Cardiovascular

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

Shinya T, Yamauchi K, et al. • Cerebellum (London, England) • 2026

PubMed 42918963 DOI 10.1007/s12311-026-02103-1
TL;DR

The CCAS-Scale showed a statistically significant change and moderate responsiveness during acute hospitalization after cerebellar stroke, but the median score rose by only 1 point (71 to 72) and the SRM 95% CI was relatively wide, so the clinical significance of the change should be interpreted cautiously.

Key Findings

Results

CCAS-Scale total scores improved slightly but significantly from 7 days after onset to discharge in patients with acute cerebellar stroke.

  • Single-center prospective observational study of 21 patients with first-ever cerebellar stroke.
  • Assessments were done 7 days after onset and at discharge (median, 21 days).
  • Median CCAS-Scale score increased from 71 to 72 (p = 0.018), analyzed with the Wilcoxon signed-rank test.
Results

The number of failed CCAS-Scale items decreased significantly between the two assessments.

  • Median failed items decreased from 4 to 3 (p = 0.035).
  • Wilcoxon signed-rank test was used for the comparison.
Results

The proportion of patients with definite CCAS decreased, but every patient still had at least possible CCAS at discharge.

  • Definite CCAS decreased from 81.0% to 66.7%.
  • All patients had at least possible CCAS at discharge.
Results

The CCAS-Scale showed moderate responsiveness, with a relatively wide confidence interval.

  • Standardized response mean (SRM) was 0.52 (95% CI, 0.20-0.88).
  • The authors describe this as moderate responsiveness.
Results

Responsiveness of SARA and FIM was large, whereas MMSE responsiveness was small, compared with the moderate responsiveness of the CCAS-Scale.

  • Comparison measures were the Scale for the Assessment and Rating of Ataxia (SARA), Functional Independence Measure (FIM), and Mini-Mental State Examination (MMSE).
  • SARA and FIM showed large responsiveness; MMSE showed small responsiveness.
Results

Change in the CCAS-Scale correlated with change in FIM but not with change in SARA or MMSE.

  • CCAS-Scale change correlated with FIM change (rho = 0.44; p = 0.046) using Spearman's rank correlation.
  • No significant correlation was found with SARA change or MMSE change.
Conclusions

The clinical significance of the CCAS-Scale change should be interpreted cautiously.

  • The median score increased by only 1 point (71 to 72).
  • The 95% CI for the SRM was relatively wide (0.20-0.88).
  • The sample was small (n = 21) and from a single center.

What This Means

This study followed 21 people who had a first stroke affecting the cerebellum, a brain region involved in coordination and also in thinking and emotion. Researchers tested them about a week after the stroke and again at hospital discharge (around 3 weeks) using a scale designed to detect cerebellar cognitive affective syndrome (CCAS), along with tests of general cognition, balance and coordination, and daily living abilities. The CCAS scale scores improved slightly but significantly, with the median score rising from 71 to 72. The share of patients with definite CCAS fell from about 81% to 67%, yet everyone still had at least possible CCAS at discharge. The scale's sensitivity to change was moderate, less than for the coordination and daily-living measures. Changes in the CCAS scale tracked with changes in daily living ability but not with coordination or general cognition tests. This research suggests the CCAS scale can pick up change during early recovery, but the improvement was small and the study was small, so it is unclear how meaningful the change is in everyday life. Larger studies would be needed to confirm these findings.

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Citation

Shinya T, Yamauchi K, Tanaka S, Kanou K, Arakawa S. (2026). Longitudinal Changes and Responsiveness of the Cerebellar Cognitive Affective Syndrome Scale in Patients with Acute Cerebellar Stroke.. Cerebellum (London, England). https://doi.org/10.1007/s12311-026-02103-1