E1987. ⟨10.1212/WNL.0000000000006544⟩. ⟨hal-03606873⟩

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