Abstract TP426: Major Cognitive Improvement in Patients With High Grade Intracranial Stenosis (70-99%) Within 3 Months of Transient Ischemic Attack or Minor Ischemic Stroke
Bibliographic record
Abstract
Importance: Cognitive impairment appears to be common manifestation in patients with high grade intracranial stenosis. The rates of improvement in cognitive impairment and associated factors are not well known. Objective: Identify the rates and predictors of major cognitive improvement in patients with non-disabling stroke or TIA attributed to 70%-99% stenosis of a major intracranial artery. Methods: A post hoc analysis of patients in the Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis (SAMMPRIS) Trial was performed. Each patient underwent cognitive assessment using the Montreal Cognitive Assessment (MoCA) prior to (within 30 day of TIA or non-disabling stroke) and at 3 months post randomization. Major cognitive improvement was defined by an increase in Montreal Cognitive Assessment score of 2 points or greater at follow up evaluation. Results: A total of 172 (38.1%, 95% confidence interval [CI] 32.8 - 44.2) of 451 patients randomized had major improvement in cognitive assessment. The rate of major cognitive improvement was 151 (33.5% 95% CI 28.5 - 39.2) and 21 (4.7% 95% CI 3.0 - 7.0) among patients with MoCA score of <26 and ≥26 at baseline evaluation. The rates of major cognitive improvement did not differ between patients who were randomized to stent placement compared with best medical treatment (85 [49.4%] versus 87 [50.6%], relative risk [RR] 1.1, p=0.4). The rates of major cognitive improvement were significantly higher among patients aged ≥65 years (72 [41.9%] versus 55 [31.1%], relative risk [RR] 0.8, p=.03) and those with systolic BP ≥140 mm Hg at follow up visit (53 [30.8%] versus 39 (22.0%), relative risk [RR] 0.9, p=.05). There was a trend towards lower rates of major cognitive improvement in patients with HbA1C >6 at baseline assessment. No relationship between LDL cholesterol ≥70 mg/dl at baseline or follow up visit and major cognitive improvement was identified. Conclusions: A relatively high rate of major cognitive improvement was observed in patients with high grade symptomatic intracranial stenosis within 3 months. The paradoxical relationship between greater age and higher systolic blood pressure at follow up evaluation with major cognitive improvement require further studies.
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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 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.000 | 0.000 |
| 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) | 0.004 | 0.000 |
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".