Related Experiment Video
Updated: Feb 3, 2026
Randomized, Triple-Blind, and Parallel-Controlled Trial of Transcranial Direct Current Stimulation for Cognitive Rehabilitation after Stroke
Published on: June 6, 2025
Who should undergo a comprehensive cognitive assessment after a stroke? A cognitive risk score
Olivier Godefroy1, Hugo Yaïche2, Hervé Taillia2
1From the Department of Neurology (O.G., H.Y., S.C., C.L., A.A., C.L., M.R., M.B.), Amiens University Hospital; Laboratory of Functional Neurosciences (O.G., H.Y., J.S.C., C.L., A.A., C.L., M.R., M.B.) (EA 4559), Department of Biostatistics (M.D.), and Department of Rehabilitation (S.T.-P.), Jules Verne University of Picardie, Amiens; Department of Neurology (H.T., F.B.), Val-de-Grâce Hospital, Paris; Department of Neurology (C.N.-C. C.B.), La Rochelle Hospital; Department of Neurology (J.V., F.V.-G.), Saint-Étienne University Hospital; and Department of Neurology (J.-L.M.), Saint Anne Hospital, Paris, France. godefroy.olivier@chu-amiens.fr.
Objective:
To validate the ability of a specifically developed cognitive risk score to identify patients at risk of poststroke neurocognitive disorders (NCDs) who are eligible for a comprehensive cognitive assessment.
Methods:
After assessing 404 patients (infarct 91.3%) in the Groupe de Réflexion pour l'Evaluation Cognitive VASCulaire (GRECogVASC) cross-sectional study with the National Institute of Neurological Disorders and Stroke-Canadian Stroke Network battery 6 months after stroke, we used multivariable logistic regression and bootstrap analyses to determine factors associated with NCDs. Independent, internally validated factors were included in a cognitive risk score.
Results:
Cognitive impairment was present in 170 of the 320 patients with a Rankin Scale score ≥1. The backward logistic regression selected 4 factors (≥73% of the permutations): NIH Stroke Scale score on admission ≥7 (odds ratio [OR] 2.73, 95% confidence interval [CI] 1.29-4.3, p = 0.005), multiple strokes (OR 3.78, 95% CI 1.6-8, p = 0.002), adjusted Mini-Mental State Examination (MMSEadj) score ≤27 (OR 6.69, 95% CI 3.9-11.6, p = 0.0001), and Fazekas score ≥2 (OR 2.34, 95% CI 1.3-4.2, p = 0.004). The cognitive risk score computed with these 4 factors provided good calibration, discrimination (overoptimism-corrected C = 0.793), and goodness of fit (Hosmer-Lemeshow test p = 0.99). A combination of Rankin Scale score ≥1, cognitive risk score ≥1, and MMSEadj score ≥21 selected 230 (56.9%) of the 404 patients for a comprehensive assessment. This procedure yielded good sensitivity (96.5%) and moderate specificity (43%; positive predictive value 0.66, negative predictive value 0.91) and was more accurate (p ≤ 0.03 for all) than the sole use of screening tests (MMSE or Montréal Cognitive Assessment).
Conclusion:
The GRECogVASC cognitive risk score comprises 4 easily documented factors; this procedure helps to identify patients at risk of poststroke NCDs who must therefore undergo a comprehensive assessment.
Clinicaltrialsgov Identifier:
NCT01339195.
Related Concept Videos
01:38Cognitive Dissonance
01:23Cognition and Behavior
01:21Cognitive Learning
E. C. Tolman's theory of purposive behavior emphasizes that much behavior is goal-directed. He argued that to understand behavior, we must look at the entire sequence of actions leading to a goal. For instance, high school students study hard, not just due to past reinforcement but also to achieve the goal of getting into a good college.
Tolman introduced the idea that behavior is influenced by...
01:27Language and Cognition
01:25Cognitive Therapy
01:20Introduction to Cognitive Psychology
This field emerged in the mid-20th century, following a period dominated by behaviorism, which...