Prediction of poor clinical outcome in vascular cognitive impairment: TRACE-VCI study

Abstract

Introduction: Prognostication in memory clinic patients with vascular brain injury (eg possible vascular cognitive impairment [VCI]) is often uncertain. We created a risk score to predict poor clinical outcome.

Methods: Using data from two longitudinal cohorts of memory clinic patients with vascular brain injury without advanced dementia, we created (n = 707) and validated (n = 235) the risk score. Poor clinical outcome was defined as substantial cognitive decline (change of Clinical Dementia Rating ≥1 or institutionalization) or major vascular events or death. Twenty-four candidate predictors were evaluated using Cox proportional hazard models.

Results: Age, clinical syndrome diagnosis, Disability Assessment for Dementia, Neuropsychiatric Inventory, and medial temporal lobe atrophy most strongly predicted poor outcome and constituted the risk score (C-statistic 0.71; validation cohort 0.78). Of note, none of the vascular predictors were retained in this model. The 2-year risk of poor outcome was 6.5% for the lowest (0-5) and 55.4% for the highest sum scores (10-13).

Discussion: This is the first, validated, prediction score for 2-year clinical outcome of patients with possible VCI.

Keywords: cognitive decline; death; major vascular event; memory clinic; poor clinical outcome; prediction score; prognosis; vascular cognitive impairment.

FIGURE 1

Flowchart of patients eligible for follow‐up and primary outcome measures. MMSE, Mini‐Mental State Examination; CDR, Clinical Dementia Rating

FIGURE 2

2a, TRACE‐VCI patients with poor clinical outcome (n = 170), first events. 2b, TRACE‐VCI patients with poor clinical outcome, total events (including first events + events after first event but within 2 years of follow‐up [n = 212]) in terms of cognitive decline, major cardiovascular event (MACE), death, and institutionalization due to other reasons (n = 212)

FIGURE 3

Summary of poor clinical outcome risk score