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

Olivier Godefroy; Hugo Yaïche; Hervé Taillia; Flavie Bompaire; Claudine Nédélec-Ciceri; Camille Bonnin; Jérôme Varvat; Françoise Vincent-Grangette; Momar Diouf; Jean-Louis Mas; Sandrine Canaple; Chantal Lamy; Audrey Arnoux; Claire Leclercq; Sophie Tasseel-Ponche; Martine Roussel; Mélanie Barbay; GRECogVASC Study Group

doi:10.1212/WNL.0000000000006544

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

Neurology. 2018 Nov 20;91(21):e1979-e1987. doi: 10.1212/WNL.0000000000006544. Epub 2018 Oct 17.

Authors

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; GRECogVASC Study Group

Collaborators

GRECogVASC Study Group:
Sandrine Despretz-Wannepain, Virginie Tourbier, Annie Thorel-Routier, Pascal Despretz, Hassan Berrissoul, Carl Picard, Gwénolé Loas, Hervé Deramond, Jean-Marc Constans, Véronique Quaglino, Hélène Beaunieux, Christine Moroni, Audrey Martens-Chazelles, Stéphanie Batier-Monperrus, Cécile Monteleone, Véronique Costantino, Eric Theunssens

Affiliations

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.

Publication types

Research Support, Non-U.S. Gov't
Validation Study

MeSH terms

Aged
Aged, 80 and over
Cognition Disorders / diagnosis*
Cognition Disorders / etiology*
Female
Humans
Male
Middle Aged
Neuropsychological Tests*
Stroke / complications*

Associated data

ClinicalTrials.gov/NCT01339195