Institute of Neuroscience and Physiology, Rehabilitation medicine, University of Gothenburg. Gothenburg, Sweden, Per Dubbsgatan 14, fl. 3, 413 45, Gothenburg, Sweden.
Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden.
Sci Rep. 2020 Jan 17;10(1):534. doi: 10.1038/s41598-019-57316-8.
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.
本研究旨在探讨国立卫生研究院卒中量表（NIHSS）认知分量表（Cog-4）是否能够检测急性卒中患者的认知缺陷。这是一项横断面、回顾性研究。研究样本包括急性卒中单元收治的卒中患者。Cog-4 是基于入院 NIHSS 评分计算的。入院后 36-48 小时内进行参考标准测试蒙特利尔认知评估（MoCA）。采用非参数统计学方法进行数据分析。研究共纳入 531 名平均年龄为 69 岁的患者。当 MoCA 认知障碍的阈值分别设定为≤25 分、≤23 分和≤19 分时，Cog-4 无法识别 65%、58%和 53%的患者存在认知缺陷。Cog-4 与 MoCA 的一致性较差；根据 MoCA 截断值，Cohen's kappa 值在-0.210 到-0.109 之间。Cog-4 的灵敏度分别为 35%、42%和 48%，用于 MoCA 认知障碍阈值≤25、≤23 和≤19 分。Cog-4 识别急性卒中患者认知缺陷的能力有限。应采用更具结构性和全面的测试作为诊断工具。
