J Neurol Res

Journal of Neurology Research, ISSN 1923-2845 print, 1923-2853 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Neurol Res and Elmer Press Inc

Journal website https://jnr.elmerpub.com

Original Article

Volume 15, Number 4, December 2025, pages 182-191

Prognostic Value of Stroke Severity Measured by National Institutes of Health Stroke Scale Score for Post-Stroke Neuropsychiatric Outcomes in a Hispanic Population

**Table 1.** Baseline Characteristics of the Study Population
Characteristic	Value
Continuous variables are presented as mean ± SD with median (range), and categorical variables as number and percentage (n%). Stroke types and etiologies are reported as n (%). Neuropsychiatric manifestations were assessed during follow-up, and patients could present more than one symptom. IQR: interquartile range; NIHSS: National Institutes of Health Stroke Scale; SD: standard deviation; n: number of patients; %: percentage.
Age in years (mean ± SD), median (range)	61.32 ± 14.62, 59.5 (25 - 89)
Male sex, n (%)	108 (63.5)
Type of stroke, n (%)
Ischemic	96 (56.5)
Hemorrhagic	74 (43.5)
Etiology of hemorrhagic stroke, n (%)
Hypertensive	44 (59.5)
Aneurysmal	15 (20.3)
Traumatic	9 (12.2)
Undetermined	4 (5.4)
Arteriovenous malformation	2 (2.7)
Etiology of ischemic stroke, n (%)
Cerebral arterial thrombosis	31 (32.3)
Atherosclerotic/stenotic	22 (22.9)
Hypertensive microangiopathy	17 (17.7)
Cardioembolic	16 (16.7)
Undetermined	10 (10.4)
Comorbidities, n (%)
Hypertension	127 (74.70)
Diabetes mellitus	117 (68.82)
Dyslipidemia	81 (47.64)
Chronic kidney disease	78 (45.88)
Alcohol abuse	40 (23.5)
Smoking	35 (20.6)
Cardiac disease	21 (12.35)
NIHSS at admission, median (IQR)	7 (4 - 13)
NIHSS classification, n (%)
No deficit	11 (6.5)
Mild	44 (25.9)
Moderate	83 (48.8)
Moderate-severe	14 (8.2)
Severe	18 (10.6)
Neuropsychiatric manifestations during follow-up, n (%)
Cognitive impairment	38/72 (52.8)
Sleep disturbances	38/72 (52.8)
Behavioral disorders	34/72 (47.2)
Depression	26/72 (36.1)
Anxiety	14/72 (19.4)
Psychotic disorders	8/72 (11.1)

Table 1. Baseline Characteristics of the Study Population

Characteristic

Value

Continuous variables are presented as mean ± SD with median (range), and categorical variables as number and percentage (n%). Stroke types and etiologies are reported as n (%). Neuropsychiatric manifestations were assessed during follow-up, and patients could present more than one symptom. IQR: interquartile range; NIHSS: National Institutes of Health Stroke Scale; SD: standard deviation; n: number of patients; %: percentage.

Age in years (mean ± SD), median (range)

61.32 ± 14.62, 59.5 (25 - 89)

Male sex, n (%)

108 (63.5)

Type of stroke, n (%)

Ischemic

96 (56.5)

Hemorrhagic

74 (43.5)

Etiology of hemorrhagic stroke, n (%)

Hypertensive

44 (59.5)

Aneurysmal

15 (20.3)

Traumatic

9 (12.2)

Undetermined

4 (5.4)

Arteriovenous malformation

2 (2.7)

Etiology of ischemic stroke, n (%)

Cerebral arterial thrombosis

31 (32.3)

Atherosclerotic/stenotic

22 (22.9)

Hypertensive microangiopathy

17 (17.7)

Cardioembolic

16 (16.7)

Undetermined

10 (10.4)

Comorbidities, n (%)

Hypertension

127 (74.70)

Diabetes mellitus

117 (68.82)

Dyslipidemia

81 (47.64)

Chronic kidney disease

78 (45.88)

Alcohol abuse

40 (23.5)

Smoking

35 (20.6)

Cardiac disease

21 (12.35)

NIHSS at admission, median (IQR)

7 (4 - 13)

NIHSS classification, n (%)

No deficit

11 (6.5)

Mild

44 (25.9)

Moderate

83 (48.8)

Moderate-severe

14 (8.2)

Severe

18 (10.6)

Neuropsychiatric manifestations during follow-up, n (%)

Cognitive impairment

38/72 (52.8)

Sleep disturbances

38/72 (52.8)

Behavioral disorders

34/72 (47.2)

Depression

26/72 (36.1)

Anxiety

14/72 (19.4)

Psychotic disorders

8/72 (11.1)

**Table 2.** Relationship Between the Degrees of Severity of the Cerebrovascular Event Using the NIHSS Scale and Neuropsychiatric Manifestations
Neuropsychiatric manifestation	NIHSS severity	Frequency	P-value^a
^aChi-square test. *Statistical significance. Chi-square test was used to assess associations between NIHSS severity categories and neuropsychiatric symptoms. When expected cell counts were less than 5, Fisher’s exact test was applied to ensure validity of the results. n: number of patients; NIHSS: National Institutes of Health Stroke Scale; %: percentage.
Depression	No deficit, n (%)	0 (0)	0.155
	Mild, n (%)	6 (23.08)
	Moderate, n (%)	12 (46.15)
	Moderate to severe, n (%)	2 (7.69)
	Severe, n (%)	6 (23.08)
Anxiety	No deficit, n (%)	2 (14.29)	0.065
	Mild, n (%)	2 (14.29)
	Moderate, n (%)	4 (28.57)
	Moderate to severe, n (%)	2 (14.29)
	Severe, n (%)	4 (28.57)
Psychotic disorders	No deficit, n (%)	0 (0)	0.577
	Mild, n (%)	2 (25)
	Moderate, n (%)	4 (50)
	Moderate to severe, n (%)	0 (0)
	Severe, n (%)	2 (25)
Sleep disturbances	No deficit, n (%)	0 (0)	0.024*
	Mild, n (%)	4 (10.53)
	Moderate, n (%)	24 (63.16)
	Moderate to severe, n (%)	4 (10.53)
	Severe, n (%)	6 (15.79)
Cognitive impairment	No deficit, n (%)	2 (5.26)	0.029*
	Mild, n (%)	6 (15.78)
	Moderate, n (%)	26 (68.42)
	Moderate to severe, n (%)	0 (0)
	Severe, n (%)	4 (10.52)
Behavioral disorders	No deficit, n (%)	0 (0)	0.003*
	Mild, n (%)	2 (5.88)
	Moderate, n (%)	26 (76.47)
	Moderate to severe, n (%)	2 (5.88)
	Severe, n (%)	4 (11.76)

Table 2. Relationship Between the Degrees of Severity of the Cerebrovascular Event Using the NIHSS Scale and Neuropsychiatric Manifestations

Neuropsychiatric manifestation

NIHSS severity

Frequency

P-value^a

^aChi-square test. *Statistical significance. Chi-square test was used to assess associations between NIHSS severity categories and neuropsychiatric symptoms. When expected cell counts were less than 5, Fisher’s exact test was applied to ensure validity of the results. n: number of patients; NIHSS: National Institutes of Health Stroke Scale; %: percentage.

Depression

No deficit, n (%)

0 (0)

0.155

Mild, n (%)

6 (23.08)

Moderate, n (%)

12 (46.15)

Moderate to severe, n (%)

2 (7.69)

Severe, n (%)

6 (23.08)

Anxiety

No deficit, n (%)

2 (14.29)

0.065

Mild, n (%)

2 (14.29)

Moderate, n (%)

4 (28.57)

Moderate to severe, n (%)

2 (14.29)

Severe, n (%)

4 (28.57)

Psychotic disorders

No deficit, n (%)

0 (0)

0.577

Mild, n (%)

2 (25)

Moderate, n (%)

4 (50)

Moderate to severe, n (%)

0 (0)

Severe, n (%)

2 (25)

Sleep disturbances

No deficit, n (%)

0 (0)

0.024*

Mild, n (%)

4 (10.53)

Moderate, n (%)

24 (63.16)

Moderate to severe, n (%)

4 (10.53)

Severe, n (%)

6 (15.79)

Cognitive impairment

No deficit, n (%)

2 (5.26)

0.029*

Mild, n (%)

6 (15.78)

Moderate, n (%)

26 (68.42)

Moderate to severe, n (%)

0 (0)

Severe, n (%)

4 (10.52)

Behavioral disorders

No deficit, n (%)

0 (0)

0.003*

Mild, n (%)

2 (5.88)

Moderate, n (%)

26 (76.47)

Moderate to severe, n (%)

2 (5.88)

Severe, n (%)

4 (11.76)

**Table 3.** Relationship Between the Severity of the Cerebrovascular Event Upon Admission and the Manifestation of Neuropsychiatric Disorders
Neuropsychiatric manifestation	Median (IQR)	U^a	Z^a	P-value^a
^aMann-Whitney U test. *Statistical significance. The control group includes patients who did not present specific neuropsychiatric symptoms. IQR: interquartile range; U: Mann-Whitney U test. Z: standardized test statistics.
Depression	12 (6 - 18)	7 (3.5 - 12)	2,437	2.451	0.014*
Anxiety	14 (3.75 - 20.5)	7 (4 - 12)	1,363	1.539	0.124
Psychotic disorders	10.5 (6 - 20)	7 (4 - 12)	789	1.040	0.299
Sleep disturbances	8 (5 - 15)	6 (3 - 11)	3,104	2.234	0.025*
Cognitive impairment	12 (7 - 15)	6 (3 - 10)	2,978	1.575	0.115
Behavioral disorders	12 (7 - 16)	6 (3 - 10)	3,098	3.068	0.002*

Table 3. Relationship Between the Severity of the Cerebrovascular Event Upon Admission and the Manifestation of Neuropsychiatric Disorders

Neuropsychiatric manifestation

Median (IQR)

U^a

Z^a

P-value^a

Affected group

Control group

^aMann-Whitney U test. *Statistical significance. The control group includes patients who did not present specific neuropsychiatric symptoms. IQR: interquartile range; U: Mann-Whitney U test. Z: standardized test statistics.

Depression

12 (6 - 18)

7 (3.5 - 12)

2,437

2.451

0.014*

Anxiety

14 (3.75 - 20.5)

7 (4 - 12)

1,363

1.539

0.124

Psychotic disorders

10.5 (6 - 20)

7 (4 - 12)

789

1.040

0.299

Sleep disturbances

8 (5 - 15)

6 (3 - 11)

3,104

2.234

0.025*

Cognitive impairment

12 (7 - 15)

6 (3 - 10)

2,978

1.575

0.115

Behavioral disorders

12 (7 - 16)

6 (3 - 10)

3,098

3.068

0.002*

**Table 4.** Association Between Clinical Variables and the Presence of Neuropsychiatric Manifestations in Patients With Cerebrovascular Events
Neuropsychiatric manifestation	Age, P-value (Exp(B))^a	Female sex, P-value (Exp(B))^a	Time to onset in days, P-value (Exp(B))^a	NIHSS score at admission, P-value (Exp(B))^a	Presence of ≥ 3 comorbidities, P-value (Exp(B))^a
^aBinary logistic regression. *Statistical significance. Exp(B): adjusted odds ratio; NIHSS: National Institutes of Health Stroke Scale.
Depression	0.046* (0.957)	< 0.001* (9.801)	0.581 (1.000)	0.010* (1.101)	0.607 (1.385)
Sleep disturbances	0.265 (1.022)	0.521 (0.699)	0.074 (1.002)	0.047* (1.072)	0.168 (2.068)
Cognitive impairment	0.593 (1.010)	0.211 (1.978)	0.037* (0.997)	0.602 (0.985)	0.596 (0.761)
Behavioral disorders	0.320 (0.980)	0.012* (0.227)	0.118 (1.001)	0.036* (1.071)	0.845 (0.903)

Table 4. Association Between Clinical Variables and the Presence of Neuropsychiatric Manifestations in Patients With Cerebrovascular Events

Neuropsychiatric manifestation

Age, P-value (Exp(B))^a

Female sex, P-value (Exp(B))^a

Time to onset in days, P-value (Exp(B))^a

NIHSS score at admission, P-value (Exp(B))^a

Presence of ≥ 3 comorbidities, P-value (Exp(B))^a

^aBinary logistic regression. *Statistical significance. Exp(B): adjusted odds ratio; NIHSS: National Institutes of Health Stroke Scale.

Depression

0.046* (0.957)

< 0.001* (9.801)

0.581 (1.000)

0.010* (1.101)

0.607 (1.385)

Sleep disturbances

0.265 (1.022)

0.521 (0.699)

0.074 (1.002)

0.047* (1.072)

0.168 (2.068)

Cognitive impairment

0.593 (1.010)

0.211 (1.978)

0.037* (0.997)

0.602 (0.985)

0.596 (0.761)

Behavioral disorders

0.320 (0.980)

0.012* (0.227)

0.118 (1.001)

0.036* (1.071)

0.845 (0.903)