Top

Published in:

Open Access 01-02-2016 | Original Communication

Domain-specific versus generalized cognitive screening in acute stroke

Authors: Nele Demeyere, M. J. Riddoch, E. D. Slavkova, K. Jones, I. Reckless, P. Mathieson, G. W. Humphreys

Published in: Journal of Neurology | Issue 2/2016

Abstract

Cognitive assessments after stroke are typically short form tests developed for dementia that generates pass/fail classifications (e.g. the MoCA). The Oxford Cognitive Screen (OCS) provides a domain-specific cognitive profile designed for stroke survivors. This study compared the use of the MoCA and the OCS in acute stroke with respect to symptom specificity and aspects of clinical utility. A cross-sectional study with a consecutive sample of 200 stroke patients within 3 weeks of stroke completing MoCA and OCS. Demographic data, lesion side and Barthel scores were recorded. Inclusivity was assessed in terms of completion rates and reasons for non-completion were evaluated. The incidence of cognitive impairments on both the MoCA and OCS sub-domains was calculated and differences in stroke specificity, cognitive profiles and independence of the measures were addressed. The incidence of acute cognitive impairment was high: 76 % of patients were impaired on MoCA, and 86 % demonstrated at least one impairment on the cognitive domains assessed in the OCS. OCS was more sensitive than MoCA overall (87 vs 78 % sensitivity) and OCS alone provided domain-specific information on prevalent post-stroke cognitive impairments (neglect, apraxia and reading/writing ability). Unlike the MOCA, the OCS was not dominated by left hemisphere impairments but gave differentiated profiles across the contrasting domains. The OCS detects important cognitive deficits after stroke not assessed in the MoCA, it is inclusive for patients with aphasia and neglect and it is less confounded by co-occurring difficulties in these domains.

Note that there is a long known link between aphasia and apraxia [26]; our findings concur with previous findings that most patients who demonstrate praxis problems will also have a dysphasia, though not necessarily the other way around.

We note that a ‘standard of truth’ does not exist for assessments of cognition. Here, we simply assess the sensitivity of the OCS relative to a current gold standard of clinical practice, the MOCA.

Although MoCA sentence repetition does not have task-specific cut offs, we defined failing the task if the participant made errors on at least one of the two sentence repetitions.

Fluency tasks are often used as part of assessment of organisational strategy within executive functioning (e.g. in DKEFS [29] see also the Addenbrooke’s Cognitive Examination [30].

Jaillard A, Naegele B, Trabucco-Miguel S et al (2009) Hidden dysfunctioning in subacute stroke. Stroke 40:2473–2479. doi:10.1161/strokeaha.108.541144 CrossRefPubMed

De Haan EH, Nys GM, Van Zandvoort MJ (2006) Cognitive function following stroke and vascular cognitive impairment. Curr Opin Neurol 19:559–564. doi:10.1097/01.wco.0000247612.21235.d9 CrossRefPubMed

Fure B, Wyller TB, Engedal K, Thommessen B (2006) Cognitive impairments in acute lacunar stroke. Acta Neurol Scand 114:17–22. doi:10.1111/j.1600-0404.2006.00603.x CrossRefPubMed

Van Zandvoort MJE, Kessels RPC, Nys GMS et al (2005) Early neuropsychological evaluation in patients with ischaemic stroke provides valid information. Clin Neurol Neurosurg 107:385–392. doi:10.1016/j.clineuro.2004.10.012 CrossRefPubMed

Barker-Collo S, Feigin V (2006) The impact of neuropsychological deficits on functional stroke outcomes. Neuropsychol Rev 16:53–64. doi:10.1007/s11065-006-9007-5 CrossRefPubMed

Edwards DF, Hahn MG, Baum CM et al (2006) Screening patients with stroke for rehabilitation needs: validation of the post-stroke rehabilitation guidelines. Neurorehabilitation Neural Repair 20:42–48. doi:10.1177/1545968305283038 CrossRefPubMed

Narasimhalu K, Ang S, De Silva DA et al (2009) Severity of CIND and MCI predict incidence of dementia in an ischemic stroke cohort. Neurology 73:1866–1872. doi:10.1212/WNL.0b013e3181c3fcb7 CrossRefPubMedPubMedCentral

Nys GMS, van Zandvoort MJE, van der Worp HB et al (2006) Early cognitive impairment predicts long-term depressive symptoms and quality of life after stroke. J Neurol Sci 247:149–156. doi:10.1016/j.jns.2006.04.005 CrossRefPubMed

Van Zandvoort ME, Nys GMS, de Haan EHF et al (2005) Early neuropsychological examination predicts cognitive, and functional outcome in stroke patients with discharge destination home. J Neurol Sci 229:325–325

10.

Stephens S, Kenny RA, Rowan E et al (2005) Association between mild vascular cognitive impairment and impaired activities of daily living in older stroke survivors without dementia. J Am Geriatr Soc 53:103–107. doi:10.1111/j.1532-5415.2005.53019.x CrossRefPubMed

11.

Bickerton WL, Samson D, Williamson J, Humphreys GW (2011) Separating forms of neglect using the apples test: validation and functional prediction in chronic and acute stroke. Neuropsychology 25:567–580. doi:10.1037/a0023501 CrossRefPubMed

12.

Bickerton W-L, Riddoch MJ, Samson D et al (2012) Systematic assessment of apraxia and functional predictions from the Birmingham cognitive screen. J Neurol Neurosurg Psychiatry 83:513–521. doi:10.1136/jnnp-2011-300968 CrossRefPubMed

13.

Moon YS, Kim SJ, Kim HC et al (2004) Correlates of quality of life after stroke. J Neurol Sci 224:37–41. doi:10.1016/j.jins.2004.05.018 CrossRefPubMed

14.

Nichols-Larsen DS, Clark PC, Zeringue A et al (2005) Factors influencing stroke survivors’ quality of life during subacute recovery. Stroke 36:1480–1484. doi:10.1161/01.STR.0000170706.13595.4f CrossRefPubMed

15.

Paul SL, Sturm JW, Dewey HM et al (2005) Long-term outcome in the north east Melbourne stroke incidence study—predictors of quality of life at 5 years after stroke. Stroke 36:2082–2086. doi:10.1161/01.str.0000183621.32045.31 CrossRefPubMed

16.

Nasreddine ZS, Phillips NA, Bedirian V et al (2005) The montreal cognitive assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc 53:695–699. doi:10.1111/j.1532-5415.2005.53221.x CrossRefPubMed

17.

Nasreddine ZS, Phillips N, Chertkow H (2012) Normative data for the Montreal cognitive assessment (MoCA) in a population-based sample. Neurology 78:765–766CrossRefPubMed

18.

Blackburn DJ, Bafadhel L, Randall M, Harkness KA (2013) Cognitive screening in the acute stroke setting. Age Ageing 42:113–116. doi:10.1093/ageing/afs116 CrossRefPubMed

19.

Pendlebury ST, Cuthbertson FC, Welch SJV et al (2010) Underestimation of cognitive impairment by mini-mental state examination versus the Montreal cognitive assessment in patients with transient ischemic attack and stroke a population-based study. Stroke 41:1290–1293. doi:10.1161/strokeaha.110.579888 CrossRefPubMed

20.

Cumming TB, Bernhardt J, Linden T (2011) The Montreal cognitive assessment short cognitive evaluation in a large stroke trial. Stroke 42:2642–2644. doi:10.1161/strokeaha.111.619486 CrossRefPubMed

21.

Cumming TB, Churilov L, Linden T et al (2013) Montreal cognitive assessment and mini-mental state examination are both valid cognitive tools in stroke. Acta Neurol Scand 128:122–129

22.

Van Heugten CM, Walton L, Hentschel U (2014) Can we forget the mini-mental state examination? A systematic review of the validity of cognitive screening instruments within one month after stroke. Clin Rehabil. doi:10.1177/0269215514553012

23.

Chan E, Khan S, Oliver R et al (2014) Underestimation of cognitive impairments by the Montreal cognitive assessment (MoCA) in an acute stroke unit population. J Neurol Sci 343:176–179. doi:10.1016/j.jns.2014.05.005 CrossRefPubMed

24.

Lees R, Selvarajah J, Fenton C et al (2014) Test accuracy of cognitive screening tests for diagnosis of dementia and multidomain cognitive impairment in stroke. Stroke J Cereb Circ 45:3008–3018. doi:10.1161/STROKEAHA.114.005842 CrossRef

25.

Demeyere N, Riddoch MJ, Slavkova ED et al (2015) The Oxford cognitive screen (OCS): validation of a stroke-specific short cognitive screening tool. Psychol Assess 27(3):883–894. doi:10.1037/pas0000082 CrossRefPubMed

26.

Bickerton W-L, Demeyere N, Francis D et al (2014) The BCoS cognitive profile screen: utility and predictive value for stroke. Neuropsychology 29(4):638–648. doi:10.1037/neu0000160 CrossRefPubMed

27.

Caplan D, Waters GS (1999) Verbal working memory and sentence comprehension. Behav Brain Sci 22(1):77–94PubMed

28.

Daneman M (1991) Working memory as a predictor of verbal fluency. J Psycholinguist Res 20:445–464. doi:10.1007/bf01067637 CrossRef

29.

Frith CD, Friston KJ, Liddle PF, Frackowiak RSJ (1991) A PET study of word finding. Neuropsychologia 29:1137–1148. doi:10.1016/0028-3932(91)90029-8 CrossRefPubMed

30.

Bickerton W-L, Samson D, Humphreys GW (2011) Separating forms of neglect using the apples test: validation and functional prediction in chronic and acute stroke. Neuropsychology 25(5):567–580. doi:10.1037/a0023501 CrossRefPubMed

31.

National Institute for Health and Clinical Excellence (2013) Stroke rehabilitation: Long-term rehabilitation after stroke. NICE guideline (CG162)

Title: Domain-specific versus generalized cognitive screening in acute stroke
Authors: Nele Demeyere
M. J. Riddoch
E. D. Slavkova
K. Jones
I. Reckless
P. Mathieson
G. W. Humphreys
Publication date: 01-02-2016
Publisher: Springer Berlin Heidelberg
Published in: Journal of Neurology / Issue 2/2016
Print ISSN: 0340-5354
Electronic ISSN: 1432-1459
DOI: https://doi.org/10.1007/s00415-015-7964-4

ACC 2024 Congress

Springer Medicine

Domain-specific versus generalized cognitive screening in acute stroke

Abstract

ACC 2024 Congress

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 2/2016

Isolated new onset ‘atypical’ optic neuritis in the NMO clinic: serum antibodies, prognoses and diagnoses at follow-up

The full spectrum of ethical issues in the care of patients with ALS: a systematic qualitative review

Deep brain stimulation of the internal pallidum in Huntington’s disease patients: clinical outcome and neuronal firing patterns

NEFL N98S mutation: another cause of dominant intermediate Charcot–Marie–Tooth disease with heterogeneous early-onset phenotype

Prognostic value of trans-thoracic echocardiography in patients with acute stroke and atrial fibrillation: findings from the RAF study

Vestibular-evoked myogenic potentials in central vestibular disorders