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Development and validation of a predictive nomogram for early risk stratification of post-stroke cognitive impairment

clinical-trials
cognitive-disorders
neurology

Abstract

Objective: The objective of this investigation was to develop and validate a prognostic nomogram for cognitive dysfunction following stroke (PSCI) among acute ischemic stroke patients by integrating comprehensive clinical, biochemical, and neuroimaging variables.

Methods: Within this prospective cohort investigation, 336 patients were enrolled for model development and internal validation, with an additional 48 patients for external validation. Cognitive performance was evaluated utilizing the Montreal Cognitive Assessment (MoCA) at six months following stroke. Data on demographic characteristics, vascular risk factors, stroke features, neuroimaging findings, and biochemical markers were collected. The least absolute shrinkage and selection operator (LASSO) logistic regression approach was utilized to determine independent predictors and construct the nomogram. Model performance was evaluated using receiver operating characteristic (ROC) curve analysis, calibration curves, and decision curve analysis (DCA).

Results : Five independent predictors of PSCI were identified: advanced age (OR 1.18, 95% CI 1.11-1.26), female gender (OR 4.71, 95% CI 1.67-14.84), elevated low-density lipoprotein cholesterol (LDL-C) (OR 4.50, 95% CI 2.35-9.46), key area cerebral infarction (OR 6.22, 95% CI 2.58-16.25), and global cortical atrophy (GCA) scale grade ≥2 (OR 8.50, 95% CI 1.99-41.64). The nomogram demonstrated excellent discriminative ability across the training (AUC = 0.935, 95% CI: 0.904-0.965), internal validation (AUC = 0.929, 95% CI: 0.882-0.976), and external validation cohorts (AUC = 0.884, 95% CI: 0.793-0.976). Calibration plots confirmed strong agreement between predicted and observed outcomes, and DCA revealed substantial clinical net benefits.

Conclusion : The developed nomogram, incorporating readily accessible and imaging-based predictors, provides a robust and clinically practical tool for the early and individualized risk stratification of PSCI in acute ischemic stroke survivors, facilitating targeted interventions.

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