Research Paper Volume 13, Issue 17 pp 21628—21641

Development and validation of a clinical model (DREAM-LDL) for post-stroke cognitive impairment at 6 months

Yi Dong1, , Mengyuan Ding1, , Mei Cui1, , Min Fang2, , Li Gong2, , Zhuojun Xu3, , Yue Zhang3, , Xiuzhe Wang4, , Xiaofeng Xu4, , Xueyuan Liu2, , Gang Li3, , Yuwu Zhao4, , Qiang Dong1, ,

  • 1 Department of Neurology, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Fudan University, Shanghai, China
  • 2 Department of Neurology, The Tenth People’s Hospital Affiliated to Tongji University, Shanghai, China
  • 3 Department of Neurology, The East Hospital Affiliated to Tongji University, Shanghai, China
  • 4 Department of Neurology, The Six People’s Hospital Affiliated to Shanghai Jiao Tong University, Shanghai, China

Received: March 23, 2021       Accepted: August 17, 2021       Published: September 10, 2021
How to Cite

Copyright: © 2021 Dong et al. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY 3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


Introduction: This multicenter, retrospective study assessed the prevalence of post-stroke cognitive impairment (PSCI) 6 months after acute ischemic stroke (AIS) and its risk factors to build a bedside early predictive model for PSCI using the Montreal Cognitive Assessment (MoCA).

Methods: Records of consecutive patients with AIS treated at 4 stroke centers in Shanghai had MoCA assessments within 2 weeks after AIS onset and 6 months later were reviewed. Prevalence of PSCI (MoCA<22) was calculated and risk factors were identified by multivariate logistic regression analysis. The modeling and validation and identified risk factors were included in a predictive model using multivariate regression.

Results: There were 383 patients included and prevalence of PSCI 6 months after AIS was 34.2%, significantly lower than prevalence of patients with acute cognitive impairment (49.6%). Aging, less education, higher glucose level and severe stroke were PSCI risk factors, while level of low-density lipoprotein cholesterol (LDL-C) had a paradox effect on the risk of PSCI. 40.0% of the patients with cognitive impairment at acute phase reverted to normal, and patients with LDL-C 1.8-2.5 mmol/L were more likely to revert. The predictive model we built, DREAM-LDL (Diabetes [fasting blood glucose level], Rating [NIHSS], level of Education, Age, baseline MoCA and LDL-C level), had an AUROC of 0.93 for predicting PSCI at 6 months.

Conclusion: PSCI was common among AIS patients 6 months after AIS. We provided a practical tool to predict PSCI based on MoCA and risk factors present during acute phase of AIS.


AIS: acute ischemic stroke; LDLC: low-density lipoprotein cholesterol; PSCI: Post-stroke cognitive impairment; IRB: Institutional Review Board; MoCA: Montreal Cognitive Assessment; NIHSS: National Institutes of Health Stroke Scale; OCSP: Oxfordshire Community Stroke Project; CI: confidential interval; DREAM-LDL: Diabetes [fasting blood glucose level], Rating [NIHSS], level of Education, Age, baseline MoCA and LDL-C level; IQR: interquartile range; ASCVD: atherosclerotic cardiovascular disease; FBG: fasting blood glucose level; OR: odd ratio; SD: standard deviation.