SIS Score Research Articles

The effect of stent retriever mechanical thrombectomy combined with tirofiban in treating acute ischemic stroke

Objective To analyze the effectiveness of stent retriever mechanical thrombectomy combined with tirofiban in treating acute ischemic stroke. Methods Markedly effective is defined as an SIS score of over 90, effective is indicated by an SIS score of between 50–90, and a score of below 50 suggests ineffective treatment results. Results ①The treatment’s overall effectiveness in the observation group (91.30%) was significantly higher than that in the control group (75.56%) (p < 0.05). ②The vascular recanalization rate in the observation group (89.13%) was significantly higher than that in the control group (71.11%) (p < 0.05). ③The stent retrieval operation count (2.41 ± 0.23) was significantly lower in the observation group than in the control group (1.29 ± 0.16) (p < 0.05). ④ After treatment, the platelet aggregation rate (10.74 ± 3.95) and NIHSS scores (6.58 ± 1.04) were significantly lower, and the Barthel index (77.86 ± 7.21) was significantly higher in the observation group compared to the control group (26.47 ± 5.12, 7.75 ± 2.36, 68.12 ± 6.15) (p < 0.05). All platelet aggregation rate, NIHSS scores and Barthel Index showed significant improvement after treatment when compared to those before treatment (p < 0.05). Conclusion The combined application of stent retriever mechanical thrombectomy and tirofiban in acute ischemic stroke treatment shows promising effectiveness. Compared to stent retriever alone, tirofiban adjunctive therapy enhances vascular recanalization, reduces retrieval procedures, shortens treatment duration, inhibits platelet aggregation, and improves neurological function recovery, daily living activities, and prognosis. Moreover, it doesn’t significantly increase symptom-related risks.

Sexual dysfunction in Wilson disease: Prevalence and influencing factors

Wilson disease is a rare neurogenetic disorder that receives significant attention due to its manifestations, such as jaundice, cirrhosis, tremor, dystonia, and others. However, the impact of Wilson disease on sexual function has been overlooked. In this study, we aimed to investigate current status of sexual dysfunction in Wilson disease. In this study, we investigated the sexual function status and possible influencing factors of 245 Wilson disease patients by questionnaire. Our study identified sexual dysfunction as a prevalent issue in Wilson disease patients, with an overall prevalence of 49.0 %, of which 33.9 % in males and 63.7 % in females, both higher than the prevalence of sexual dysfunction in the normal Chinese population. Compared with non-sexual dysfunction patients, sexual dysfunction was more common in the older age group, females, less educated, rural residence, no occupation, lower income, taking sedatives/antipsychotics, and high SIS scores (P < 0.05). Our binary logistic regression analysis revealed that older age (OR: 1.103, 95 %CI: 1.058–1.151, P < 0.001), being female (OR: 5.900,95 %CI: 2.966–11.736, P < 0.001), and the use of antipsychotics or sedatives (OR: 3.277,95 %CI: 1.065–10.077, P < 0.05) were all positively linked with an increased risk of sexual dysfunction. Despite the well-known symptoms of Wilson disease, sexual dysfunction is also a frequent issue in Wilson disease patients, necessitating further attention.

Lifetime and Acute Stress Predict Functional Outcomes Following Stroke: Findings From the Longitudinal STRONG Study.

Stroke is a sudden-onset, uncontrollable event; stroke-related stress may impede rehabilitation and recovery. Lifetime stress may sensitize patients to experiencing greater stroke-related stress and indirectly affect outcomes. We examine lifetime stress as predictor of poststroke acute stress and examine lifetime and acute stress as predictors of 3- and 12-month functional status. We also compare acute stress and baseline National Institutes of Health Stroke Scale as predictors of poststroke functional status. Between 2016 and 2020 the STRONG Study (Stroke, Stress, Rehabilitation, and Genetics) enrolled adults with new radiologically confirmed stroke 2 to 10 days poststroke onset at 28 acute care US hospitals. Participants were interviewed 3 times: acute admission (acute stress; Acute Stress Disorder Interview), 3 months (Fugl-Meyer Upper Extremity motor impairment [Fugl-Meyer Upper Arm Assessment; N=431], modified Rankin Scale [3 months; N=542], Stroke Impact Scale-Activities of Daily Living [3 months; N=511], Lifetime Stress Exposure Inventory), and 12 months (modified Rankin Scale, N=533; Stroke Impact Scale 3.0 Activities of Daily Living; N=485; Telephone Montreal Cognitive Assessment; N=484) poststroke. Structural equation models examined whether acute stress predicted 3- and 12-month functional outcomes, and mediated an association between lifetime stress and outcomes controlling for demographics and initial National Institutes of Health Stroke Scale. Standardized betas are reported. Sample (N=763) was 19 to 95 years old (mean=63; SD=14.9); 448 (58.7%) were male. Acute stress scores ranged from 0 to 14 (mean, 3.52 [95% CI, 3.31-3.73]). Controlling for age, gender, baseline National Institutes of Health Stroke Scale, and race and ethnicity, higher lifetime stress predicted higher acute stress (β=0.18, P<0.001), which predicted lower 3-month Fugl-Meyer Upper Arm Assessment scores (β=-0.19, P<0.001), lower Stroke Impact Scale 3.0 Activities of Daily Living scores at 3 months (β=-0.21, P<0.001) and 12 months (β=-0.21, P<0.001), higher modified Rankin Scale scores at 3 months (β=0.23, P<0.001) and 12 months (β=0.22, P<0.001), and lower 12-month Telephone Montreal Cognitive Assessment scores (β=-0.20, P<0.001). Acute stress predicted 12-month tMoCA (χ2[1]=5.29, P=0.022) more strongly, 3-month and 12-month modified Rankin Scale and SIS scores as strongly (all Ps>0.18), but Fugl-Meyer scores (χ2[1]=7.01, P=0.008) less strongly than baseline National Institutes of Health Stroke Scale. Lifetime stress/trauma is associated with more poststroke acute stress, which is associated with greater motor and cognitive impairment and disability 3 and 12 months poststroke. Poststroke interventions for acute stress may help mitigate stroke-related disability.

Development of Phonemically Balanced Word List in Tamil for Speech Audiometry and Evaluation of Its Effectiveness in Adults.

Speech audiometry has become an essential component of the audiological test battery. Various speech audiometry materials have been developed in different languages and also revised later to meet criteria such as familiarity of the words, phonetic/phonemic balance, number of test items, and dialectal variations. The current study focused on developing a PB word list in Tamil for adults. The study was carried out in two phases. Phase I involved the development of a PB word list in Tamil. Phase II included evaluating the effectiveness of the developed word lists on adults with normal hearing sensitivity and hearing impairment. A total of 500 bisyllabic words were used in creating a master list. The collected words were subjected to familiarity testing with 40 native Tamil speakers. From the master list of 500 words, 90% of the participants rated 320 words as most familiar, and those words were included in the study. The 320 words were validated by eight experts working in the fields of audiology, speech-language pathology, linguistics, and psychology. The disagreed-with words were excluded from the list, and only 270 words that were agreed upon by all the experts were included in the final list. The final lists comprised four-word lists with 25 phonetically balanced (PB) words per list. The final word lists were recorded and tested for goodness. These final words were then administered to find SIS scores for two groups. Group I consisted of adults with 120 normal hearing sensitivity, and Group II consisted of 130 adults with hearing impairment. The results were analysed using SPSS software. The mean SIS in adults with normal hearing sensitivity ranged from 99.4 to 99.8%. The SIS of adults with normal hearing sensitivity revealed no significant difference (p > .05) with respect to gender, ears, or across the four-word lists. All four-word lists provided similar scores, establishing the equivalency of word lists in individuals with normal hearing sensitivity as well as hearing impairment. A psychometric curve of performance intensity function in adults with normal hearing sensitivity revealed that the SIS score increased as the sensation level increased from 10 to 40dBSL. There is a linear increase in SIS scores from 10 to 20dBSL. A plateau was attained at 40dBSL with 100% SIS scores. Thus, the present study recommends the use of 40dB SL for SIS testing. Mean SIS scores for adults with mild, moderate, and severe hearing loss were found to be 90.1%, 65.4%, and 41.8%, respectively. A significant decrease in SIS was observed as the degree of hearing loss increased.

The prognosis value of CONUT and SIS score for recurrent or metastatic esophageal squamous cell carcinoma patients treated with second-line immunotherapy.

To investigate the predictive value of Controlling Nutritional Status (CONUT) score and systemic inflammation (SIS) score in the prognosis, short-term efficacy, and immune-related side effects of patient with recurrent or metastatic esophageal squamous cell carcinoma (R/M ESCC) receiving immunotherapy as second line therapy combined with or without radiotherapy. Forty-eight patients with R/M ESCC who received second-line therapy with Camrelizumab were retrospectively studied. They were divided into the high and low score groups according to the CONUT and SIS score. Univariate and multivariate analyses were used to analyze factors that might affect patient prognosis and the effects of different CONUT score and SIS on the short-term efficacy and immune-related toxic and side effects of patients. The 1- and 2-year overall survival (OS) and progression-free survival (PFS) rates were 42.9% and 22.5%, and 29.0% and 5.8%, respectively. The CONUT score ranged from 0 to 6 (3.31 ± 1.43), whereas the SIS score ranged from 0 to 2 (1.19 ± 0.73). Multivariate analysis showed that treatment related toxicity, number of cycles of Camrelizumab used, short-term effect and SIS score were independent prognostic factors for OS (P=0.044, 0.021, 0.021, 0.030, respectively), whereas SIS and CONUT scores were independent prognostic factors for PFS (P=0.005, 0.047, respectively). Patients with low CONUT/SIS score had a low incidence rate of immune-related adverse reactions (X2=9.735, 5.693; P=0.002, 0.017) and better short-term efficacy (X2=4.427, 7.438; P=0.035, 0.006). R/M ESCC patients with low CONUT/SIS score have better prognosis, higher objective response rate, lower incidence of immune-related toxic and side effects after receiving immunotherapy as second-line therapy. CONUT scores and SIS scores may be reliable prognostic indicators for patient receiving immunotherapy as second-line therapy for R/M ESCC.

Coronary computed tomography angiography improves coronary risk prediction in general population

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Carlos III Health Institute and the European Regional Development FundAgency for Management of University and Research Grants Introduction In the next decades, it is expected an increasing incidence of acute coronary syndrome in the Spanish population. Identify high-risk patients could be the most cost-effective way to reduce its incidence and morbi-mortality burden. We studied the effect of adding coronary artery calcification (CAC) and the extent of atherosclerotic disease (SIS score) to classical cardiovascular (CV) risk factors in coronary risk prediction. Methods This was a prospective cohort study of 325 asymptomatic patients recruited between 2013-2017. Demographic characteristics and CV risk factors were obtained and all participants underwent a coronary computed tomography angiography exam in which CAC and SIS were determined. The cohort was followed-up (median= 4 years) for a composite endpoint that included CV death, myocardial infarction, coronary angiography and/or revascularization. Improvement in discrimination and in reclassification by the inclusion of CAC/SIS in the Framingham-REGICOR function were examined with the Sommer's D index and with the Net reclassification index (NRI) (categorical and continuous), respectively. Results Nine of the 251 individuals included in the study had an event in the follow-up. Of the included participants, 94 had a CAC = 0 and 85 a SIS = 0. These participants had no events. The addition of SIS or of SIS and CAC scores to the Framigham-REGICOR risk function increased significantly the discrimination capacity from 0.71 to 0.88 (Table 1). Reclassification measured by the continuous NRI also improved significantly from 69.5 to 112.4/115.5 when SIS or both scores were included (Table 2). Conclusions CAC and SIS scores were associated to 4-year CV event incidence, independently of coronary risk estimation. Discrimination and reclassification of the Framigham-REGICOR coronary function were significantly improved by both indexes, but SIS overrode the effect of CAC.

Integrating Coronary Plaque Information from CCTA by ML Predicts MACE in Patients with Suspected CAD.

Conventional prognostic risk analysis in patients undergoing noninvasive imaging is based upon a limited selection of clinical and imaging findings, whereas machine learning (ML) algorithms include a greater number and complexity of variables. Therefore, this paper aimed to explore the predictive value of integrating coronary plaque information from coronary computed tomographic angiography (CCTA) with ML to predict major adverse cardiovascular events (MACEs) in patients with suspected coronary artery disease (CAD). Patients who underwent CCTA due to suspected coronary artery disease with a 30-month follow-up for MACEs were included. We collected demographic characteristics, cardiovascular risk factors, and information on coronary plaques by analyzing CCTA information (plaque length, plaque composition and coronary artery stenosis of 18 coronary artery segments, coronary dominance, myocardial bridge (MB), and patients with vulnerable plaque) and follow-up information (cardiac death, nonfatal myocardial infarction and unstable angina requiring hospitalization). An ML algorithm was used for survival analysis (CoxBoost). This analysis showed that chest symptoms, the stenosis severity of the proximal anterior descending branch, and the stenosis severity of the middle right coronary artery were among the top three variables in the ML model. After the 22nd month of follow-up, in the testing dataset, ML showed the largest C-index and AUC compared with Cox regression, SIS, SIS score + clinical factors, and clinical factors. The DCA of all the models showed that the net benefit of the ML model was the highest when the treatment threshold probability was between 1% and 9%. Integrating coronary plaque information from CCTA based on ML technology provides a feasible and superior method to assess prognosis in patients with suspected coronary artery disease over an approximately three-year period.

The value of SPARCC sacroiliac MRI scoring in axial psoriatic arthritis and its association with other disease parameters.

This study aimed to assess patients with axial psoriatic arthritis (AxPsA) using the Canadian Spondyloarthritis Research Consortium (SPARCC) sacroiliac joint (SIJ) scores and to seek correlations between magnetic resonance imaging (MRI) scores and disease characteristics. Forty PsA patients (32 females, mean age 46.4years) who had been documented to have active or structural lesions on SIJ MRI were retrospectively evaluated. Disease duration, medications, and disease activity, including Disease Activity in Psoriatic Arthritis (DAPSA), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), minimal disease activity (MDA), and Ankylosing Spondylitis Disease Activity Score (ASDAS) were recorded. On sacroiliac MRI scans, the SPARCC scores of sacroiliac joint inflammation (SIS) and sacroiliac joint structural damage (SSS) were evaluated. The mean disease duration was 51.4±70.4months. MRI showed active inflammation in 30 patients (75%) and at least 1 structural lesion in 32 patients (92.5%). The most prevalent structural lesion was erosion (82.5%), followed by fat metaplasia (65%), backfill (12.5%), and ankylosis (2.5%). Only fat metaplasia scores were significantly higher in men than in women (P=.007). Of clinical and laboratory parameters, only C-reactive protein (CRP) was significantly higher in the presence of active inflammation (P=.01). The SIS score was significantly correlated with disease duration (r=-.35) and CRP levels (r=.42,). The SSS score was inversely correlated with BASDAI (r=-.37), ASDAS-CRP (r=-.39), and ASDAS - erythrocyte sedimentation rate (r=-.32). The overall SPARCC scores did not differ between patients in DAPSA remission and non-remission and between those in MDA and non-MDA. Although radiologic involvement is generally not severe in AxPsA, MRI still provides additional information about inflammatory activity and structural lesions. CRP may be helpful in monitoring the radiologic disease activity in AxPsA.

Spanish Influenza Score (SIS): utilidad del Machine Learning en el desarrollo de una escala temprana de predicción de mortalidad en la gripe grave

To develop a mortality prediction score (Spanish Influenza Score [SIS]) for patients with severe influenza considering only variables at ICU admission, and compare its performance respect of Random Forest (RF). Sub-analysis from the GETGAG/SEMICYUC database. Intensive Care Medicine. Patients admitted to 184 Spanish ICUs (2009-2018) with influenza infection Intervention: None. Demographic data, severity of illness, times from symptoms onset until hospital admission (Gap-H), hospital to ICU (Gap-ICU) or hospital to diagnosis (Gap-Dg), antiviral vaccination, number of quadrants infiltrated, acute renal failure, invasive or noninvasive ventilation, shock and comorbidities. The study variable cut-off points and importance were obtained automatically. Logistic regression analysis with cross-validation was performed to develop the SIS score using the output coefficients. Accuracy and discrimination (AUC-ROC) were applied to evaluate SIS and RF. All analyses were performed using R (CRAN-R Project). A total of 3959 patients were included. The mean age was 55 years (range 43-67), 60% were men, APACHE II 16 (12-21) and SOFA 5 (4-8), with ICU mortality 21.3%. Mechanical ventilation, shock, APACHE II, SOFA, acute renal failure and Gap-ICU were included in the SIS. The latter was generated according to the ORs obtained by logistic regression, and showed an accuracy of 83% with an AUC-ROC of 82%, similar to RF (AUC-ROC 82%). The SIS score is easy to apply and shows adequate capacity to stratify the risk of ICU mortality. However, further studies are needed to validate the tool prospectively.

Correlation of Clinical Findings in Acute Spinal Injury Patients with Magnetic Resonance Including Diffusion Tensor Imaging and Fiber Tractography.

Introduction Many types of research are being carried out in the fields of understanding of the pathogenesis, early recognition, and improving the outcomes after spinal cord injury (SCI). Diffusion tensor imaging (DTI) is one of the modalities used in vivo microstructural assessment of SCI. The aim of the present study is to evaluate the role of DTI imaging and fiber tractography in acute spinal injury with clinical profile and neurological outcome. Methods The study was carried out on twenty-five patients of acute spinal cord injury who presented within 48 hours of injury and completed minimum of six months follow-up. Results The mean age of patients was 37.32±13.31 years and male & female ratio of 18:7. Total MIS score was 91.64±6.0 initially which improved to 96.92±3.68 after 3 months and 99.4±1.35 after 6 months. Total SIS score was similar at all the time intervals i.e. 224±0. Maximum subjects 14(56%) were classified into AIS C and 5(20%) into AIS D whereas only 6(24%) subjects were having no deficit (AIS E). At the end of 6 months, 13(52%) subjects had no deficit (AIS E). Mean fractional anisotropy (FA) initially was 0.451 (± 0.120) but after 6 months, it increased to 0.482 (± 0.097) (p<0.001). The mean apparent diffusion coefficient (ADC) initially was 3.13 (± 2.68) but after 6 months, it decreased to 3.06 (± 2.68) and this change was found to be statistically highly significant (p<0.001). Mean anisotropy index (AI) initially was 0.420 (± 0.245) but after 6 months, it increased to 0.430 (± 3.41) and this change was found to be statistically significant (p<0.01). Conclusions DTI is a sensitive tool to detect neurological damage in SCI and subsequent neurological recovery. FA correlated with ASIA impairment scale. It can be useful as an adjunct to conventional MRI for better evaluation and predicting prognosis in SCI patients.

Spondyloarthritis Research Consortium of Canada sacroiliac joint inflammation and structural scores: change score reliability and recalibration utility in children

BackgroundThe SPARCC sacroiliac joint inflammation (SIS) and structural (SSS) scores are reliable measures to quantify abnormalities in the pediatric sacroiliac joint. We aimed to evaluate the utility of online calibration modules for the SIS and SSS and the reliability of their component change scores.MethodsChange score reliability of 6 raters was assessed by overall and pairwise intraclass correlation coefficients (ICCs) before and after the use of real-time iterative calibration (RETIC) modules for both the SIS and SSS comprised of 20 adult cases. Acceptable ICC for change scores was > 0.7 for SIS and > 0.5 for all SSS components. Sensitivity to change was assessed by the standardized response mean (SRM).ResultsIn scoring exercise 1, the SIS had acceptable reliability with a change score ICC of 0.80 and sclerosis was the only SSS lesion that met the acceptability threshold with a change score ICC of 0.52. After RETIC calibration, the SIS overall (ICC = 0.83) and mean pairwise (ICC = 0.83) change scores remained reliable with a large SRM (0.90). All SSS components except sclerosis met the overall and mean pairwise change score ICC acceptability thresholds—backfill: overall = 0.54, mean pairwise = 0.50; fat metaplasia: overall = 0.65, mean pairwise = 0.57; erosion: overall = 0.60, mean pairwise = 0.58; and ankylosis: overall = 0.96, mean pairwise = 0.96. The SSS RETIC module augmented the number of SSS components surpassing the acceptability threshold from 1 to 4. Sensitivity to change, as measured by the SRM, was large for erosion (0.96), moderate for backfill (0.55) and sclerosis (0.70), and small for fat metaplasia (0.36) and ankylosis (0.28).ConclusionRETIC modules improved the overall reliability of SPARCC SIS and SSS change scores for previously calibrated raters. SIS recalibration was not as helpful to the most experienced raters who achieved high levels of agreement before recalibration. The SPARCC SIS and all SSS components except sclerosis are reliable measures to quantify change over time in children. A pediatric-specific RETIC tool should be developed to enhance the calibration of readers.

An Exploratory Study on the Central Nervous Correlates of Sexual Excitation and Sexual Inhibition

The Sexual Inhibition/Sexual Excitation Scales (SIS/SES) measure sexual excitation and sexual inhibition proneness. We used SIS and SES scores of 62 heterosexual teleiophilic men (Mage 34.3, SD = 9.9) to predict brain activation levels during the presentation of male and female visual sexual stimuli in a magnetic resonance imaging (MRI) scanner. Statistical analyses revealed significant correlations. SES and SIS1 scores were positively associated with brain activation in various brain regions during the presentation of both male and female stimuli. SIS2 turned out to be a weaker predictor of brain activation, still revealing one significant correlation in the right lateral orbitofrontal cortex. Significant regions for SES and SIS1 were, among others, primary and supplementary motor areas, the caudate nucleus, the dorsal anterior cingulate cortex, anterior insula, and prefrontal areas. Our study can be seen as an exploratory investigation of SIS and SES with means of functional brain imaging. The results provide a promising contribution to the assertion of neurophysiological systems of sexual inhibition and excitation proneness.

Clinical and Biochemical Correlations of Aggression in Young Patients with Mental Disorders

Hyperdopaminergia has been identified at impulsive or psychotic patients, the polymorphism of COMT or other enzymes that metabolize dopamine could be involved. The deficiencies of the serotoninergic system in suicidal behaviour has been mentioned by many studies that indicate the reduction of 5-HT, 5-HIAA in CSF or 5-HTT polymorphism. Young patients with psychotic or depression symptoms manifest, frequently, aggressive and self-harm behaviour. Besides the association between the young age and the aggressivity of the patients with serious mental disorders, our study shows gender differences and this matter is sustained by hormonal factors. The study was conducted at the Gheorghe Preda Psychiatric Hospital in Sibiu. The study comprises 52 patients aged between 18 and 35 who were diagnosed with the diagnosis of Schizophrenia, Bipolar Affective Disorder, Depressive Episode and Major depressive disorder according to the DSM-5 criteria. Evaluation of the severity of psychiatric and depressive symptomathology were assessed with Brief Psychiatric Rating Scale and Beck Depression Inventory; aggression and self-aggression in the patients with Schizophrenia, respectively with Bipolar disorder, depressive episode and Major depression disorder were assessed with Buss Perry Aggression Questionnaire and Suicide Intent Scale. Regarding the severity of aggression in the young patients from our study (Buss Perry scale score), male gender is higher than female gender: higher percentages in males (35% and 10%) than in females (16 and 0%). Determining aggression in schizophrenia is possible due to COMT polymorphism that lead to impulsivity or psychotic symptoms. The study show a significant positive correlation between the severity of symptoms of schizophrenia and aggression. From the analysis of the severity of depression in young patients (SIS score) it is noted that its severity is higher in the female gender. Women had higher scores of moderate depression (58%) and severe (26%) than men (37 and 25%, respectively). This relationships could be possible due to the polymorphism of the gene encoding the 5-HTT serotonin transporter related with serotonin deficiency.The study do not show a significant positive correlation between the severity of the depressive symptomatology and the degree of the suicide intent.

Self-reported inner speech in aphasia is related to phonological retrieval

Self-reported inner speech in aphasia is related to phonological retrieval

Abstract TMP120: Race and Sex Differences in the Trajectory of Cognitive Decline After Incident Stroke

Background and Objectives: Race and sex differences in the trajectory of survivors’ cognitive changes after stroke are uncertain. We measured changes in cognitive function associated with incident stroke and variability by race (black vs white) and sex, controlling for prestroke cognitive trajectories. Methods: Prospective study of 654 survivors of incident stroke and 22,969 stroke-free participants aged ≥45 years without baseline cognitive impairment from the REGARDS cohort enrolled 2003-2007 and followed through September 30, 2014. Median follow-up was 7.3 years. Changes in global cognition (Six-Item Screener [SIS]; range, 0-6; primary outcome), new learning, verbal memory, and executive function (Word-List Learning, Word-List Delayed Recall, and Animal Fluency Test) were measured using a regression discontinuity analytic approach, where the acute effect of stroke was estimated as the difference in the expected cognitive level on the day of the stroke from the modeled trajectory of cognitive functioning before the stroke and the trajectory of cognitive functioning after the stroke. These trajectories of post-baseline cognitive function were estimated after adjustment for calendar time and baseline values of socio-demographics, vascular risk factors, clinical factors, baseline cognitive score, and random effects for intercept and slope. Results: After stroke, acute declines in global cognition were greater in men compared with women (P=0.003) and also greater in blacks compared with whites (P=0.03) (Figure). Adjusted declines in SIS scores were 0.22 points (95% CI, 0.14 to 0.31) in black men, 0.13 points (95% CI, 0.06 to 0.20) in white men, 0.10 points (95% CI, 0.02 to 0.18) in black women, and 0.01 points (95% CI, -0.06 to 0.09) in white women. Secondary cognitive assessments did not differ significantly by race or sex. Conclusion: The acute declines in global cognition after stroke are greater in men compared with women and in blacks compared with whites.

Predicting Participation Level Six Month Following Inpatient Stroke Rehabilitation

Objective(s): To explore how well discharge Functional Independence Measures motor (FIM-M) and cognitive (FIM-C) and Activity MeasureePost Acute Care Basic Mobility (AMPAC-BM), Daily Activities (AMPAC-DA) and Applied Cognition (AMPAC-AC) sub-scores predict outcome 6 months following inpatient stroke rehabilitation (ISR). Design: Retrospective analyses of clinical database. Setting: Rehabilitation unit within an academic medical center. Participants: Sixty-two of 165 (38%) ISR patients with follow-up (no differences based on follow-up) having a mean ageZ68.1(14.3) y, NIHSSZ8.1(6.4) and rehabilitation length of stayZ15.8(7.9) d. Seventy four percent had an ischemic stroke and it was a recurrent stroke ion 23%. Interventions: ISR. Main Outcome Measure(s): Stroke Impact Scale-Participation (SIS-P) and recovery scale (SIS-RS) scores 6m post-discharge, controlling for age and NIHSS. Results: Mean discharge AMPAC-BM, AMPAC-DA and AMPAC-AC subscores were 51.9(12.2), 44.6(9.0) and 41.4(10.3), respectively. Mean FIM-M and FIM-C subscores were 55.8(16.0) and 28.7(6.4) and mean SIS-P and SIS-RS scores were 56.0(25.1) and 62.9(24.9), respectively. Spearman’s rho between FIM subscores and 6m SIS scores ranged from 0.327 to 0.565 (all p<.01). Correlation coefficients for AMPAC-BM and AMPAC-DA subscores ranged from 0.435 to 0.606 (all p<.001) while coefficients between AMPAC-AC and SIS-P and SIS-RS were 0.239 (pZ.06) and 0.301 (p<.02), respectively. Separate ordinal regressions were performed for FIM and AMPAC predicting 6m SIS-P. Both were significant (p<.001) with a Nagelkerke pseudo R of 0.33 and 0.34, respectively. Similarly, regressions for FIM and AMPAC predicting 6m SIS-RS were significant (p<.001), both R Z 0.36. Conclusions: FIM and AMPAC subscales assessed at discharge from ISR hold weak to moderate univariate correlations with participation 6m after ISR. Even though much faster and easier to administer, the AMPAC appears identical with the FIM in its ability to predict participation levels 6m outcomes after ISR.

Trajectory of Cognitive Decline After Incident Stroke.

Cognitive decline is a major cause of disability in stroke survivors. The magnitude of survivors' cognitive changes after stroke is uncertain. To measure changes in cognitive function among survivors of incident stroke, controlling for their prestroke cognitive trajectories. Prospective study of 23,572 participants 45 years or older without baseline cognitive impairment from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) cohort, residing in the continental United States, enrolled 2003-2007 and followed up through March 31, 2013. Over a median follow-up of 6.1 years (interquartile range, 5.0-7.1 years), 515 participants survived expert-adjudicated incident stroke and 23,057 remained stroke free. Time-dependent incident stroke. The primary outcome was change in global cognition (Six-Item Screener [SIS], range, 0-6). Secondary outcomes were change in new learning (Consortium to Establish a Registry for Alzheimer Disease Word-List Learning; range, 0-30), verbal memory (Word-List Delayed Recall; range, 0-10), and executive function (Animal Fluency Test; range, ≥0), and cognitive impairment (SIS score <5 [impaired] vs ≥5 [unimpaired]). For all tests, higher scores indicate better performance. Stroke was associated with acute decline in global cognition (0.10 points [95% CI, 0.04 to 0.17]), new learning (1.80 points [95% CI, 0.73 to 2.86]), and verbal memory (0.60 points [95% CI, 0.13 to 1.07]). Participants with stroke, compared with those without stroke, demonstrated faster declines in global cognition (0.06 points per year faster [95% CI, 0.03 to 0.08]) and executive function (0.63 points per year faster [95% CI, 0.12 to 1.15]), but not in new learning and verbal memory, compared with prestroke slopes. Among survivors, the difference in risk of cognitive impairment acutely after stroke, compared with immediately before stroke, was not statistically significant (odds ratio, 1.32 [95% CI, 0.95 to 1.83]; P = .10); however, there was a significantly faster poststroke rate of incident cognitive impairment compared with the prestroke rate (odds ratio, 1.23 per year [95% CI, 1.10 to 1.38]; P < .001). For a 70-year-old black woman with average values for all covariates at baseline, stroke at year 3 was associated with greater incident cognitive impairment: absolute difference of 4.0% (95% CI, -1.2% to 9.2%) at year 3 and 12.4% (95% CI, 7.7% to 17.1%) at year 6. Incident stroke was associated with an acute decline in cognitive function and also accelerated and persistent cognitive decline over 6 years.

Abstract T P413: Early Executive Dysfunction Predicts Poor Stroke Outcomes One Year Following Mild Ischemic Stroke

Background: Cognitive dysfunction has been considered a primary deficit to be addressed after mild stroke. Higher order cognitive deficits immediately after mild stroke may lead to poor longitudinal outcomes. However, existing stroke outcome studies tend to focus on physical capacity and mood rather than cognitive function. Aim: To examine contribution of acute impairment of executive function(EF) and verbal memory (VM) after mild stroke to one year outcomes on Stroke Impact Scale (SIS, health-related quality of life), Activity Card Sort (ACS, activity participation), and Reintegration to Normal Living (RNL, life satisfaction), independent of demographics, ADL and depression. Methods: Patients with ischemic stroke and initial NIHSS ≤ 5 enrolled in PROTECT-DC trial were included. Multiple linear regression analyses identified baseline variables significantly associated with each outcome of interest for all patients completing both baseline and one-year assessments. For each outcome, Model 1 included covariates: age, sex, race, education, lesion side, NIHSS, Barthel Index, Lawton IADL, and depression. In Model 2, all Model 1 variables and dichotomized cognitive variables (impaired versus not impaired) were entered into the equation. Examination of R2 change between Models 1 &amp; 2 identified unique contributions of impaired EF or VM to each one-year outcome beyond Model 1 variables. Results: A total of 86 participants completed baseline assessment and one-year SIS were included for analyses. Our results show that EF was significantly and independently associated with the SIS total score beyond other baseline variables. Participants with acute EF deficits at baseline had poorer SIS outcome at one year: mean 7.47 lower SIS score compared to patients without EF deficits (p = .021). Similar results were found for ACS and RNL. Conclusion: Analyses suggest impact of EF deficits on activity participation, health-related quality of life, and life satisfaction one year after mild stroke. The findings highlight importance of assessment of EF deficits after mild stroke. We suggest that rehabilitation interventions aimed at improving long-term outcomes require careful consideration of assessing and treating EF deficits during the acute phase of mild stroke.

Abstract T P110: Combined Task-Specific and Cognitive Strategy Training in Subacute Stroke: A Phase II Randomized Controlled Trial

Background and Objectives: Task-specific training (TST) may improve basic mobility and activities of daily living; however, used alone, these improvements are not generalized and transferred to home, community, or work settings, nor do they impact overall health status. In contrast, approaches incorporating cognitive strategy training have shown great promise in these areas, suggesting that a combined approach may have a greater overall effect. Cognitive Orientation to daily Occupational Performance (CO-OP) is an approach that uses cognitive strategies in combination with TST. The objective of this trial is to estimate the effect of CO-OP compared to standard out-patient rehabilitation on health status and functional skill performance in adults less than 3 months post stroke Methods: Participants less than 3 months post ischemic stroke (ICD-10 codes 163, 164) and admitted to outpatient rehabilitation services at 2 sites were randomized to receive either standard out-patient therapy (ST) or CO-OP. The main outcomes, administered pre, post, and at 3-month follow-up by a blind assessor, were health status (Stroke Impact Scale-SIS), and functional skill performance (Performance Quality Rating Scale-PQRS). Results: At the time of interim analysis, 21 participants (mean age 60.2 years, 33% female) were enrolled, 11 CO-OP and 10 ST. Post-test data were available for 14, follow-up for 8. SIS scores indicated larger changes for CO-OP for 7 of 9 domains, moderate effect for the composite physical health outcome SIS-16 at post-test (Cohen’s d=0.6), and large effect at follow-up (Cohen’s d=2.2). CO-OP had a large effect on PQRS scores for functional skills not trained in therapy (Cohen’s d=3.2), suggesting transfer beyond the clinical setting. Conclusions: The CO-OP treatment approach is associated with greater improvements than standard rehabilitation in most health status domains and in performance of skills untrained in therapy, indicating transfer beyond the clinical setting. A multi-site Phase III trial is warranted.

Abstract T MP92: Patient Valuation of Each Level of the Modified Rankin Global Disability Scale: Insights from the Stroke Impact Scale

Background: The modified Rankin Scale (mRS) assessment of global disability is the most commonly used primary endpoint in acute stroke clinical trials and is endorsed for use by US and European drug/device regulatory authorities. However, the mRS is an ordinal scale with ranks an unknown distance apart, hampering identification of minimally clinically important differences in scale outcome distributions. The Stroke Therapy Academic Industry Roundtable and other authorities have called for studies to assign utility weights to each scale level, permitting construction of a “utility-weighted mRS”. Methods: Consecutive patients undergoing 3 month final outcome visits in the NIH FAST-MAG phase 3 trial were assessed with the mRS and the Stroke Impact Scale, a patient-reported, stroke specific quality of life instrument. The SIS has 8 subscales, assessing different outcome dimensions. Results: Among 44 alive patients, mean age was 71.9 (SD±13.9), 68% were male, and entry NIHSS was 9.3 (SD±8.6). At 90d, the median mRS was 1 (IQR 0 - 3, lower better). On the SIS patient global judgment of recovery, the 90d median value was 80 (IQR, 60-95, higher better). Score distributions of the 8 SIS functioning domains showed varied patterns across the 6 Rankin levels. At low mRS scores, SIS-QOL scores were modestly lowered in the domains of strength, emotion, activities of daily living, and social participation; lower SIS-QOL in the domains of memory and thinking, communication, and mobility only began to accrue at moderate to severe mRS scores. Utility weights for the mRS, derived from a cross-dimension average SIS score, were: mRS 0 - 0.95, mRS 1 - 0.90; mRS 2 - 0.74; mRS 3 - 0.67; mRS 4 - 0.44; mRS 5 - 0.36. The utility values were monotonic, with natural clusters at mRS 0-1, mRS 2-3, and mRS 4-5. Conclusion: Mild scores on the modified Rankin Scale are particularly associated with quality of life deficits in the domains of strength, emotion, activities of daily living, and social participation, while more severe mRS abnormalities compromise QOL across all domains of functioning. Utility values for the modified Rankin Scale derived from the Stroke Impact Scale show a decrement with each mRS level, with a natural tetrachotomization of the mRS at 0-1, 2-3, 4-5, and 6.