Development and Validation of a Clinical Model (SHACEA) for Post-stroke Cognitive Impairment Prognosis Occurred at Acute Phase and Last to 6 Months.

Abstract

Post-stroke cognitive impairment (PSCI) leads to poor long-term stroke outcomes, severely increasing social and economic burdens. It is helpful to identify and intervene in PSCI in the early stage. This study intends to develop a new clinical risk score for identifying stroke survivors at significant risk of PSCI from the acute phase to 6 months of onset and to validate the new score using both internal and external cohorts. Analysis aiming to evaluate prognostic factors of acute-phase cognitive impairment lasting 6 months was carried out using two independent datasets, with one for model development and the other for validation. All enrolled patients completed baseline demographic, clinical, and imaging data collection and cognitive function scale assessment. The follow-up period was 6 months after the stroke, and interviews and cognitive function assessments were completed. A multivariate logistic regression analysis was performed, and the most important predictors were finally screened for modeling a prediction model. Six months post-stroke, 39.19% maintained PSCI in the development dataset. The final nine-point SHACEA (Stenosis, Hyperintensity, Age, Chronic cortical infarcts, Education, Atrophy) had an AUROC of 0.87 (95% CI 0.69-0.92) and was overall predictive of PSCI (LR χ² statistic of 89.34; p < 0.001). In the validation cohort, the SHACEA risk score was still relatively reliable in the validation cohort with an AUC of 0.74 (95% CI 0.71-0.80). The SHACEA risk score adequately identified acute stroke patients with cognitive impairment who are at an increased risk of developing PSCI after 6 months.