Available online 19 May 2023

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The Oxford Cognitive Screen (OCS) was developed to measure cognitive impairment in stroke. Here, we test if the OCS administered acutely in stroke patients provides useful information in predicting long-term functional outcome. A group of first-time stroke patients (n=74) underwent an acute behavioral assessment comprising the OCS and the NIHSS within one-week post-stroke. Functional outcome was evaluated using the Stroke Impact Scale 3.0 (SIS 3.0) and the Geriatric Depression Scale (GDS) at 6 and 12-months post-stroke. We compared the predictive ability of the OCS and NIHSS, separately or in combination, to predict different domains of behavioral impairment at a chronic evaluation. The OCS accounted for 61% of variance of SIS physical domain, 61% of memory domain, 79% of language domain, 70% of participation domain and 70% of recovery domain. The OCS accounted for a greater percentage of outcome variance than demographics and NIHSS. The most informative predictive model included the combination of demographics, OCS and NIHSS data. The OCS, performed early after stroke, is a strong independent predictor of long-term functional outcome and significantly improves the prediction of outcome when considered alongside the NIHSS and demographics.

Section snippetsINTRODUCTION

Stroke prognosis can be determined by predictors such as age, acute severity, gender, education level, and pre-existing comorbidities1,2,3. Among these features, acute severity is considered the most important factor affecting long-term outcome4,5,6. In clinical practice, stroke severity is typically assessed with the National Institutes of Health Stroke Scale (NIHSS), a stroke-specific version of the neurological examination, including subtests covering different functional domains (i.e.

METHODS

We report how we determined our sample size, all data exclusions, all inclusion/exclusion criteria, whether inclusion/exclusion criteria were established prior to data analysis, all manipulations, and all measures in the study. No part of the study procedures or analysis plans was preregistered prior to the research being conducted.

Results

A sample of patients (n=114) with a first symptomatic stroke, either ischemic or hemorrhagic, were prospectively recruited from two neurology units of the Azienda Ospedale Universita’ of Padua according to the inclusion criteria. Patients were tested with an acute neurobehavioral battery at 5±3.6 days post stroke. Approximately half of the patients (n=58) were contacted by phone at 6 months (187±20 days) after the first neurobehavioral assessment, of which n=38 underwent the follow-up

DISCUSSION

We investigated whether the Oxford Cognitive Screen (OCS) can be considered an acute predictor of long-term functional outcome. Furthermore, we studied the combination of predictors that better explain long-term functional impairment. We aimed to define the role of the OCS compared to other clinically relevant predictors in the definition of post stroke prognosis.

LIMITATIONS

Regarding the present study’s limitations, it is important to note that the final sample included n=74 patients. This represents a small-medium population and replication studies in larger independent datasets are necessary to confirm our results. Nevertheless, our results showed reliable statistical significance and general agreement with the known literature. Another limitation relates to the evaluation of the patients’ pre-stroke status. Specifically, quantitative information on the amount

CONCLUSION

The high prevalence of cognitive deficits following stroke and their impact on patients' recovery strongly suggests the importance of a cognitive evaluation early after stroke. In this study we show that a prompt detection of cognitive deficits is a strong predictor of post stroke functional outcome. Most importantly, we demonstrate that the integration of a short, bedside cognitive screening tool with common clinical features significantly improves the clinicians’ ability to predict patients’

Uncited reference

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DATA AVAILABILITY

The data that support the findings of this study are available from the corresponding author. The conditions of our ethics approval do not permit public archiving of anonymised study data. Readers seeking access to the data should contact the lead author ALB or the local ethics committee at the Department of Neuroscience, University of Padova. Access will be granted to named individuals in accordance with ethical procedures governing the reuse of sensitive data. Requestors do not have

CRediT authorship contribution statement

Antonio Luigi Bisogno: Conceptualization, Data curation, Writing – original draft, preparation. Luca Novelletto: Data curation, Writing – original draft, preparation. Andrea Zangrossi: Methodology, Writing – original draft, preparation. Serena De Pellegrin: Investigation. Silvia Facchini: Investigation. Anna Maria Basile: Supervision. Claudio Baracchini: Supervision. Maurizio Corbetta: Conceptualization, Writing – review & editing.

Declaration of Competing Interest

The authors report no conflicts of interest. All co-authors have seen and agree with the contents of the manuscript and there is no financial interest to report. We certify that the submission is original work and is not under review at any other publication.

ACKNOWLEDGEMENTS

The principal investigators wish to thank the participants who participated in the study for their time and effort. MC was supported by FLAG-ERA JTC 2017 (grant ANR-17-HBPR-0001); MIUR - Departments of Excellence Italian Ministry of Research (MART_ECCELLENZA18_01); Fondazione Cassa di Risparmio di Padova e Rovigo (CARIPARO) - Ricerca Scientifica di Eccellenza 2018 – (Grant Agreement number 55403);Ministry of Health Italy Brain connectivity measured with high-density electroencephalography: a

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