Drag Lauren L, Mlynash Michael, Aslan Alperen, Musabbir Muhith, Bradley Amy, Lansberg Maarten G, Allan Stuart M, Aghaeepour Nima, Smith Craig, Buckwalter Marion S
Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Palo Alto, CA. (L.L.D., M. Mlynash, A.A., M. Musabbir, M.G.L., M.S.B.).
Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre (A.B., C.S.).
Stroke. 2025 May 23. doi: 10.1161/STROKEAHA.124.049217.
Poststroke cognitive impairment can significantly impact functional outcomes and quality of life. While comprehensive neuropsychological evaluations are valuable in characterizing this impairment, their time-intensive nature is not always feasible. Thus, we set out to develop a brief cognitive battery that is sensitive to poststroke cognitive impairment.
Neuropsychological testing was completed in a validation sample of 126 participants with chronic ischemic stroke (median days since stroke, 337 [interquartile range, 235-1057]) as part of StrokeCog, a prospective observational cohort study. This comprehensive 60-minute cognitive battery contained 9 tests covering 5 cognitive domains. A partial least square regression analysis informed the selection of a brief, 15-minute battery of 4 tests (StrokeCog-15) covering 4 cognitive domains: language, memory, working memory, and processing speed/executive functioning. We then compared StrokeCog-15 with Montreal Cognitive Assessment and an established 30-minute battery in its ability to detect cognitive impairment as identified by the comprehensive battery. Finally, we assessed the utility of StrokeCog-15 in an external validation sample of 61 participants (median days since stroke, 210 [interquartile range, 193-230]) enrolled in the parallel Stroke-IMPaCT study.
Cognitive impairment was common, occurring in 50% (n=61) and 66% (n=40) of the 2 cohorts. Deficits occurred most frequently in the memory and processing speed/executive functioning domains. In the derivation sample, StrokeCog-15 demonstrated high sensitivity (0.97) and adequate specificity (0.78) in detecting cognitive impairment on the comprehensive battery, outperforming both Montreal Cognitive Assessment (sensitivity, 0.77; specificity, 0.73) and the 30-minute battery (sensitivity, 0.97; specificity, 0.35). StrokeCog-15 similarly demonstrated high sensitivity (0.93) and adequate specificity (0.67) in the validation sample.
A brief 15-minute battery of tests has high sensitivity to detect cognitive impairment as identified on a longer neuropsychological test battery. StrokeCog-15 assesses multiple cognitive domains commonly impacted by stroke and represents an efficient yet effective means to identify chronic poststroke cognitive impairment.
中风后认知障碍会显著影响功能结局和生活质量。虽然全面的神经心理学评估对于描述这种障碍很有价值，但其耗时的特性并非总是可行。因此，我们着手开发一种对中风后认知障碍敏感的简短认知测试组合。
作为前瞻性观察队列研究StrokeCog的一部分，对126名慢性缺血性中风参与者（中风后中位数天数为337天[四分位间距为235 - 1057天]）的验证样本完成了神经心理学测试。这个全面的60分钟认知测试组合包含9项测试，涵盖5个认知领域。偏最小二乘回归分析为选择一个简短的、15分钟的由4项测试组成的测试组合（StrokeCog - 15）提供了依据，该组合涵盖4个认知领域：语言、记忆、工作记忆以及处理速度/执行功能。然后，我们将StrokeCog - 15与蒙特利尔认知评估以及一个既定的30分钟测试组合在检测由全面测试组合确定的认知障碍方面的能力进行了比较。最后，我们在参与平行的Stroke - IMPaCT研究的61名参与者（中风后中位数天数为210天[四分位间距为193 - 230天]）的外部验证样本中评估了StrokeCog - 15的效用。
认知障碍很常见，在两个队列中分别有50%（n = 61）和66%（n = 40）的参与者出现。缺陷最常出现在记忆和处理速度/执行功能领域。在推导样本中，StrokeCog - 15在检测全面测试组合中的认知障碍方面表现出高敏感性（0.97）和足够的特异性（0.78），优于蒙特利尔认知评估（敏感性为0.77；特异性为0.73）和30分钟测试组合（敏感性为0.97；特异性为0.35）。StrokeCog - 15在验证样本中同样表现出高敏感性（0.93）和足够的特异性（0.67）。
一个简短的15分钟测试组合在检测由更长的神经心理学测试组合确定的认知障碍方面具有高敏感性。StrokeCog - 15评估了中风通常影响的多个认知领域，是识别慢性中风后认知障碍的一种有效且高效的手段。
