Abstract T MP117: Early Cognitive Dysfunction is Associated With Poor Short Term Functional Outcome in Hospitalized Stroke Patients
Bibliographic record
Abstract
Introduction: More than one-half of all patients experience cognitive dysfunction (CD) after stroke, and up to one-third develop dementia. As a Comprehensive Stroke Center, we screen all stroke inpatients for CD, though the feasibility and utility of early screening have not been established. We assessed the hypotheses that early cognitive screening in hospitalized stroke patients is feasible and that early CD is associated with poor short term functional outcome. Methods: The medical records of all patients admitted with ischemic stroke (IS) or intracerebral hemorrhage (ICH) between 2/1/13 and 4/15/13 were reviewed. A Brief Neurocognitive Screening Test assessing registration, delayed recall, fluency, and orientation was performed (4 items from the Montreal Cognitive Assessment, higher score better; maximum 12 points). Patients were eligible if they did not have a medical condition precluding screening (e.g. death, comfort care). Results: Of 303 IS and ICH inpatients, 209 (68.98%) were screened for CD. Over 85% of all eligible patients were screened (87.1% IS and 81.1% ICH). In a multivariate logistic regression model, factors associated with being screened for CD included lower baseline NIHSS (OR 0.91, 95% CI 0.88-0.94) and IS subtype, as compared to ICH subtype (OR 1.97, 95% CI 1.1-3.52). Median scores (IQR) for IS and ICH patients were 8 (3-10) and 5.5 (1.5-9.5), respectively. More than half of all IS and ICH patients (56.94%) screened positive for CD (score < 9). Patients most likely to screen positive for CD included those of older age (OR 1.04, 95% CI 1.02-1.06) and increased NIHSS (OR 1.14, 95% CI 1.08-1.19). Screening positive for CD was associated with poor discharge/day 7 outcome (mRS > 3), independent of age, baseline NIHSS, and stroke subtype (OR 2.37, 95% CI 1.06-5.28). Conclusion: Screening hospitalized stroke patients for CD is feasible and CD in stroke inpatients is common. Older patients and those with more severe strokes are more likely to screen positive. Early CD is associated with poor short term functional outcome. Our results provide preliminary evidence supporting the use of early CD screening in stroke patients. Additional studies on quality of life and long-term outcome are necessary to further assess the utility of early CD screening.
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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 | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.007 | 0.001 |
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".