Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Jun 26;7(1):e001107.
doi: 10.1136/bmjno-2025-001107. eCollection 2025.

Measuring neurological severity and complexity in acute setting: the modified Neurological Impairment Scale

Alessandro Padovani  1   2   3   4 , Irene Mattioli  1   2 , Tiziana Comunale  1 , Nicola Zoppi  1   5 , Cinzia Zatti  1   2   6 , Enis Guso  1 , Marcello Catania  1 , Andrea Morotti  1   2 , Chiara Agosti  2 , Stefano Gipponi  2   7 , Lynne Turner-Stokes  8   9 , Andrea Pilotto  1   2   3   6   10 ; Brescia School of Neurology Working Group
Collaborators, Affiliations

Measuring neurological severity and complexity in acute setting: the modified Neurological Impairment Scale

Alessandro Padovani et al. BMJ Neurol Open. .

Abstract

Background: Given the increasing diversity among neurological patients, standardised protocols are essential for evaluating the severity and complexity of the variety of conditions. The aim of the present work was to standardise the assessment of the severity and complexity of neurological impairment in an acute setting by using a modified version of the Neurological Impairment Scale (mNIS).

Methods: Consecutively hospitalised neurological inpatients underwent a multidimensional standardised assessment of multimorbidity, frailty, functional dependency and neurological impairment using mNIS and other validated scales. Inter-rater reliability of the mNIS total and subscores was evaluated. Construct validity was assessed separately in patients with cerebrovascular disease, performing correlations between corresponding subscores of mNIS, original NIS and National Institutes of Health Stroke Scale. mNIS Complexity Index (mNIS-CI) for neurological severity was used to classify patients into subtle, mild, moderate and severe impairment.

Results: 1081 neurological patients admitted to a neurological ward from the emergency setting were enrolled. The inter-rater reliability was remarkable for mNIS total and subscores (intraclass correlation coefficient 0.90, 95% CI 0.82 to 0.95). The mNIS showed strong construct validity for total and subscores compared with other clinical scales (r 0.47-0.97, p<0.001) and 52.7% of patients scored at least one in one of the four newly listed items. The stratification of patients according to mNIS-CI exhibited high construct validity, distinguishing the extent of impairment and involved domains.

Conclusions: The mNIS is valuable for measuring neurological severity and complexity in acute inpatients and holds significant potential for application in different settings.

Keywords: CEREBROVASCULAR DISEASE; CLINICAL NEUROLOGY.

PubMed Disclaimer

Conflict of interest statement

APa received personal compensation as a consultant/scientific advisory board member for Biogen, Lundbeck, Roche, Nutricia, General Healthcare (GE). APa has been supported by grants of the Italian Ministry of University and Research PRIN COCOON (2017MYJ5TH) and PRIN 2021 RePlast (20202THZAW), the H2020 IMI IDEA-FAST (ID853981), Italian Ministry of Health, Grant/Award Number: RF-2018-12366209, RF-2019-12369272 and PNRR-Health PNRR-MAD-2022-12376110. IM, TC, NZ, CZ, MC, EG, SG, BSNWG, AM, CA report no competing interests. LT-S is director of the UK Rehabilitation Outcomes Collaborative (UKROC) and was the lead developer of the UKROC tools including the Neurological Impairment Scale. However, neither she nor her employing institution has any financial interest in the tools which are disseminated free of charge. APi received consultancy/speaker fees from AbbVie, Angelini, Bial, Lundbeck, Roche and Zambon pharmaceuticals and the Movement Disorder Society. APi has been supported by grants of Airalzh Foundation AGYR2021 Life-Bio Grant, The LIMPE-DISMOV Foundation Segala Grant 2021, the Italian Ministry of University and Research PRIN COCOON (2017MYJ5TH) and PRIN 2021 RePlast (20202THZAW), the H2020 IMI IDEA-FAST (ID853981), Italian Ministry of Health, Grant/Award Number: RF-2018-12366209 and PNRR-Health PNRR-MAD-2022-12376110.

Figures

Figure 1
Figure 1. Distribution of neurological severity within neurological disorders. CNS, central nervous system; FND, functional neurological disorders; ICH, intracerebral haemorrhage; MUS, medically unexplained symptoms; NDD, neurodegenerative disorders.
Figure 2
Figure 2. mNIS Complexity Index (mNIS-CI) distribution according to severity classification and within different neurological diagnosis. CNS, central nervous system; FND, functional neurological disorders; ICH, intracerebral haemorrhage; MUS, medically unexplained symptoms; NDD, neurodegenerative disorders.
See this image and copyright information in PMC

References

    1. Iacono LA, Wells C, Mann-Finnerty K. Standardizing neurological assessments. J Neurosci Nurs. 2014;46:125–32. doi: 10.1097/JNN.0000000000000035. - DOI - PubMed
    1. Schmidt WU, Lutz M, Ploner CJ, et al. The diagnostic value of the neurological examination in coma of unknown etiology. J Neurol. 2021;268:3826–34. doi: 10.1007/s00415-021-10527-4. - DOI - PMC - PubMed
    1. Nicholl DJ, Appleton JP. Clinical neurology: why this still matters in the 21st century. J Neurol Neurosurg Psychiatry . 2015;86:229–33. doi: 10.1136/jnnp-2013-306881. - DOI - PMC - PubMed
    1. Zasler ND. Validity assessment and the neurological physical examination. NeuroRehabilitation. 2015;36:401–13. doi: 10.3233/NRE-151229. - DOI - PubMed
    1. Lansky AJ, Messé SR, Brickman AM, et al. Proposed Standardized Neurological Endpoints for Cardiovascular Clinical Trials: An Academic Research Consortium Initiative. Eur Heart J. 2018;39:1687–97. doi: 10.1093/eurheartj/ehx037. - DOI - PMC - PubMed

LinkOut - more resources