Skip to main content
Top
Published in: BMC Neurology 1/2015

Open Access 01-12-2015 | Research article

Validation of NINDS-CSN neuropsychological battery for vascular cognitive impairment in Chinese stroke patients

Authors: Xiangliang Chen, Adrian Wong, Ruidong Ye, Lulu Xiao, Zhaojun Wang, Ying Lin, Fang Yang, Hua Li, Ting Feng, Lihui Duan, Yunfei Han, Qiliang Dai, Juan Du, Gelin Xu, Vincent Mok, Yunyun Xiong, Xinfeng Liu

Published in: BMC Neurology | Issue 1/2015

Login to get access

Abstract

Background

The NINDS-Canadian Stroke Network (NINDS-CSN) recommended a neuropsychological battery of three protocols to diagnose vascular cognitive impairment (VCI), however, due to culture and language differences, the battery cannot be directly used in China. Validation of the battery in mandarin Chinese is lacking. Our study investigated the reliability and validity of the adapted Chinese versions of the battery in stroke patients with high probability of VCI.

Methods

Fifty mild stroke patients (median of National Institute of Health Stroke Scale [NIHSS] score, 2) and 50 stroke-free normal controls were recruited. All subjects’ demographics, clinical history, and stroke severity were recorded. The NINDS-CSN neuropsychological protocols were adapted into the Chinese versions. External validity, defined as the ability of the protocol summary scores to differentiate stroke patients from controls, was determined using the area under the curve (AUC) of the receiver operating characteristics curve. We also evaluated internal consistency and intra-rater reliability.

Results

Stroke patients performed significantly poorer than controls on all three protocols (F statistics between 24.9 and 31.4, P < 0.001). External validity evaluated by AUCs was 0.88 (95% confidence interval [CI], 0.81-0.95), 0.88 (95% CI, 0.81-0.94), and 0.86 (95% CI, 0.79-0.94) for the 60-min, 30-min and 5-min protocols, respectively. Cronbach’s alpha of the cognitive tests was 0.87 for all subjects. Intra-rater reliability was acceptable with intraclass correlation coefficients 0.90, 0.83 and 0.75 for the 60-min, 30-min and 5-min protocols, respectively.

Conclusions

The adapted Chinese versions of three NINDS-CSN neuropsychological protocols were valid and reliable for assessing VCI in Chinese patients with mild stroke.
Literature
1.
go back to reference Gorelick PB, Scuteri A, Black SE, Decarli C, Greenberg SM, Iadecola C, et al. Vascular contributions to cognitive impairment and dementia: a statement for healthcare professionals from the american heart association/american stroke association. Stroke. 2011;42:2672–713.CrossRefPubMedPubMedCentral Gorelick PB, Scuteri A, Black SE, Decarli C, Greenberg SM, Iadecola C, et al. Vascular contributions to cognitive impairment and dementia: a statement for healthcare professionals from the american heart association/american stroke association. Stroke. 2011;42:2672–713.CrossRefPubMedPubMedCentral
2.
go back to reference Jaillard A, Naegele B, Trabucco-Miguel S, LeBas JF, Hommel M. Hidden dysfunctioning in subacute stroke. Stroke. 2009;40:2473–9.CrossRefPubMed Jaillard A, Naegele B, Trabucco-Miguel S, LeBas JF, Hommel M. Hidden dysfunctioning in subacute stroke. Stroke. 2009;40:2473–9.CrossRefPubMed
3.
go back to reference Yu KH, Cho SJ, Oh MS, Jung S, Lee JH, Shin JH, et al. Cognitive impairment evaluated with vascular cognitive impairment harmonization standards in a multicenter prospective stroke cohort in Korea. Stroke. 2013;44:786–8.CrossRefPubMed Yu KH, Cho SJ, Oh MS, Jung S, Lee JH, Shin JH, et al. Cognitive impairment evaluated with vascular cognitive impairment harmonization standards in a multicenter prospective stroke cohort in Korea. Stroke. 2013;44:786–8.CrossRefPubMed
4.
go back to reference Baumann M, Le Bihan E, Chau K, Chau N. Associations between quality of life and socioeconomic factors, functional impairments and dissatisfaction with received information and home-care services among survivors living at home two years after stroke onset. BMC Neurol. 2014;14:92.CrossRefPubMedPubMedCentral Baumann M, Le Bihan E, Chau K, Chau N. Associations between quality of life and socioeconomic factors, functional impairments and dissatisfaction with received information and home-care services among survivors living at home two years after stroke onset. BMC Neurol. 2014;14:92.CrossRefPubMedPubMedCentral
5.
go back to reference Ayerbe L, Ayis S, Rudd AG, Heuschmann PU, Wolfe CDA. Natural history, predictors, and associations of depression 5 years after stroke: the south london stroke register. Stroke. 2011;42:1907–11.CrossRefPubMed Ayerbe L, Ayis S, Rudd AG, Heuschmann PU, Wolfe CDA. Natural history, predictors, and associations of depression 5 years after stroke: the south london stroke register. Stroke. 2011;42:1907–11.CrossRefPubMed
6.
go back to reference Oksala NKJ, Jokinen H, Melkas S, Oksala A, Pohjasvaara T, Hietanen M, et al. Cognitive impairment predicts poststroke death in long-term follow-up. J Neurol Neurosurg Psychiatry. 2009;80:1230–5.CrossRefPubMed Oksala NKJ, Jokinen H, Melkas S, Oksala A, Pohjasvaara T, Hietanen M, et al. Cognitive impairment predicts poststroke death in long-term follow-up. J Neurol Neurosurg Psychiatry. 2009;80:1230–5.CrossRefPubMed
7.
go back to reference Hachinski V, Iadecola C, Petersen RC, Breteler MM, Nyenhuis DL, Black SE, et al. National Institute of neurological disorders and stroke-Canadian stroke network vascular cognitive impairment harmonization standards. Stroke. 2006;37:2220–41.CrossRefPubMed Hachinski V, Iadecola C, Petersen RC, Breteler MM, Nyenhuis DL, Black SE, et al. National Institute of neurological disorders and stroke-Canadian stroke network vascular cognitive impairment harmonization standards. Stroke. 2006;37:2220–41.CrossRefPubMed
8.
go back to reference Wong A, Xiong YY, Wang D, Lin S, Chu WW, Kwan PW, et al. The NINDS-Canadian stroke network vascular cognitive impairment neuropsychology protocols in Chinese. J Neurol Neurosurg Psychiatry. 2013;84:499–504.CrossRefPubMed Wong A, Xiong YY, Wang D, Lin S, Chu WW, Kwan PW, et al. The NINDS-Canadian stroke network vascular cognitive impairment neuropsychology protocols in Chinese. J Neurol Neurosurg Psychiatry. 2013;84:499–504.CrossRefPubMed
9.
go back to reference Godefroy O, Leclercq C, Roussel M, Moroni C, Quaglino V, Beaunieux H, et al. French adaptation of the vascular cognitive impairment harmonization standards: the GRECOG-VASC study. Int J Stroke. 2012;7:362–3.CrossRefPubMed Godefroy O, Leclercq C, Roussel M, Moroni C, Quaglino V, Beaunieux H, et al. French adaptation of the vascular cognitive impairment harmonization standards: the GRECOG-VASC study. Int J Stroke. 2012;7:362–3.CrossRefPubMed
10.
go back to reference Chen C, Dong Y, Slavin M, Xu X, Anqi Q, Sachdev P, et al. The discriminant validity of the NINDS-CSN harmonization neurocognitive battery in detecting VCI in Singaporean patients with ischemic stroke and TIA. Toronto, Ontario: 6th International Society of Vascular, Cognitive and Behavioural Disorders Congress; 2013. Abstract 143. Chen C, Dong Y, Slavin M, Xu X, Anqi Q, Sachdev P, et al. The discriminant validity of the NINDS-CSN harmonization neurocognitive battery in detecting VCI in Singaporean patients with ischemic stroke and TIA. Toronto, Ontario: 6th International Society of Vascular, Cognitive and Behavioural Disorders Congress; 2013. Abstract 143.
11.
go back to reference Chan KY, Wang W, Wu JJ, Liu L, Theodoratou E, Car J, et al. Epidemiology of Alzheimer’s disease and other forms of dementia in China, 1990–2010: a systematic review and analysis. Lancet. 2013;381:2016–23.CrossRefPubMed Chan KY, Wang W, Wu JJ, Liu L, Theodoratou E, Car J, et al. Epidemiology of Alzheimer’s disease and other forms of dementia in China, 1990–2010: a systematic review and analysis. Lancet. 2013;381:2016–23.CrossRefPubMed
12.
go back to reference Kim AS, Johnston SC. Global variation in the relative burden of stroke and ischemic heart disease. Circulation. 2011;124:314–23.CrossRefPubMed Kim AS, Johnston SC. Global variation in the relative burden of stroke and ischemic heart disease. Circulation. 2011;124:314–23.CrossRefPubMed
13.
go back to reference Perneczky R, Wagenpfeil S, Komossa K, Grimmer T, Diehl J, Kurz A. Mapping scores onto stages: mini-mental state examination and clinical dementia rating. Am J Geriatr Psychiatry. 2006;14:139–44.CrossRefPubMed Perneczky R, Wagenpfeil S, Komossa K, Grimmer T, Diehl J, Kurz A. Mapping scores onto stages: mini-mental state examination and clinical dementia rating. Am J Geriatr Psychiatry. 2006;14:139–44.CrossRefPubMed
14.
go back to reference Kaufer DI, Cummings JL, Ketchel P, Smith V, MacMillan A, Shelley T, et al. Validation of the NPI-Q, a brief clinical form of the neuropsychiatric inventory. J Neuropsychiatry Clin Neurosci. 2000;12:233–9.CrossRefPubMed Kaufer DI, Cummings JL, Ketchel P, Smith V, MacMillan A, Shelley T, et al. Validation of the NPI-Q, a brief clinical form of the neuropsychiatric inventory. J Neuropsychiatry Clin Neurosci. 2000;12:233–9.CrossRefPubMed
15.
go back to reference Brink TL, Yesavage JA, Lum O, Heersema PH, Adey M, Rose TL. Screening tests for geriatric depression. Clin Gerontol. 1982;1:37–43.CrossRef Brink TL, Yesavage JA, Lum O, Heersema PH, Adey M, Rose TL. Screening tests for geriatric depression. Clin Gerontol. 1982;1:37–43.CrossRef
16.
go back to reference Isaacs B, Kennie AT. The set test as an aid to the detection of dementia in old people. Br J Psychiatry. 1973;123:467–70.CrossRefPubMed Isaacs B, Kennie AT. The set test as an aid to the detection of dementia in old people. Br J Psychiatry. 1973;123:467–70.CrossRefPubMed
17.
go back to reference Wechsler D. WAIS-III administration and scoring manual. New York: The Psychological Corporation; 1997. Wechsler D. WAIS-III administration and scoring manual. New York: The Psychological Corporation; 1997.
18.
go back to reference Reitan RM. Validity of the trail making test as an indicator of organic brain damage. Percept Mot Skills. 1958;8:271–6.CrossRef Reitan RM. Validity of the trail making test as an indicator of organic brain damage. Percept Mot Skills. 1958;8:271–6.CrossRef
19.
go back to reference Franzen MD, Haut MW, Rankin E, Keefover R. Empirical comparison of alternate forms of the Boston Naming Test. Clin Neuropsychol. 1995;9:225–9.CrossRef Franzen MD, Haut MW, Rankin E, Keefover R. Empirical comparison of alternate forms of the Boston Naming Test. Clin Neuropsychol. 1995;9:225–9.CrossRef
20.
go back to reference Osterrieth PA. Le test de copie d’une figure complexe. Arch de Psychol. 1944;30:206–356. Osterrieth PA. Le test de copie d’une figure complexe. Arch de Psychol. 1944;30:206–356.
21.
go back to reference Benedict RHB, Schretlen D, Groninger L, Brandt J. Hopkins verbal learning test-revised: normative data and analysis of inter-form and test-retest reliability. Clin Neuropsychol. 1998;12:43–55.CrossRef Benedict RHB, Schretlen D, Groninger L, Brandt J. Hopkins verbal learning test-revised: normative data and analysis of inter-form and test-retest reliability. Clin Neuropsychol. 1998;12:43–55.CrossRef
22.
go back to reference Katzman R, Zhang MY, Ouang YQ, Wang ZY, Liu WT, Yu E, et al. A Chinese version of the Mini-Mental State Examination; Impact of illiteracy in a Shanghai dementia survey. J Clin Epidemiol. 1988;41:971–8.CrossRefPubMed Katzman R, Zhang MY, Ouang YQ, Wang ZY, Liu WT, Yu E, et al. A Chinese version of the Mini-Mental State Examination; Impact of illiteracy in a Shanghai dementia survey. J Clin Epidemiol. 1988;41:971–8.CrossRefPubMed
23.
go back to reference Cui GH, Yao YH, Xu RF, Tang HD, Jiang GX, Wang Y, et al. Cognitive impairment using education-based cutoff points for CMMSE scores in elderly Chinese people of agricultural and rural Shanghai China. Acta Neurol Scand. 2011;124:361–7.CrossRefPubMed Cui GH, Yao YH, Xu RF, Tang HD, Jiang GX, Wang Y, et al. Cognitive impairment using education-based cutoff points for CMMSE scores in elderly Chinese people of agricultural and rural Shanghai China. Acta Neurol Scand. 2011;124:361–7.CrossRefPubMed
24.
go back to reference Lu J, Li D, Li F, Zhou A, Wang F, Zuo X, et al. Montreal cognitive assessment in detecting cognitive impairment in Chinese elderly individuals: a population-based study. J Geriatr Psychiatry Neurol. 2011;24:184–90.CrossRefPubMed Lu J, Li D, Li F, Zhou A, Wang F, Zuo X, et al. Montreal cognitive assessment in detecting cognitive impairment in Chinese elderly individuals: a population-based study. J Geriatr Psychiatry Neurol. 2011;24:184–90.CrossRefPubMed
25.
go back to reference Cohen J. Statistical power analysis for the behavioral sciences. 2nd ed. Hillsdale, NJ: Lawence Erlbaum; 1988. Cohen J. Statistical power analysis for the behavioral sciences. 2nd ed. Hillsdale, NJ: Lawence Erlbaum; 1988.
26.
go back to reference Zweig MH, Campbell G. Receiveroperating characteristic (ROC) plots: a fundamental evaluation tool in clinical medicine. Clin Chem. 1993;39:561–77.PubMed Zweig MH, Campbell G. Receiveroperating characteristic (ROC) plots: a fundamental evaluation tool in clinical medicine. Clin Chem. 1993;39:561–77.PubMed
27.
go back to reference Carletta J. Assessing agreement on classification tasks: the Kappa statistic. Comput Ling. 1996;22:249–54. Carletta J. Assessing agreement on classification tasks: the Kappa statistic. Comput Ling. 1996;22:249–54.
28.
go back to reference Shrout PE, Fleiss JL. Intraclass correlations: uses in assessing rater reliability. Psychol Bull. 1979;86:420–8.CrossRefPubMed Shrout PE, Fleiss JL. Intraclass correlations: uses in assessing rater reliability. Psychol Bull. 1979;86:420–8.CrossRefPubMed
29.
go back to reference Bravo G, Potvin L. Estimating the reliability of continuous measures with Cronbach’s alpha or the intraclass correlation coefficient: toward the integration of two traditions. J Clin Epidemiol. 1991;44:381–90.CrossRefPubMed Bravo G, Potvin L. Estimating the reliability of continuous measures with Cronbach’s alpha or the intraclass correlation coefficient: toward the integration of two traditions. J Clin Epidemiol. 1991;44:381–90.CrossRefPubMed
30.
go back to reference Jia J, Wang F, Wei C, Zhou A, Jia X, Li F, et al. The prevalence of dementia in urban and rural areas of China. Alzheimers Dement. 2013;10:1–9.CrossRefPubMed Jia J, Wang F, Wei C, Zhou A, Jia X, Li F, et al. The prevalence of dementia in urban and rural areas of China. Alzheimers Dement. 2013;10:1–9.CrossRefPubMed
31.
go back to reference Savva GM, Stephan BC, Alzheimer’s Society Vascular Dementia Systematic Review G. Epidemiological studies of the effect of stroke on incident dementia: a systematic review. Stroke. 2010;41:e41–46.CrossRefPubMed Savva GM, Stephan BC, Alzheimer’s Society Vascular Dementia Systematic Review G. Epidemiological studies of the effect of stroke on incident dementia: a systematic review. Stroke. 2010;41:e41–46.CrossRefPubMed
32.
go back to reference Tombaugh TN, McIntyre NJ. The mini-mental state examination: a comprehensive review. J Am Geriatr Soc. 1992;40:922–35.CrossRefPubMed Tombaugh TN, McIntyre NJ. The mini-mental state examination: a comprehensive review. J Am Geriatr Soc. 1992;40:922–35.CrossRefPubMed
33.
go back to reference Pendlebury ST, Mariz J, Bull L, Mehta Z, Rothwell PM. MoCA, ACE-R, and MMSE versus the National Institute of neurological disorders and stroke-Canadian stroke network vascular cognitive impairment harmonization standards neuropsychological battery after TIA and stroke. Stroke. 2012;43:464–9.CrossRefPubMed Pendlebury ST, Mariz J, Bull L, Mehta Z, Rothwell PM. MoCA, ACE-R, and MMSE versus the National Institute of neurological disorders and stroke-Canadian stroke network vascular cognitive impairment harmonization standards neuropsychological battery after TIA and stroke. Stroke. 2012;43:464–9.CrossRefPubMed
34.
go back to reference Schmidt FL, Hunter JE, Urry VW. Statistical power in criterion-related validation studies. J Appl Psychol. 1976;61:473–85.CrossRef Schmidt FL, Hunter JE, Urry VW. Statistical power in criterion-related validation studies. J Appl Psychol. 1976;61:473–85.CrossRef
Metadata
Title
Validation of NINDS-CSN neuropsychological battery for vascular cognitive impairment in Chinese stroke patients
Authors
Xiangliang Chen
Adrian Wong
Ruidong Ye
Lulu Xiao
Zhaojun Wang
Ying Lin
Fang Yang
Hua Li
Ting Feng
Lihui Duan
Yunfei Han
Qiliang Dai
Juan Du
Gelin Xu
Vincent Mok
Yunyun Xiong
Xinfeng Liu
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Neurology / Issue 1/2015
Electronic ISSN: 1471-2377
DOI
https://doi.org/10.1186/s12883-015-0270-z

Other articles of this Issue 1/2015

BMC Neurology 1/2015 Go to the issue