Abstract
BackgroundThe prognostic value of frailty measures for post-stroke neurocognitive disorder (NCD) remains to be evaluated.AimsThe aim of this study was to compare the predictive value of pre-stroke FI with pre-stroke modified Rankin Scale (mRS) for post-stroke cognitive impairment. Further, we explored the added value of including FI in prediction models for cognitive prognosis post-stroke.MethodsWe generated a 36-item Frailty Index (FI), based on the Rockwood FI, to measure frailty based on pre-stroke medical conditions recorded in the Nor-COAST multicentre prospective study baseline assessments. Consecutive participants with a FI score and completed cognitive test battery at three months were included. We generated Odds Ratio (OR) with NCD as the dependent variable. The predictors of primary interest were pre-stroke frailty and mRS. We also measured the predictive values of mRS and FI by the area (AUC) under the receiver operating characteristic curve.Results598 participants (43.0% women, mean/SD age = 71.6/11.9, mean/SD education = 12.5/3.8, mean/SD pre-stroke mRS = 0.8/1.0, mean/SD GDS pre-stroke = 1.4/0.8, mean/SD NIHSS day 1 3/4), had a FI mean/SD score = 0.14/0.10. The logistic regression analyses showed that FI (OR 3.09), as well as the mRS (OR 2.21), were strong predictors of major NCD. When FI and mRS were entered as predictors simultaneously, the OR for mRS decreased relatively more than that for FI. AUC for NCD post-stroke was higher for FI than for mRS, both for major NCD (0.762 vs 0.677) and for any NCD (0.681 vs 0.638).ConclusionsFI is a stronger predictor of post-stroke NCD than pre-stroke mRS and could be a part of the prediction models for cognitive prognosis post-stroke.Trial RegistrationClinicalTrials.gov Identifier: NCT02650531.
Highlights
The prognostic value of frailty measures for post-stroke neurocognitive disorder (NCD) remains to be evaluated
Frailty Index (FI) is a stronger predictor of post-stroke NCD than pre-stroke modified Rankin Scale (mRS) and could be a part of the prediction models for cognitive prognosis post-stroke
When FI and pre-stroke mRS were entered as predictors for major NCD simultaneously, the Odds Ratio (OR) for pre-stroke mRS decreased relatively more than the OR for FI
Summary
The prognostic value of frailty measures for post-stroke neurocognitive disorder (NCD) remains to be evaluated. Disability and cognition pre-stroke are important prognostic factors in a stroke population. Stroke related factors, and frailty measures are addressed in existing prediction models of post-stroke NCD [3, 4]. Frailty is a condition of vulnerability associated with an increased risk of adverse health outcomes such as functional decline and mortality. In the model by Fried and colleagues, the so-called physical frailty phenotype is described as a clinical syndrome [8]. The second theory, developed by Rockwood and colleagues, describes frailty by measuring accumulated deficits across multiple systems such as comorbidity, physical function, nutritional status, and cognitive function [9]. Based on the number of deficits, it is possible to calculate a Frailty Index (FI), and a higher index indicates more pronounced frailty and predicts adverse outcomes [5]
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