Screening for cognitive deficits after stroke: A comparison of three screening tools

Department of Geriatric Medicine, Ullevaal University Hospital, Oslo, Norway.
Clinical Rehabilitation (Impact Factor: 2.24). 01/2009; 22(12):1095-104. DOI: 10.1177/0269215508094711
Source: PubMed


To assess the concurrent validity of three screening tests for focal cognitive impairments after stroke.
Comparison of results from the screening tests with those from a more comprehensive neuropsychological battery.
Stroke rehabilitation wards of a general hospital and a rehabilitation hospital.
Forty-nine stroke patients (25-91 years, 35% women).
Screening tests were the Cognistat, the Screening Instrument for Neuropsychological Impairments in Stroke (SINS) and the Clock Drawing Test. Health professionals, blind to the results of the reference method, did the screening. Reference method was a neuropsychological assessment based on the Norwegian Basic Neuropsychological Assessment, classifying the patients as ;impaired' or ;not impaired' within the following cognitive domains: language, visuospatial function, attention and neglect, apraxia, speed in unaffected arm, and memory.
The best sensitivity (95% confidence interval) was achieved for language problems by Cognistat, naming (80%, 44-98); for visuospatial dysfunction, attention deficits and reduced speed, all by SINS visuocognitive (82%, 60-95, 72%, 39-94, and 78%, 56-93, respectively); and for memory problems by Cognistat memory (69%, 52-87). The data were insufficient to assess any subtest for apraxia. Sensitivity in detecting deficits in any domain was 82% (71-94) for the Cognistat composite score, 71% (57-85) for the SINS composite score, and 63% (49-78) for the most sensitive score of the Clock Drawing Test.
The Cognistat and the SINS may be used as screening instruments for cognitive deficits after stroke, but cannot replace a neuropsychological assessment. The Clock Drawing Test added little to the detection of cognitive deficits.

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    • "However, deficits in naming objects emerge as a frequent symptom of brain damage (Bayles and Tomoeda, 1983; Bell et al., 2001; Hodges et al., 2000; Hodges and Patterson, 2007) occurring, for instance, in at least 14% of stroke patients (e.g. Nøkleby et al., 2008; Tatemichi et al., 1994). In clinical practice, object naming is widely used as a test of language functions in bedside neuropsychological examination (e.g. in MoCA, MMSE). "
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    ABSTRACT: We report a lesion–symptom mapping analysis of visual speech production deficits in a large group (280) of stroke patients at the sub-acute stage (<120 days post-stroke). Performance on object naming was evaluated alongside three other tests of visual speech production, namely sentence production to a picture, sentence reading and nonword reading. A principal component analysis was performed on all these tests' scores and revealed a ‘shared’ component that loaded across all the visual speech production tasks and a ‘unique’ component that isolated object naming from the other three tasks. Regions for the shared component were observed in the left fronto-temporal cortices, fusiform gyrus and bilateral visual cortices. Lesions in these regions linked to both poor object naming and impairment in general visual–speech production. On the other hand, the unique naming component was potentially associated with the bilateral anterior temporal poles, hippocampus and cerebellar areas. This is in line with the models proposing that object naming relies on a left-lateralised language dominant system that interacts with a bilateral anterior temporal network. Neuropsychological deficits in object naming can reflect both the increased demands specific to the task and the more general difficulties in language processing.
    Clinical neuroimaging 01/2015; 214. DOI:10.1016/j.nicl.2015.01.015 · 2.53 Impact Factor
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    • "The Cognistat was found to be appropriate for use with people who have had a stroke (Hinkle, 2002). In addition to brevity (10–20 minutes) and ease of administration, the Cognistat has well established validity and reliability (Schwamm et al., 1987; Mysiw et al., 1999; Man et al., 2006; Nokleby et al., 2008). The DTVP-A, a recently revised version of a perceptual standardized test battery referred to as the Developmental Test of Visual Perception 2nd edition, assesses perception in participants aged 11 to 74 years of age (Reynolds et al., 2002). "
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    ABSTRACT: Most individuals who have had a stroke present with some degree of residual cognitive and/or perceptual impairment. Occupational therapists often utilize standardized cognitive and perceptual assessments with clients to establish a baseline of skill performance as well as to inform goal setting and intervention planning. Being able to predict the functional independence of individuals who have had a stroke based on cognitive and perceptual impairments would assist with appropriate discharge planning and follow-up resource allocation. The study objective was to investigate the ability of the Developmental Test of Visual Perception - Adolescents and Adults (DTVP-A) and the Neurobehavioural Cognitive Status Exam (Cognistat) to predict the functional performance as measured by the Barthel Index of individuals who have had a stroke. Data was collected using the DTVP-A, Cognistat and the Barthal Index from 32 adults recovering from stroke. Two standard multiple regression models were used to determine predictive variables of the functional independence dependent variable. Both the Cognistat and DTVP-A had a statistically significant ability to predict functional performance (as measured by the Barthel Index) accounting for 64.4% and 27.9% of each regression model, respectively. Two Cognistat subscales (Comprehension [beta = 0.48; p < 0.001)] and Repetition [beta = 0.45; p < 0.004]) and one DTVP-A subscale (Copying [beta = 0.46; p < 0.014]) made statistically significant contributions to the regression models as independent variables. On the basis of the regression model findings, it appears that DTVP-A's Copying and the Cognistat's Comprehension and Repetition subscales are useful in predicting the functional independence (as measured by the Barthel Index) in those individuals who have had a stroke. Given the fundamental importance that cognition and perception has for one's ability to function independently, further investigation is warranted to determine other predictors of functional performance of individuals with a stroke. Copyright © 2012 John Wiley & Sons, Ltd.
    Occupational Therapy International 03/2013; 20(1). DOI:10.1002/oti.1334 · 0.78 Impact Factor
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    • " in non–English-speaking patients, and it assesses especially executive function [8]. The validity of the CDT to screen for cognitive impairment has been done in several settings such as dementia, stroke, and elderly people [10] [11] [12]. However, there is no study available on its use in FM patients. "
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    ABSTRACT: The objective of the study was to assess the validity and reliability of the clock drawing test (CDT) in comparison with the Mini-Mental State Examination (MMSE) as a screening tool for cognitive impairment in patients with fibromyalgia (FM). Fifty female patients with FM and 51 healthy female controls were enrolled in the study. Cognitive functioning of the subjects was evaluated by the CDT and the MMSE. Each CDT was scored according to 3 different clock scoring methods (Shulman, Sunderland, and Watson). Two experienced clinicians scored the CDTs to evaluate the interrater reliability. Validity, sensitivity, specificity, and predictive accuracy of each clock scoring method were analyzed. The Shulman score had the highest correlation with the MMSE score (r =0.65, P < .01). The Shulman and Sunderland methods had significantly the largest areas under the receiver operating characteristic curve (0.82 and 0.81, respectively; P = .000). They also had the highest sensitivity (68.8% and 65.5%, respectively) and specificity (84.2%, and 84.1%, respectively). The interrater correlation coefficients were high for all 3 clock scoring methods. The CDT has been proven to be a valid and reliable tool for screening cognitive impairment in FM patients. The Shulman or Sunderland scoring methods are more appropriate than the Watson scoring method. Further studies are needed for using the CDT to detect cognitive impairment in patients with FM.
    Comprehensive psychiatry 05/2011; 53(1):81-6. DOI:10.1016/j.comppsych.2011.02.001 · 2.25 Impact Factor
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