Cognitive Functioning in the Acute Phase Poststroke: A Predictor of Discharge Destination?
Cognitive Functioning in the Acute Phase Poststroke: A Predictor of Discharge Destination?
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DOI：
10.1016/j.jstrokecerebrovasdis.2010.03.009
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发表时间：
2011-11-01
影响因子：
2.5
通讯作者：
van Heugten, Caroline M.
中科院分区：
文献类型：
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作者：
van der Zwaluw, Carmen S.;Valentijn, Susanne A. M.;van Heugten, Caroline M.
超过一半的中风幸存者会出现认知功能障碍，并可能对日常生活中的功能产生深远的影响。对认知功能的评估在确定住院后适当的出院目的地方面起着重要作用。本研究旨在确定认知筛查在卒中后急性期的可行性，并探讨这种认知筛查是否能够准确地预测独立或依赖生活状态的放电目的地。共有287名首次中风连续住进综合医院卒中病房的患者符合研究条件。所有患者在卒中后7天内接受神经心理筛查，包括简易智力状态检查(MMSE)、认知筛查(CST)和画钟表测试。73.2%的患者筛查是可行的。Logistic回归分析显示，Barthel指数(BI)评分(即日常生活活动能力)可以预测出院目的地，当考虑年龄和BI评分时，解释方差为47%。随着年龄和BI的增加，3项认知测试显著提高了模型的解释方差(53%)，其中Bland CST的贡献显著。卒中后急性期的认知筛查似乎是可行的，并能够支持患者出院回家或依赖生活的决定。功能状态提高了模型的预测值，MMSE不适用于预测。建议使用包括认知在内的一套全面的各种预测指标来支持出院计划。
Cognitive dysfunction occurs in more than half of stroke survivors and can have far-reaching consequences for functioning in daily life. Assessment of cognitive function can play a major role in determining the appropriate discharge destination after a hospital stay. The present study aimed to determine the feasibility of cognitive screening in the acute phase poststroke and to investigate whether this cognitive screening can accurately predict discharge destination to either a dependent or an independent living situation. A total of 287 patients with a first-ever cerebral stroke consecutively admitted to a stroke unit of a general hospital were eligible for the study. All patients underwent neuropsychological screening, consisting of the Mini-Mental State Examination (MMSE), Cognitive Screening Test (CST), and Clock-Drawing Test, within 7 days poststroke. Screening was feasible in 73.2% of the patients. Logistic regression analysis showed that the Barthel Index (BI) score (ie, ability to perform activities of daily living) could predict the discharge destination with 47% explained variance when age and BI score were taken into account. Adding the 3 cognitive tests to the model with age and BI improved the explained variance substantially (53%), with a significant contribution of Bland CST. Cognitive screening in the acute phase poststroke appeared to be feasible and capable of supporting the decision of whether to discharge a patient to home or to a dependent living situation. Functional status improved the predictive value of the model; the MMSE was not suitable for prediction. A comprehensive set of various predictors, including cognition, is recommended to support discharge planning.