Neurology Unit, Luigi Sacco University Hospital, Milan, Italy.
Stroke and Dementia Lab, "Luigi Sacco" Department of Biomedical and Clinical Sciences, University of Milan, Via Giovanni Battista Grassi 74, 20157, Milan, Italy.
J Neurol. 2022 Jan;269(1):342-349. doi: 10.1007/s00415-021-10637-z. Epub 2021 Jun 6.
The early detection of patients at risk of post-stroke cognitive impairment (PSCI) may help planning subacute and long-term care. We aimed to determine the predictivity of two screening cognitive tests on the occurrence of mild cognitive impairment or dementia in acute stroke patients.
A cognitive assessment within a few days of ischemic or hemorrhagic stroke was performed in patients consecutively admitted to a stroke unit over 14 months by means of the Clock Drawing Test (CDT) and the Montreal Cognitive Assessment-Basic (MoCA-B).
Out of 191 stroke survivors who were non-demented at baseline, 168 attended at least one follow-up visit. At follow-up (mean duration ± SD 12.8 ± 8.7 months), 28 (18.9%) incident cases of MCI and 27 (18%) cases of dementia were recorded. In comparison with patients who remained cognitively stable at follow-up, these patients were older, less educated, had more comorbidities, a higher score on the National Institutes of Health Stroke Scale (NIHSS) at admission, more severe cerebral atrophy, and lower MoCA-B and CDT scores at baseline. In multi-adjusted (for age, education, comorbidities score, NIHSS at admission and atrophy score) model, a pathological score on baseline CDT (< 6.55) was associated with a higher risk of PSCI at follow-up (HR 2.022; 95% CI 1.025-3.989, p < 0.05) with respect to non-pathological scores. A pathological baseline score on MoCA-B (< 24) did not predict increased risk of cognitive decline at follow-up nor increased predictivity of stand-alone CDT.
A bedside cognitive screening with the CDT helps identifying patients at higher risk of PSCI.
早期发现有卒中后认知障碍（PSCI）风险的患者有助于规划亚急性和长期护理。我们旨在确定两种筛查认知测试在急性卒中患者中发生轻度认知障碍或痴呆的预测能力。
在 14 个月内，通过画钟测验（CDT）和蒙特利尔认知评估-基础版（MoCA-B）对连续入住卒中单元的患者进行认知评估。
在基线时无痴呆的 191 例卒中幸存者中，有 168 例至少参加了一次随访。在随访时（平均随访时间为 12.8±8.7 个月），记录了 28 例（18.9%）新发 MCI 和 27 例（18%）痴呆病例。与在随访时认知稳定的患者相比，这些患者年龄更大，受教育程度更低，合并症更多，入院时 NIHSS 评分更高，脑萎缩更严重，基线时 MoCA-B 和 CDT 评分更低。在多因素调整（年龄、教育程度、合并症评分、入院 NIHSS 评分和萎缩评分）模型中，基线 CDT 得分异常（<6.55）与随访时 PSCI 风险升高相关（HR 2.022；95%CI 1.025-3.989，p<0.05），而非异常得分。基线 MoCA-B 得分异常（<24）并不能预测随访时认知能力下降的风险增加，也不能提高 CDT 单独预测的准确性。
床边认知筛查 CDT 有助于识别 PSCI 风险较高的患者。
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