A nomogram to predict cognitive impairment after supratentorial spontaneous intracranial hematoma in adult patients: A retrospective cohort study

A nomogram for predicting mild cognitive impairment in older adults with hypertension

BACKGROUND

Hyper- and hypotension increase the risk of cognitive dysfunction. As effective control of blood pressure can reduce the risk of mild cognitive impairment (MCI), early risk assessment is necessary to identify MCI in senile hypertension as soon as possible and reduce the risk of developing dementia. No perfect risk-prediction model or nomogram has been developed to evaluate the risk of MCI in older adults with hypertension. We aimed to develop a nomogram model for predicting MCI in older patients with hypertension.

METHODS

We selected 345 older patients with hypertension in Xixiangtang District, Nanning City, as the modeling group and divided into the MCI (n = 197) and non-MCI groups (n = 148). Comparing the general conditions, lifestyle, disease factors, psychosocial and other indicators. Logistic regression was used to analyze risk factors for MCI in older hypertensive patients, and R Programming Language was used to draw the nomogram. We selected 146 older patients with hypertension in Qingxiu District, Nanning City, as the verification group. The effectiveness and discrimination ability of the nomogram was evaluated through internal and external verification.

RESULTS

Multivariate logistic regression analysis identified 11 factors, including hypertension grade, education level, complicated diabetes, hypertension years, stress history, smoking, physical exercise, reading, social support, sleep disorders, and medication compliance, as risk factors for MCI in older patients with hypertension. To develop a nomogram model, the validity of the prediction model was evaluated by fitting the curve, which revealed a good fit for both the modeling (P = 0.98) and verification groups (P = 0.96). The discrimination of the nomogram model was evaluated in the modeling group using a receiver operating characteristic curve. The area under the curve was 0.795, and the Hosmer-Lemeshow test yielded P = 0.703. In the validation group, the area under the curve was 0.765, and the Hosmer-Lemeshow test yielded P = 0.234.

CONCLUSIONS

We developed a nomogram to help clinicians identify high-risk groups for MCI among older patients with hypertension. This model demonstrated good discrimination and validity, providing a scientific basis for community medical staff to evaluate and identify the risk of MCI in these patients at an early stage.

Post-Stroke Cognitive Impairment: Epidemiology, Risk Factors, and Management

Stroke, characterized as a neurological deficit of cerebrovascular cause, is very common in older adults. Increasing evidence suggests stroke contributes to the risk and severity of cognitive impairment. People with cognitive impairment following stroke often face with quality-of-life issues and require ongoing support, which have a profound effect on caregivers and society. The high morbidity of post-stroke cognitive impairment (PSCI) demands effective management strategies, in which preventive strategies are more appealing, especially those targeting towards modifiable risk factors. In this review article, we attempt to summarize existing evidence and knowledge gaps on PSCI: elaborating on the heterogeneity in current definitions, reporting the inconsistent findings in PSCI prevalence in the literature, exploring established or less established predictors, outlining prevention and treatment strategies potentially effective or currently being tested, and proposing promising directions for future research.

European Stroke Organisation and European Academy of Neurology joint guidelines on post-stroke cognitive impairment

BACKGROUND AND PURPOSE

The optimal management of post-stroke cognitive impairment (PSCI) remains controversial. These joint European Stroke Organisation (ESO) and European Academy of Neurology (EAN) guidelines provide evidence-based recommendations to assist clinicians in decision making regarding prevention, diagnosis, treatment and prognosis.

METHODS

Guidelines were developed according to the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology. The working group identified relevant clinical questions, performed systematic reviews, assessed the quality of the available evidence, and made specific recommendations. Expert consensus statements were provided where insufficient evidence was available to provide recommendations.

RESULTS

There was limited randomized controlled trial (RCT) evidence regarding single or multicomponent interventions to prevent post-stroke cognitive decline. Lifestyle interventions and treating vascular risk factors have many health benefits, but a cognitive effect is not proven. We found no evidence regarding routine cognitive screening following stroke, but recognize the importance of targeted cognitive assessment. We describe the accuracy of various cognitive screening tests, but found no clearly superior approach to testing. There was insufficient evidence to make a recommendation for use of cholinesterase inhibitors, memantine nootropics or cognitive rehabilitation. There was limited evidence on the use of prediction tools for post-stroke cognition. The association between PSCI and acute structural brain imaging features was unclear, although the presence of substantial white matter hyperintensities of presumed vascular origin on brain magnetic resonance imaging may help predict cognitive outcomes.

CONCLUSIONS

These guidelines highlight fundamental areas where robust evidence is lacking. Further definitive RCTs are needed, and we suggest priority areas for future research.

European Stroke Organisation and European Academy of Neurology joint guidelines on post-stroke cognitive impairment

The optimal management of post-stroke cognitive impairment remains controversial. These joint European Stroke Organisation (ESO) and European Academy of Neurology (EAN) guidelines provide evidence-based recommendations to assist clinicians in decision making around prevention, diagnosis, treatment and prognosis. These guidelines were developed according to ESO standard operating procedure and the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology. The working group identified relevant clinical questions, performed systematic reviews and, where possible, meta-analyses of the literature, assessed the quality of the available evidence and made specific recommendations. Expert consensus statements were provided where insufficient evidence was available to provide recommendations based on the GRADE approach. There was limited randomised controlled trial evidence regarding single or multicomponent interventions to prevent post-stroke cognitive decline. Interventions to improve lifestyle and treat vascular risk factors may have many health benefits but a beneficial effect on cognition is not proven. We found no evidence around routine cognitive screening following stroke but recognise the importance of targeted cognitive assessment. We described the accuracy of various cognitive screening tests but found no clearly superior approach to testing. There was insufficient evidence to make a recommendation for use of cholinesterase inhibitors, memantine nootropics or cognitive rehabilitation. There was limited evidence on the use of prediction tools for post-stroke cognitive syndromes (cognitive impairment, dementia and delirium). The association between post-stroke cognitive impairment and most acute structural brain imaging features was unclear, although the presence of substantial white matter hyperintensities of presumed vascular origin on acute MRI brain may help predict cognitive outcomes. These guidelines have highlighted fundamental areas where robust evidence is lacking. Further, definitive randomised controlled trials are needed, and we suggest priority areas for future research.

Comparing the inter-observer reliability of the Tada formula among neurosurgeons while estimating the intracerebral haematoma volume

OBJECTIVE

To compare the inter-observer reliability among neurosurgeons while estimating the intracerebral haematoma (ICH) volume by the Tada formula and assess its influence on predicting the severity and prognosis of various ICHs.

METHODS

We obtained clinical data from 262 consecutive patients with spontaneous ICH. The haematoma volume was independently calculated and compared by 3D Slicer and eight neurosurgeons. The inter-observer reliability was obtained by calculating the intraclass correlation coefficients (ICC) and Cohen's kappa score (kappa), within different shape and volume ICH subgroups. We conducted the receiver operating characteristic analysis to assess the predictive value of the ICH volume evaluated for clinical features, including the Glasgow Coma Scale at the onset of the disease, ICH-related surgical treatments, the length of stay in the intensive care unit, the length of hospitalisation, the modified Rankin Scale score at discharge, and in-hospital deaths.

RESULTS

The median haematoma volume was 17.4 ml (range, 7.3-34.7 ml). The estimated volumes were significantly different among neurosurgeons (p < 0.001). Six out of eight neurosurgeons demonstrated obvious deviations from the 3D Slicer software (p < 0.001). Round (ICC: 0.947) and tapered (ICC: 0.954) haematomas were more consistently evaluated between the neurosurgeons. We observed a substantial strength of agreement between neurosurgeons with kappa> 0.693 and ICC: 0.938 in the entire volume range, and slight to fair strength of agreement with kappa> 0.175 and ICC: 0.689 between 20 ml and 40 ml volume interval. All estimated volumes had a positive predictive value for clinical features, with the area under the curve > 0.5 (p < 0.05). However, the 3D Slicer software performed relatively better than most neurosurgeons.

CONCLUSIONS

There exists a significant inter-observer variability among neurosurgeons when utilizing the Tada formula, thus demonstrating significant implications for ICH-related clinical practices and researches.

Prognostic rules for predicting cognitive syndromes following stroke: A systematic review

Purpose

Stroke survivors are at high risk of developing cognitive syndromes, such as delirium and dementia. Accurate prediction of future cognitive outcomes may aid timely diagnosis, intervention planning, and stratification in clinical trials. We aimed to identify, describe and appraise existing multivariable prognostic rules for prediction of post-stroke cognitive status.

Method

We systematically searched four electronic databases from inception to November 2019 for publications describing a method to estimate individual probability of developing a cognitive syndrome following stroke. We extracted data from selected studies using a pre-specified proforma and applied the Prediction model Risk Of Bias Assessment Tool (PROBAST) for critical appraisal.

Findings

Of 17,390 titles, we included 10 studies (3143 participants), presenting the development of 11 prognostic rules – 7 for post-stroke cognitive impairment and 4 for delirium. Most commonly incorporated predictors were: demographics, imaging findings, stroke type and symptom severity. Among studies assessing predictive discrimination, the area under the receiver operating characteristic (AUROC) in apparent validation ranged from 0.80 to 0.91. The overall risk of bias for each study was high. Only one prognostic rule had been externally validated.

Discussion/conclusion: Research into the prognosis of cognitive outcomes following stroke is an expanding field, still at its early stages. Recommending use of specific prognostic rules is limited by the high risk of bias in all identified studies, and lack of supporting evidence from external validation. To ensure the quality of future research, investigators should adhere to current, endorsed best practice guidelines for conduct of prediction model studies.

Decision-making impairments under ambiguous and risky situations in patients with prefrontal tumor: A neuropsychological study

INTRODUCTION

The neural mechanism underlying decision-making, which is an important component of executive function, is complex and not fully understood. Few studies have directly investigated the two types of decision-making functions - under ambiguity and under risk - in patients with brain tumors in different brain regions.

METHODS

Participants were classified into the ventral prefrontal cortex tumor group (VPFC, n = 27), the dorsolateral prefrontal cortex tumor group (DLPFC, n = 29), and matched healthy controls (HCs, n = 32). All participants were given a battery of neuropsychological tests, and they then performed the Iowa Gambling Task (IGT) and the Game of Dice Task (GDT) to assess their decision-making under ambiguity and under risk, respectively.

RESULTS

The two patient groups performed significantly worse on attention, memory, information processing, and executive function. Additionally, patients in the DLPFC group performed significantly worse on the memory and information processing tests compared with the VPFC and HC groups.

CONCLUSION

This study found that the decision-making functions of participants in the VPFC and DLPFC tumor groups were impaired to varying degrees. Among them, there was decision-making impairment under ambiguity and under risk in the VPFC group, and there was decision-making impairment under risk in the DLPFC group.