Characteristics of Cerebellar Cognitive Affective Syndrome (CCAS) in patients with acute cerebellar stroke and its impact on outcome

Abstract

AbstractBackgroundRecently, cerebellar cognitive affective syndrome-scale (CCAS-S) was developed to assess CCAS—a syndrome in which cognitive impairment is caused by cerebellar lesions. Literature regarding CCAS in patients with stroke is scarce, and its impact on outcomes is unclear. This study aimed to evaluate CCAS in patients with acute cerebellar stroke and examine its relationship with the outcomes.MethodsPatients who experienced acute cerebellar stroke for the first time and were hospitalized in Steel Memorial Yawata Hospital within 7 days of stroke onset between April 2021 and April 2023 were included in this observational study. CCAS-S, Mini-Mental State Examination (MMSE), and Scale for the Assessment and Rating of Ataxia (SARA) scores were measured 1 week after stroke onset, and Functional Independence measure (FIM)/Barthel Index (BI) at discharge, physical function, activities of daily life (ADL), length of hospital stay, and outcome (discharge destination) were evaluated. The Mann–Whitney U test was used to compare CCAS-S scores and variables.ResultsThirteen consecutive patients with acute cerebellar stroke (9 women) and age-and sex-matched healthy controls (7 women) were included. The MMSE score was within the normal range in all patients; however, patients with stroke had a lower total CCAS-S score (median 72, interquartile range [IQR] 66–80) and a higher number of failed tests (median 4, IQR 3–5) than those of healthy controls. Significant deficits were observed in semantic fluency (p=0.008), category switching (p=0001), and similarity (p=009). Possible, probable, and definite CCAS were diagnosed in 2, 1, and 10 patients, respectively. Patients discharged home showed better SARA and FIM/BI scores but similar CCAS-S scores compared to those discharged to rehabilitation hospitals.ConclusionCCAS along with impaired executive and language functions is frequently observed in patients with acute cerebellar stroke; however, impaired motor function, and not CCAS, influences the outcome.