Response to Letter Regarding Article, “Serial Montreal Cognitive Assessments Demonstrate Reversible Cognitive Impairment in Patients With Acute Transient Ischemic Attack and Minor Stroke”
Bibliographic record
Abstract
We thank Dr Regal for his interest and comments regarding our article. 1It is important to consider delirium in the differential diagnosis of stroke and to recognize that delirium can occur in the acute phase of ischemic stroke. 2 We do agree that delirium and transient ischemic attack/minor stroke patients both exhibit rapid early neurological improvement.As pointed out by Dr Regal, these conditions are distinct from dementia and minimal cognitive impairment.Unlike the patients included in Dr Regal's study, however, our patients demonstrated no signs of fluctuating attention or level of consciousness suggestive of delirium.In fact, we excluded patients with dementia as well as any acute medical condition associated with delirium.We, therefore, think that the rapidly reversible single-domain and multiple-domain impairment we observed was more likely related to the effects of focal cerebral ischemia itself, as has been described in the nonminor stroke population. 3he rate of change of cognitive domain change analysis by Dr Regal elegantly demonstrates the rapid improvement in overall cognition in our patients.In our patients, the attention domain was relatively stable between baseline and day 90.Instead, the majority of the improvement in overall cognitive function seems to be related to better recall at day 7. 1 We agree that prestroke test scores would have been useful to quantify cognitive decline and improvement later, although this certainly is a more difficult study.In addition to differences in the attention domain, grouping transient ischemic attack/minor stroke and Central Coast Australia Delirium Intervention Study (CADIS) 4 patients may be problematic, because the latter likely have multiple causes.Finally, the median (interquartile range) in-hospital stay for our study patients was 2 (5) days, which is considerably shorter than that previously reported for elderly delirious patients where the mean was 9 to 32 days. 5Regardless, we do agree that patients with transient ischemic attack/minor stroke should be assessed for transient cognitive changes using the same approach and tools currently being used by Dr Regal in the CADIS study.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.016 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.025 | 0.015 |
| Insufficient payload (model declined to judge) | 0.005 | 0.006 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".