Assessing the Predictive Validity of Simple Dementia Risk Models in Harmonized Stroke Cohorts

Abstract

Background and purpose: Stroke is associated with an increased risk of dementia. To assist in the early identification of individuals at high risk of future dementia, numerous prediction models have been developed for use in the general population. However, it is not known whether such models also provide accurate predictions among stroke patients. Therefore, the aim of this study was to determine whether existing dementia risk prediction models that were developed for use in the general population can also be applied to individuals with a history of stroke to predict poststroke dementia with equivalent predictive validity.

Methods: Data were harmonized from 4 stroke studies (follow-up range, ≈12-18 months poststroke) from Hong Kong, the United States, the Netherlands, and France. Regression analysis was used to test 3 risk prediction models: the Cardiovascular Risk Factors, Aging and Dementia score, the Australian National University Alzheimer Disease Risk Index, and the Brief Dementia Screening Indicator. Model performance or discrimination accuracy was assessed using the C statistic or area under the curve. Calibration was tested using the Grønnesby and Borgan and the goodness-of-fit tests.

Results: The predictive accuracy of the models varied but was generally low compared with the original development cohorts, with the Australian National University Alzheimer Disease Risk Index (C-statistic, 0.66) and the Brief Dementia Screening Indicator (C-statistic, 0.61) both performing better than the Cardiovascular Risk Factors, Aging and Dementia score (area under the curve, 0.53).

Conclusions: Dementia risk prediction models developed for the general population do not perform well in individuals with stroke. Their poor performance could have been due to the need for additional or different predictors related to stroke and vascular risk factors or methodological differences across studies (eg, length of follow-up, age distribution). Future work is needed to develop simple and cost-effective risk prediction models specific to poststroke dementia.

Keywords: aging; dementia; follow-up studies; risk factors; risk prediction.

Figure.

Performance of each model in the harmonized dataset. Red line is the mean of the original development cohort area under the curve or C statistic. ANU-ADRI indicates Australian National University Alzheimer Disease Risk Index; BDSI, Brief Dementia Screening Indicator; CAIDE, Cardiovascular Risk Factors, Aging and Dementia score; CHS, Cardiovascular Health Study; CVHS, Cardiovascular Health Cognition Study; FHS, Framingham Heart Study; HRS, Health and Retirement Study; KP, Kungsholmen Project; MAP, Rush Memory and Aging Project; and SALSA, Sacramento Area Latino Study on Aging.