Nomogram to Predict Cognitive Dysfunction After a Minor Ischemic Stroke in Hospitalized-Population.

Area of Science:

• Neurology
• Cardiovascular Medicine
• Biochemistry

Background:

• Predicting cognitive impairment after minor ischemic stroke is challenging due to the lack of accessible scoring systems.
• Post-stroke cognitive impairment (PSCI) significantly impacts patient recovery and quality of life.
• The role of Trimethylamine N-oxide (TMAO) in PSCI requires further investigation.

Purpose of the Study:

• To develop and externally validate a nomogram for predicting PSCI in hospitalized patients with minor stroke.
• To investigate the association between plasma TMAO levels and PSCI.

Main Methods:

• Prospective development and external validation cohorts were established.
• Cognitive impairment was defined as a Montreal Cognition Assessment (MoCA) score <22 at 6-12 months post-stroke.
• A nomogram was generated using multivariate logistic regression, including age, sex, Fazekas score, education, intracranial atherosclerotic stenosis (ICAS), HbA1c, and cortical infarction.
• Plasma TMAO levels were measured using liquid chromatography tandem mass spectrometry.

Main Results:

• The nomogram demonstrated good predictive performance with an AUC-ROC of 0.829 in the development cohort and 0.812 in the validation cohort.
• Independent predictors for PSCI included age, female sex, Fazekas score, educational level, ICAS, HbA1c, and cortical infarction.
• Patients with PSCI had significantly higher plasma TMAO levels compared to those without cognitive dysfunction (4.56 vs. 3.22 μmol/L, p ≤ 0.001).

Conclusions:

• This study presents the first validated nomogram for individualized prediction of PSCI after minor stroke.
• The developed scoring system provides an accessible tool for risk stratification.
• Elevated plasma TMAO levels at admission may serve as a potential biomarker for predicting PSCI.