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The NIH stroke scale can establish cognitive function after stroke


Cumming, Toby B., Blomstrand, Christian, Bernhardt, Julie, Linden, Thomas


Cerebrovascular Diseases (Basel, Switzerland), Volume: 30, No.: 1, Pages.: 7-14

Year of Publication



Background: Cognitive impairment is an important but underrecognised consequence of stroke. We investigated whether a subset of items from the NIH Stroke Scale (NIHSS) could yield valid information on cognitive status in a group of stroke patients.; Methods: 149 stroke patients from the Göteborg 70+ Stroke Study were investigated after 18 months. We extracted 4 items corresponding to the NIHSS items on orientation, executive function, language and inattention. Scores on this subset of 4 NIHSS items (Cog-4) and the Mini-Mental State Examination (MMSE) were evaluated against a reference diagnosis of severe cognitive impairment.; Results: The area under the receiver-operator curve (AUC) plotted for the Cog-4 scale against the diagnosis of severe cognitive impairment was 0.78; the MMSE had a slightly better diagnostic precision, with an AUC of 0.84. Making the executive task more difficult increased the precision of the Cog-4, raising the AUC to 0.81.; Conclusions: A composite score based on 4 NIHSS items is almost as good as the MMSE in detecting severe cognitive impairment. Ideally, dedicated measures of cognition should be employed as a matter of course after stroke, but in their absence, the Cog-4 subscale provides an indication of cognitive functioning.; Copyright 2010 S. Karger AG, Basel.

Bibtex Citation

@article{Cumming_2010, doi = {10.1159/000313438}, url = {}, year = 2010, publisher = {S. Karger {AG}}, volume = {30}, number = {1}, pages = {7--14}, author = {Toby B. Cumming and Christian Blomstrand and Julie Bernhardt and Thomas Linden}, title = {The {NIH} Stroke Scale Can Establish Cognitive Function after Stroke}, journal = {Cerebrovasc Dis} }


aged, area under curve, attention, cognition, cognition disorders, diagnosis, epidemiology, etiology, executive function, female, humans, language, male, mortality, national institutes of health us, orientation, predictive value of tests, psychiatric status rating scales, psychology, roc curve, severity of illness index, stroke, sweden, united states

Countries of Study


Types of Dementia

Dementia (general / unspecified), Mild Cognitive Impairment (MCI)

Types of Study

Cohort Study

Type of Interventions

Diagnostic Target Identification

Diagnostic Targets

Cognition testing (inc. task driven tests such as clock drawing)