Longitudinal Changes and Responsiveness of the Cerebellar Cognitive Affective Syndrome Scale in Patients with Acute Cerebellar Stroke.

Cognitive and affective disturbances due to cerebellar lesions are termed cerebellar cognitive affective syndrome (CCAS). Although CCAS is frequent after acute cerebellar stroke, CCAS-Scale responsiveness during acute hospitalization remains unclear. Objective: To examine longitudinal changes and responsiveness of the CCAS-Scale and compare its changes with global cognitive function, ataxia, and activities of daily living (ADL). In this single-center prospective observational study, 21 patients with first-ever cerebellar stroke were assessed 7 days after onset and at discharge (median, 21 days) using the CCAS-Scale, Mini-Mental State Examination (MMSE), Scale for the Assessment and Rating of Ataxia (SARA), and Functional Independence Measure (FIM). Changes were analyzed using the Wilcoxon signed-rank test, standardized response mean (SRM), and Spearman's rank correlation. Median CCAS-Scale score increased from 71 to 72 (p = 0.018), and failed items decreased from 4 to 3 (p = 0.035). Definite CCAS decreased from 81.0% to 66.7%, and all patients had at least possible CCAS at discharge. The SRM was 0.52 (95% CI, 0.20-0.88), indicating moderate responsiveness, whereas SARA and FIM showed large and MMSE small responsiveness. CCAS-Scale change correlated with FIM change (rho = 0.44; p = 0.046) but not with SARA or MMSE. The CCAS-Scale showed a statistically significant change and moderate responsiveness. However, the median score increased by only 1 point (71 to 72), and the 95% CI for the SRM was relatively wide, suggesting that the clinical significance of this change should be interpreted cautiously.