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

Archive ouverte

Godefroy, Olivier | Yaiche, Hugo | Taillia, Herve | Bompaire, Flavie | Nédélec-Ciceri, Claudine | Varvat, Jerome | Vincent-Grangette, Francoise | Diouf, Momar | Mas, Jean-Louis | Canaple, Sandrine | Lamy, Chantal | Arnoux, Audrey | Leclercq, Claire | Tasseel-Ponche, Sophie | Roussel, Martine | Barbay, Melanie

Edité par CCSD ; American Academy of Neurology -

International audience. 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.

• Description
• Sujet/Public
• Outil
• Outil d'anticipation
• Mémoire et thèse
• Gestion