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Prediction of post-stroke dementia using NINDS-CSN 5-minute neuropsychology protocol in acute stroke

  • Jae-Sung Lim (a1), Mi Sun Oh (a1), Ju-Hun Lee (a1), San Jung (a1), Chulho Kim (a1), Min Uk Jang (a1), Sang-Hwa Lee (a1), Yeo Jin Kim (a1), Yerim Kim (a1), Jaeseol Park (a1), Yeonwook Kang (a2), Kyung-Ho Yu (a1) and Byung-Chul Lee (a1)...

Abstract

Background:

The National Institute of Neurological Disease and Stroke-Canadian Stroke Network (NINDS-CSN) 5-minute neuropsychology protocol consists of only verbal tasks, and is proposed as a brief screening method for vascular cognitive impairment. We evaluated its feasibility within two weeks after stroke and ability to predict the development of post-stroke dementia (PSD) at 3 months after stroke.

Method:

We prospectively enrolled subjects with ischemic stroke within seven days of symptom onset who were consecutively admitted to 12 university hospitals. Neuropsychological assessments using the NINDS-CSN 5-minute and 60-minute neuropsychology protocols were administered within two weeks and at 3 months after stroke onset, respectively. PSD was diagnosed with reference to the American Heart Association/American Stroke Association statement, requiring deficits in at least two cognitive domains.

Results:

Of 620 patients, 512 (82.6%) were feasible for the NINDS-CSN 5-minute protocol within two weeks after stroke. The incidence of PSD was 16.2% in 308 subjects who had completed follow-up at 3 months after stroke onset. The total score of the NINDS-CSN 5-minute protocol differed significantly between those with and without PSD (4.0 ± 2.7, 7.4 ± 2.7, respectively; p < 0.01). A cut-off value of 6/7 showed reasonable discriminative power (sensitivity 0.82, specificity 0.67, AUC 0.74). The NINDS-CSN 5-minute protocol score was a significant predictor for PSD (adjusted odds ratio 6.32, 95% CI 2.65–15.05).

Discussion:

The NINDS-CSN 5-minute protocol is feasible to evaluate cognitive functions in patients with acute ischemic stroke. It might be a useful screening method for early identification of high-risk groups for PSD.

Copyright

Corresponding author

Correspondence should be addressed to: Byung-Chul Lee, MD, PhD, Department of Neurology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, 22 Gwanpyeong-ro 17beon-gil, Dongan-gu, Anyang 14068, Republic of Korea. Phone: +82-31-380-3740; Fax: +82-31-380-4659. Email: ssbrain@hallym.ac.kr.
Kyung-ho Yu, MD. PhD, Department of Neurology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, 22 Gwanpyeong-ro 17beon-gil, Dongan-gu, Anyang 14068, Republic of Korea. Phone: +82-31-380-3743; Fax: +82-31-380-4659. E-mail: ykh1030@hallym.or.kr

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