title: Cognitive Impairment after Mild Stroke: Development and Validation of the SIGNAL2 Risk Score.
abstract: BACKGROUND
  Post stroke cognitive impairment (PSCI), an important complication of strokes, has numerous risk factors. A scale adequately classifying risk of cognitive impairment 3-6 months after mild stroke will be useful for clinicians.
  
  
  OBJECTIVE
  To develop a risk score based on clinical and neuroimaging variables that will be useful in identifying mild ischemic stroke patients at high risk for PSCI.
  
  
  METHODS
  The risk score development cohort comprised of a retrospective dataset of 209 mild stroke patients with MRI confirmed infarcts, without pre-stroke cognitive impairment, and evaluated within 6 months post-stroke for PSCI. Logistic regression identified factors predictive of PSCI and a risk score was developed based on regression coefficients. The risk score was checked for stability using 10-fold cross-validation and validated in an independent prospective cohort of 185 ischemic mild stroke patients.
  
  
  RESULTS
  Within 6 months post-stroke, 37.32% developed PSCI in the retrospective dataset. A 15-point risk score based on age, education, acute cortical infarcts, white matter hyperintensity, chronic lacunes, global cortical atrophy, and intracranial large vessel stenosis was highly predictive of PSCI with an AUC of 0.829. 10.11% with low scores, 52.69% with moderate scores, and 74.07% with high scores developed PSCI. In the prospective validation cohort, the model had an AUC of 0.776, and exhibited similar accuracy and stability statistics at both 6 and 12 months.
  
  
  CONCLUSIONS
  The seven item risk score adequately identified mild stroke patients who are at an increased risk of developing PSCI.
authors.affiliation: Department of Neurology, National Neuroscience Institute, Singapore.|Duke-NUS Graduate Medical School Singapore, Singapore.
authors.forename: Nagaendran
authors.initials: N
authors.lastname: Kandiah
authors.affiliation: Department of Neurology, National Neuroscience Institute, Singapore.
authors.forename: Russell Jude
authors.initials: RJ
authors.lastname: Chander
authors.affiliation: Department of Neurology, National Neuroscience Institute, Singapore.
authors.forename: Xuling
authors.initials: X
authors.lastname: Lin
authors.affiliation: Department of Neurology, National Neuroscience Institute, Singapore.
authors.forename: Aloysius
authors.initials: A
authors.lastname: Ng
authors.affiliation: Department of Neurology, National Neuroscience Institute, Singapore.|Duke-NUS Graduate Medical School Singapore, Singapore.
authors.forename: Yen Yeong
authors.initials: YY
authors.lastname: Poh
authors.affiliation: Department of Neurology, National Neuroscience Institute, Singapore.
authors.forename: Chin Yee
authors.initials: CY
authors.lastname: Cheong
authors.affiliation: Department of Neurology, National Neuroscience Institute, Singapore.
authors.forename: Alvin Rae
authors.initials: AR
authors.lastname: Cenina
authors.affiliation: Centre for Qualitative Medicine, Duke-NUS Graduate Medical School, Singapore.|Singapore Clinical Research Institute, Singapore.
authors.forename: Pryseley Nkouibert
authors.initials: PN
authors.lastname: Assam
mesh_terms: D000368:Aged; D000375:Aging / Q000473:pathology; D019540:Area Under Curve; D001921:Brain / Q000473:pathology; D002545:Brain Ischemia / Q000150:complications* / Q000175:diagnosis / Q000473:pathology / Q000523:psychology; D003072:Cognition Disorders / Q000175:diagnosis* / Q000209:etiology* / Q000473:pathology; D003251:Constriction, Pathologic; D004522:Educational Status; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012189:Retrospective Studies; D012306:Risk; D012720:Severity of Illness Index; D020521:Stroke / Q000150:complications* / Q000175:diagnosis / Q000473:pathology / Q000523:psychology; D066127:White Matter / Q000473:pathology
keywords: Cognitive impairment; ischemic stroke; magnetic resonance imaging; prognosis; risk score