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ObjectiveTo validate the ability of a specifically developed cognitive risk score to identify patients at risk of poststroke neurocognitive disorders (NCDs) who are eligible for a comprehensive cognitive assessment.MethodsAfter assessing 404 patients (infarct 91.3%) in the Groupe de Réflexion pour l'Evaluation Cognitive VASCulaire (GRECogVASC) cross-sectional study with the National Institute of Neurological Disorders and Stroke–Canadian Stroke Network battery 6 months after stroke, we used multivariable logistic regression and bootstrap analyses to determine factors associated with NCDs. Independent, internally validated factors were included in a cognitive risk score.ResultsCognitive impairment was present in 170 of the 320 patients with a Rankin Scale score ≥1. The backward logistic regression selected 4 factors (≥73% of the permutations): NIH Stroke Scale score on admission ≥7 (odds ratio [OR] 2.73, 95% confidence interval [CI] 1.29–4.3, p = 0.005), multiple strokes (OR 3.78, 95% CI 1.6–8, p = 0.002), adjusted Mini-Mental State Examination (MMSEadj) score ≤27 (OR 6.69, 95% CI 3.9–11.6, p = 0.0001), and Fazekas score ≥2 (OR 2.34, 95% CI 1.3–4.2, p = 0.004). The cognitive risk score computed with these 4 factors provided good calibration, discrimination (overoptimism-corrected C = 0.793), and goodness of fit (Hosmer-Lemeshow test p = 0.99). A combination of Rankin Scale score ≥1, cognitive risk score ≥1, and MMSEadj score ≥21 selected 230 (56.9%) of the 404 patients for a comprehensive assessment. This procedure yielded good sensitivity (96.5%) and moderate specificity (43%; positive predictive value 0.66, negative predictive value 0.91) and was more accurate (p ≤ 0.03 for all) than the sole use of screening tests (MMSE or Montréal Cognitive Assessment).ConclusionThe GRECogVASC cognitive risk score comprises 4 easily documented factors; this procedure helps to identify patients at risk of poststroke NCDs who must therefore undergo a comprehensive assessment.ClinicalTrials.gov identifier:NCT01339195.

Background It is not clear whether cognitive adverse events can occur after subthalamic nuclei deep brain stimulation in Parkinson disease, and the putative mechanisms are poorly understood. Case Description We report on a rare case of a 68-year-old woman with Parkinson disease but no previous cognitive impairment. The day after deep brain stimulation of the subthalamic nuclei, the woman presented with new-onset dementia and acute, severe, persistent, global cognitive decline, prompting a diagnosis of Alzheimer disease. Conclusions In patients seen in routine clinical practice, the simultaneous presence of several neurodegenerative diseases might not be uncommon. The assessment of mild cognitive impairment with a standardized method is highly recommended, a systematic 3-dimensional volumetric analysis of hippocampal structures should be part of the pre−deep brain stimulation evaluation, and cerebrospinal fluid biomarkers should be screened for if at least 1 of the 2 previously mentioned aspects is abnormal.

Introduction Les troubles neurocognitifs (TNC) post-AVC sont frequents et leur detection est difficile, en raison d’une sensibilite sous-optimale des tests de reperage. Objectifs L’objectif de notre etude etait d’elaborer un score de risque cognitif developpe specifiquement pour identifier les patients a risque de presenter un TNC post-AVC, necessitant un bilan neuropsychologique complet. Methodes Nous avons evalue, a 6 mois post-AVC, 404 patients (infarctus : 91,3 %) et 1003 sujets controles sains dans la cohorte GRECOG-VASC avec la batterie du NINDS-CSN. Nous avons utilise des analyses de regression logistique multivariee et bootstrap pour determiner les facteurs associes aux TNC. Des facteurs independants, valides en interne, ont ete inclus dans un score de risque cognitif. Resultats Presence d’un TNC chez 170 des 320 patients ayant un mRs ≥ 1. La regression logistique a selectionne 4 facteurs : score NIHSS initial ≥ 7 (OR = 2,73), AVC multiples (OR = 3,78), score MMSE ajuste (MMSEadj) ≤ 27 (OR = 6,69) et score de Fazekas ≥ 2 (OR = 2,34). La combinaison d’un mRs ≥ 1, d’un score de risque cognitif ≥ 1 et d’un MMSEadj ≥ 21 a selectionne 56,9 % des patients pour une evaluation complete, avec une bonne sensibilite (96,5 %) et une specificite moderee (43 %), plus precise que les tests de reperage. Discussion Nous proposons un score de risque cognitif base sur quatre facteurs facilement collectes dans la pratique clinique en routine, utilisant les donnees de la phase aigue (score NIHSS), l’IRM (presence de plusieurs AVC et le score Fazekas), et sur le suivi (MMSEadj). L’importance de ces facteurs est confirmee dans des etudes evaluant les TNC legers et majeurs post-AVC. Conclusion Le score de risque cognitif GRECOG-VASC comprend 4 facteurs, faciles a recueillir en routine et pourrait permettre d’identifier les patients a risque de TNC post-AVC afin de les orienter vers une evaluation neuropsychologique et d’optimiser leur prise en charge.