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基于认知轨迹预测轻度缺血性中风和短暂性脑缺血发作后认知障碍的列线图的开发与内部验证:一项前瞻性队列研究

Development and internal validation of a nomogram for predicting cognitive impairment after mild ischemic stroke and transient ischemic attack based on cognitive trajectories: a prospective cohort study.

作者信息

Zhao Panpan, Shi Lin, Zhang Guimei, Wei Chunxiao, Zhai Weijie, Shen Yanxin, Wang Yongchun, Wang Zicheng, Sun Li

机构信息

Department of Neurology, The First Affiliated Hospital of Henan University, Henan University, Kaifeng, China.

Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Jilin University, Changchun, China.

出版信息

Front Aging Neurosci. 2025 Jan 29;17:1427737. doi: 10.3389/fnagi.2025.1427737. eCollection 2025.


DOI:10.3389/fnagi.2025.1427737
PMID:39944167
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11814159/
Abstract

INTRODUCTION: Many predictive models for cognitive impairment after mild stroke and transient ischemic attack are based on cognitive scales at a certain timepoint. We aimed to develop two easy-to-use predictive models based on longitudinal cognitive trajectories to facilitate early identification and treatment. METHODS: This was a prospective cohort study of 556 patients, followed up every 3 months. Patients with at least two cognitive scales within 2.5 years were included in the latent class growth analysis (LCGA). The patients were categorized into two groups based on the LCGA. First, a difference analysis was performed, and further univariate and stepwise backward multifactorial logistic regression was performed. The results were presented as nomograms, and receiver operating characteristic curve analysis, calibration, decision curve analysis, and cross-validation were performed to assess model performance. RESULTS: The LCGA eventually included 255 patients, and the "22" group was selected for further subgroup analysis. Among them, 29.8% were included in the cognitive impairment trajectory. Model 1, which incorporated baseline Montreal Cognitive Assessment, ferritin, age, and previous stroke, achieved an area under the curve (AUC) of 0.973, and model 2, which incorporated age, previous stroke, education, and ferritin, with an AUC of 0.771. Decision curve analysis and cross-validation showed excellent clinical applicability. DISCUSSION: Here, we developed two simple and easy-to-use predictive models of post-stroke cognitive trajectories based on a LCGA, which are presented in the form of nomograms suitable for clinical application. These models provide a basis for early detection and prompt treatment.

摘要

引言:许多针对轻度中风和短暂性脑缺血发作后认知障碍的预测模型是基于特定时间点的认知量表。我们旨在基于纵向认知轨迹开发两个易于使用的预测模型,以促进早期识别和治疗。 方法:这是一项对556例患者的前瞻性队列研究,每3个月进行一次随访。在2.5年内至少有两次认知量表测量结果的患者被纳入潜在类别增长分析(LCGA)。根据LCGA将患者分为两组。首先进行差异分析,然后进一步进行单因素和逐步向后多因素逻辑回归分析。结果以列线图表示,并进行受试者工作特征曲线分析、校准、决策曲线分析和交叉验证以评估模型性能。 结果:LCGA最终纳入255例患者,并选择“22”组进行进一步亚组分析。其中,29.8%被纳入认知障碍轨迹。纳入基线蒙特利尔认知评估、铁蛋白、年龄和既往中风史的模型1的曲线下面积(AUC)为0.973,纳入年龄、既往中风史、教育程度和铁蛋白的模型2的AUC为0.771。决策曲线分析和交叉验证显示出良好的临床适用性。 讨论:在此,我们基于LCGA开发了两个简单易用的中风后认知轨迹预测模型,并以适合临床应用的列线图形式呈现。这些模型为早期检测和及时治疗提供了依据。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a3a9/11814159/1b162f98060c/fnagi-17-1427737-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a3a9/11814159/cb8682f8d19e/fnagi-17-1427737-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a3a9/11814159/e142a2760ace/fnagi-17-1427737-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a3a9/11814159/0643616bb5ef/fnagi-17-1427737-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a3a9/11814159/1b162f98060c/fnagi-17-1427737-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a3a9/11814159/cb8682f8d19e/fnagi-17-1427737-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a3a9/11814159/e142a2760ace/fnagi-17-1427737-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a3a9/11814159/0643616bb5ef/fnagi-17-1427737-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a3a9/11814159/1b162f98060c/fnagi-17-1427737-g004.jpg

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引用本文的文献

[1]
Plasma inflammatory cytokines are associated with cognitive impairment after acute minor ischemic stroke and transient ischemic attack.

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[2]
Prediction of Post-Stroke Cognitive Impairment Based on Iron Metabolism Parameters: Results From A Prospective Study.

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本文引用的文献

[1]
Iron homeostasis and ferroptosis in human diseases: mechanisms and therapeutic prospects.

Signal Transduct Target Ther. 2024-10-14

[2]
Prediction of post-stroke cognitive impairment after acute ischemic stroke using machine learning.

Alzheimers Res Ther. 2023-8-31

[3]
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Stroke. 2023-9

[4]
Trends in cognitive function before and after stroke in China.

BMC Med. 2023-6-6

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Neuroimaging standards for research into small vessel disease-advances since 2013.

Lancet Neurol. 2023-7

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A novel view of ferritin in cancer.

Biochim Biophys Acta Rev Cancer. 2023-7

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Which cutoff value of the Montreal Cognitive Assessment should be used for post-stroke cognitive impairment? A systematic review and meta-analysis on diagnostic test accuracy.

Int J Stroke. 2023-10

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Cognitive Impairment After Ischemic and Hemorrhagic Stroke: A Scientific Statement From the American Heart Association/American Stroke Association.

Stroke. 2023-6

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Antioxidants (Basel). 2023-4-12

[10]
Short-term Trajectories of Poststroke Cognitive Function: A STROKOG Collaboration Study.

Neurology. 2023-6-6

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