Boomsma Jooske M F, Exalto Lieza G, Barkhof Frederik, Chen Christopher L H, Hilal Saima, Leeuwis Anna E, Prins Niels D, Saridin Francis N, Scheltens Philip, Teunissen Charlotte E, Verwer Jurre H, Weinstein Henry C, van der Flier Wiesje M, Biessels Geert Jan
Department of Neurology and Neurosurgery UMC Utrecht Brain Center University Medical Center Utrecht Utrecht Universiteit Utrecht the Netherlands.
Department of Neurology OLVG West Amsterdam the Netherlands.
Alzheimers Dement (Amst). 2020 Aug 10;12(1):e12077. doi: 10.1002/dad2.12077. eCollection 2020.
Prognostication in memory clinic patients with vascular brain injury (eg possible vascular cognitive impairment [VCI]) is often uncertain. We created a risk score to predict poor clinical outcome.
Using data from two longitudinal cohorts of memory clinic patients with vascular brain injury without advanced dementia, we created (n = 707) and validated (n = 235) the risk score. Poor clinical outcome was defined as substantial cognitive decline (change of Clinical Dementia Rating ≥1 or institutionalization) or major vascular events or death. Twenty-four candidate predictors were evaluated using Cox proportional hazard models.
Age, clinical syndrome diagnosis, Disability Assessment for Dementia, Neuropsychiatric Inventory, and medial temporal lobe atrophy most strongly predicted poor outcome and constituted the risk score (C-statistic 0.71; validation cohort 0.78). Of note, none of the vascular predictors were retained in this model. The 2-year risk of poor outcome was 6.5% for the lowest (0-5) and 55.4% for the highest sum scores (10-13).
This is the first, validated, prediction score for 2-year clinical outcome of patients with possible VCI.
在记忆门诊中，患有血管性脑损伤（如可能的血管性认知障碍[VCI]）患者的预后通常难以确定。我们创建了一个风险评分来预测不良临床结局。
利用两个纵向队列中无晚期痴呆的记忆门诊血管性脑损伤患者的数据，我们创建了（n = 707）并验证了（n = 235）该风险评分。不良临床结局定义为显著的认知衰退（临床痴呆评定量表变化≥1或入住机构）、重大血管事件或死亡。使用Cox比例风险模型评估了24个候选预测因素。
年龄、临床综合征诊断、痴呆残疾评估、神经精神科问卷和内侧颞叶萎缩最能强烈预测不良结局，并构成风险评分（C统计量0.71；验证队列中为(0.78)）。值得注意的是，该模型中没有保留任何血管预测因素。最低总分（0 - 5）患者2年不良结局风险为(6.5%)，最高总分（10 - 13）患者为(55.4%)。
这是首个经过验证的、针对可能患有VCI患者2年临床结局的预测评分。
