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NIHSS is not enough for cognitive screening in acute stroke: A cross-sectional, retrospective study.

ABSTRACT: The aim of this study was to investigate whether the cognitive subscale of the National Institute of Health Stroke Scale (NIHSS), the Cog-4, can detect cognitive deficits in acute stroke. This was a cross-sectional, retrospective study. The study sample consisted of people with stroke enrolled in an acute stroke unit. The index test Cog-4 was calculated based on admission NIHSS score. The reference standard instrument, the Montreal Cognitive Assessment (MoCA), was performed within 36-48?h of admission. Non-parametric statistics were used for data analyses. The study included 531 participants with a mean age of 69 years. The Cog-4 failed to identify cognitive deficits in 65%, 58%, and 53% of patients when the MoCA thresholds for impaired cognition were set at ?25 p, ?23 p, and ?19 p, respectively, were chosen for impaired cognition. The agreement between the Cog-4 and the MoCA was poor; Cohen's kappa was from -0.210 to -0.109, depending on the MoCA cut-offs. The sensitivity of the Cog-4 was 35%, 42% and 48% for the MoCA thresholds for impaired cognition ?25, ?23 and ?19 points, respectively. The Cog-4 has a limited ability to identify cognitive deficits in acute stroke. More structured and comprehensive tests should be employed as diagnostic tools.

SUBMITTER: Abzhandadze T

PROVIDER: S-EPMC6969160 | biostudies-literature | 2020 Jan

REPOSITORIES: biostudies-literature

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NIHSS is not enough for cognitive screening in acute stroke: A cross-sectional, retrospective study.

Abzhandadze Tamar T Reinholdsson Malin M Stibrant Sunnerhagen Katharina K

Scientific reports 20200117 1

The aim of this study was to investigate whether the cognitive subscale of the National Institute of Health Stroke Scale (NIHSS), the Cog-4, can detect cognitive deficits in acute stroke. This was a cross-sectional, retrospective study. The study sample consisted of people with stroke enrolled in an acute stroke unit. The index test Cog-4 was calculated based on admission NIHSS score. The reference standard instrument, the Montreal Cognitive Assessment (MoCA), was performed within 36-48 h of adm ...[more]

PMID: 31953508

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Project description:BackgroundMotor and cognitive impairments are frequently observed following stroke, but are often managed as distinct entities, and there is little evidence regarding how they are related. The aim of this study was to describe the prevalence of concurrent motor and cognitive impairments 3 months after stroke and to examine how motor performance was associated with memory, executive function and global cognition.MethodsThe Norwegian Cognitive Impairment After Stroke (Nor-COAST) study is a prospective multicentre cohort study including patients hospitalized with acute stroke between May 2015 and March 2017. The National Institutes of Health Stroke Scale (NIHSS) was used to measure stroke severity at admission. Level of disability was assessed by the Modified Rankin Scale (mRS). Motor and cognitive functions were assessed 3 months post-stroke using the Montreal Cognitive Assessment (MoCA), Trail Making Test Part B (TMT-B), 10-Word List Recall (10WLR), Short Physical Performance Battery (SPPB), dual-task cost (DTC) and grip strength (Jamar®). Cut-offs were set according to current recommendations. Associations were examined using linear regression with cognitive tests as dependent variables and motor domains as covariates, adjusted for age, sex, education and stroke severity.ResultsOf 567 participants included, 242 (43%) were women, mean (SD) age was 72.2 (11.7) years, 416 (75%) had an NIHSS score???4 and 475 (84%) had an mRS score of ?2. Prevalence of concurrent motor and cognitive impairment ranged from 9.5% for DTC and 10WLR to 22.9% for grip strength and TMT-B. SPPB was associated with MoCA (regression coefficient B?=?0.465, 95%CI [0.352, 0.578]), TMT-B (B?=?-9.494, 95%CI [-?11.726, -?7.925]) and 10WLR (B?=?0.132, 95%CI [0.054, 0.211]). Grip strength was associated with MoCA (B?=?0.075, 95%CI [0.039, 0.112]), TMT-B (B?=?-1.972, 95%CI [-?2.672, -?1.272]) and 10WLR (B?=?0.041, 95%CI [0.016, 0.066]). Higher DTC was associated with more time needed to complete TMT-B (B?=?0.475, 95%CI [0.075, 0.875]) but not with MoCA or 10WLR.ConclusionThree months after suffering mainly minor strokes, 30-40% of participants had motor or cognitive impairments, while 20% had concurrent impairments. Motor performance was associated with memory, executive function and global cognition. The identification of concurrent impairments could be relevant for preventing functional decline.Trial registrationClinicalTrials.gov Identifier: NCT02650531 .

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NIHSS is not enough for cognitive screening in acute stroke: A cross-sectional, retrospective study.

Publications

NIHSS is not enough for cognitive screening in acute stroke: A cross-sectional, retrospective study.

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