Clinical Evaluation and Early Intervention Strategies of Post-Stroke Cognitive Impairment
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Published on: December 16, 2022
1Department of Neurology, Lanxi Hospital of Traditional Chinese Medicine, Lanxi, China.
Background:
The aim of this study was to explore the clinical evaluation and early intervention strategies of post-stroke cognitive impairment (PSCI).
Methods:
This study consisted of 2 parts. (A) A 2022-2023 retrospective cohort developing/validating a risk nomogram. One hundred forty-one patients were categorized into the PSCI group (n=82) and post-stroke no-cognitive impairment group (n=59) according to the Saint Louis University Mental Status Examination (SLUMS) score at 6 months after cerebral infarction. The nomogram model was constructed by multiple logistic regression analysis and R language. (B) A 2024-2025 ward-level cluster-assigned pilot intervention. The patients were classified into the control group (routine nursing, n=33) and intervention group (Montessori sensory education intervention on the basis of routine nursing, n=35). Outcome indicators were scores of SLUMS, Activity of Daily Living (ADL), and Hamilton Depression Rating Scale (HAMD).
Results:
Part A: Age, ADL, National Institutes of Health Stroke Scale (NIHSS), HAMD-17 were independent risk factors for PSCI. H-L goodness-of-fit test was performed on the model and found P=.592 > α=.05, and the AUC of the prediction model was 0.87 (95% CI=0.81-0.93). Decision curve revealed that the net benefit of the prediction model was higher than that of the other 2 extreme curves, and the model could produce better clinical benefits when the threshold probability ranged from 0.02 to 0.98. Part B: The T0-T12 difference of SLUMS score and differences of ADL in the intervention group were higher than those in the control group (P=.002, .004).
Conclusion:
Part A: Based on age, ADL, NIHSS, HAMD-17, this study preliminarily constructs a nomogram prediction model for PSCI risk. However, it is still in the preliminary exploration stage, and further external verification is needed in independent and diverse cohorts. Part B: Montessori sensory education intervention demonstrates a certain effect within the scope of the pilot. However, its long-term effect and applicability still need to be verified by larger-scale, randomized and multi-center clinical trials in combination with long-term follow-up.
