The Hong Kong version of the Oxford Cognitive Screen (HK-OCS): validation study for Cantonese-speaking chronic stroke survivors

Screening for post-stroke neurocognitive disorders in diverse populations: A systematic review

Objective: Although neurocognitive disorders (NCD) are common post-stroke, many populations do not have adapted cognitive screens and cut-offs. We therefore reviewed the appropriateness of the Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA) and Oxford Cognitive Screen (OCS) for diagnosing NCD in culturally diverse stroke populations. Method: Using an extensive search string, diagnostic accuracy studies for MMSE, MoCA and OCS in the stroke population were retrieved from four databases. We compared translations and adaptations, adjustments in scores and cut-offs, and their diagnostic accuracy. Results: The search resulted in 28 MMSE, 39 MoCA and 5 OCS-studies in 13 western, educated, industrialized, rich and democratic (WEIRD) and 4 other countries. There was a lack of studies on South-American, African, and non-Chinese-Asian populations. All three tests needed adaptation for less WEIRD populations and populations with languages with non-Latin features. Optimal MMSE and OCS subtest cut-offs were similar across WEIRD and less WEIRD populations, whereas optimal MoCA cut-offs appeared lower for less WEIRD populations. The use of adjusted scores resulted in different optimal cut-offs or similar cut-offs with better accuracy. Conclusions: MoCA, MMSE and OCS are promising tools for diagnosing post-stroke-NCD. For culturally diverse populations, translation, adaptation and adjusted scores or cut-offs are necessary for diagnostic accuracy. Available studies report scarcely about their sample's cultural background and there is a lack of diagnostic accuracy studies in less WEIRD or culturally diverse populations. Future studies should report more cultural characteristics of their sample to provide better insight into the tests' accuracy in culturally diverse populations.

The Korean Version of the Oxford Cognitive Screen (K-OCS) Normative Study

OBJECTIVE

To generate a Korean version of the Oxford Cognitive Screen (K-OCS) and obtain cutoff scores that determine the impairment of each subdomain. Post-stroke cognitive impairment (PSCI) negatively impacts the rehabilitation process and independence in daily life. Its obscure manifestations require effective screening for appropriate rehabilitation. However, in most rehabilitation clinics, psychological evaluation tools for Alzheimer's dementia have been used without such considerations. The OCS is a screening assessment tool for PSCI and vascular dementia that can evaluate the cognitive domains most often affected by stroke, including language, attention, memory, praxis, and numerical cognition. It comprises 10 subtasks and enables quick and effective cognitive evaluation.

METHODS

The K-OCS, which considers Korea's unique cultural and linguistic characteristics, was developed with the approval and cooperation of the original author. Enrollment of participants without disabilities was announced at Duksung Women's University, Yongin Sevrance Hospital, CHA Bundang Medical Center. The study was conducted between September 2020 and March 2022 on 97 male and female participants aged ≥30 years.

RESULTS

All the 97 participants completed the task. In this study, the 5th percentile score was presumed to be the cutoff value for each score, and the values are provided here. The cutoff score for each OCS subtask was similar to that of the original British version.

CONCLUSION

We suggest the usability of the K-OCS as a screening tool for PSCI by providing the cutoff value of each subtask.

International Classification of Functioning, Disability, and Health-based rehabilitation program promotes activity and participation of post-stroke patients

Background

The International Classification of Functioning, Disability, and Health (ICF) model has been applied in post-stroke rehabilitation, yet limited studies explored its clinical application on enhancing patients' Activity and Participation (ICF-A&P) level.

Purpose

This study gathered evidence of the effects of an ICF-based post-stroke rehabilitation program (ICF-PSRP) in enhancing community reintegration in terms of ICF-A&P of post-stroke patients.

Methods

Fifty-two post-stroke patients completed an 8 to 12 weeks multidisciplinary ICF-PSRP after setting personal treatment goals in an outpatient community rehabilitation center. Intake and pre-discharge assessments were administered for primary outcomes of Body function (ICF-BF; e.g., muscle strength) and ICF-A&P (e.g., mobility), and secondary outcomes of perceived improvements in ability (e.g., goal attainment and quality of life).

Results

There were significantly higher levels in the ICF-BF and ICF-A&P domains, except cognitive function under the ICF-BF. Improvements in the primary outcomes predicted corresponding secondary outcomes. Firstly, expressive and receptive functions (ICP-BF) were mediated by the everyday language (ICF-A&P) which predicted patients' satisfaction with the language-related quality of life. Secondly, upper extremity function (ICP-BF) was mediated by the lower extremity mobility (ICF-A&P) predicting work and productivity-related quality of life. Content analyses showed that combined ICF-BF and ICF-A&P contents throughout the ICF-PSRP contributed to the positive treatment effects.

Conclusion

The ICF-PSRP was effective in promoting body function, and activity and participation levels of post-stroke patients. Positive treatment effects are characterized by goal-setting process, cross-domain content design, and community-setting delivery.Clinical trial registration: https://clinicaltrials.gov/study/NCT05941078?id=NCT05941078&rank=1, identifier NCT05941078.

Reading and listening comprehension in Cantonese-speaking people with right hemisphere versus left hemisphere brain damage

The problem in language comprehension in people with right hemisphere damage (RHD) is more equivocal than people with left hemisphere damage. This study explores the reading and listening comprehension of Cantonese-speaking individuals with RHD, left hemisphere damage, and neurotypical healthy controls using the Cantonese Computerized Revised Token Test (CRTT-Cantonese) adapted from the English CRTT. Eighteen native Cantonese-speaking individuals with RHD, 32 individuals with left hemisphere damage and aphasia (PWA), and 42 healthy controls participated in this study. All the participants completed the Cantonese Aphasia Battery, Hong Kong Oxford Cognitive Screen, the listening comprehension version of CRTT-Cantonese (CRTT-L-Cantonese), and the reading comprehension version of CRTT-Cantonese (CRTT-R-_WF-Cantonese) across different sessions. Linear mixed-effect analysis revealed significant differences among the groups in CRTT-Cantonese tests. However, there were no significant difference between CRTT-L-Cantonese and CRTT-R-_WF-Cantonese within the PWA, RHD and healthy control groups. Tukey post-hoc pairwise comparisons showed that PWA scored significantly lower than RHD and healthy control groups (p < 0.0001) in both CRTT-L-Cantonese and CRTT-R-_WF-Cantonese, and the RHD group scored significantly lower than healthy control group only on the CRTT-R-_WF-Cantonese. The results demonstrate that the CRTT-L-Cantonese and CRTT-R-_WF-Cantonese differentiate language comprehension abilities among PWA, RHD and healthy control groups. Although the current findings did not show any diversion between reading and listening comprehension in RHD group, this group showed poorer performance in reading comprehension when compared to healthy controls. The latter findings may support the view that the right hemisphere contributes to reading comprehension in Chinese.

The Oxford Cognitive Screen for use with Australian people after stroke (OCS-AU): The adaptation process and determining cut scores for cognitive impairment using a cross-sectional normative study

INTRODUCTION

Two parallel versions (A and B) of the Oxford Cognitive Screen (OCS) were developed in the United Kingdom (UK) as a stroke-specific screen of five key cognitive domains commonly affected post-stroke. We aimed to develop the Australian versions A and B (OCS-AU), including Australian cut-scores indicative of impairment. We hypothesised there to be no difference in performance between the UK and Australian normative data cohorts.

METHODS

Our multidisciplinary expert panel used the UK pre-defined process to develop the OCS-AU versions A and B. We then conducted a cross-sectional normative study. We purposively recruited community-dwelling, Australian-born, and educated adults; with no known cognitive impairment; representative of age, sex, education level, and living location; at seven sites (four metropolitan, three regional) across four Australian states. Participants completed one or both OCS-AU versions in a randomised order. Australian cohorts were compared with the corresponding UK cohorts for demographics using Pearson's chi-squared test for sex and education, and Welch two-sample t test for age. For the cut-scores indicating cognitive impairment, the fifth (95th) percentiles and group mean performance score for each scored item were compared using Welch two-sample t tests. The pre-defined criteria for retaining OCS cut-scores had no statistically significant difference in either percentile or group mean scores for each scored item.

RESULTS

Participants (n = 83) were recruited: fifty-eight completed version A [age (years) mean = 61,SD = 15; 62% female], 60 completed version B [age (years) mean = 62,SD = 13, 53% female], and 35 completed both [age (years) mean = 64,SD = 11, 54% female]. Education was different between the cohorts for version B (12 years, p = 0.002). Cut-scores for all 16 scored items for the OCS-AU version B and 15/16 for version A met our pre-defined criteria for retaining the OCS cut scores.

CONCLUSIONS

The OCS-AU provides clinicians with an Australian-specific, first-line cognitive screening tool for people after stroke. Early screening can guide treatment and management.

Intervention and Prevention of Dementia in the Greater Bay Area (GBA) of China

Reserve and resilience are recognized as essential for effective intervention and prevention of dementia. However, it is not known if these factors also protect against risk for dementia in the Greater Bay Area (GBA) of Mainland China. Studies of risk factors across regions of China provide an evidence base for future research in the GBA. However, population-based studies are rare and do not account for the cultural differences in levels of education, income, literacy and modifiable lifestyle factors. Critically, extant studies do not allow for differences in languages spoken across the region, which will bias results and potentially minimize true prevalence. Based on the conclusions reported in this Special Collection, research in the GBA should focus on resilience and reserve using preserved native language communication skills.

The Prognostic Value of Domain-Specific Cognitive Abilities Assessed by Chinese Version of Oxford Cognitive Screen on Determining ADLs Recovery in Patients with Post-Stroke Cognitive Impairment

Background

Poststroke cognitive impairment (PSCI) has been increasingly recognized in patients. However, it remains unclear whether ADLs recovery is more susceptible to domain-specific cognitive abilities after a stroke. Therefore, the study was designed to investigate the cognitive functions of patients with PSCI at admission by using the Chinese (Putonghua) Version of the Oxford Cognitive Screen (OCS-P) as well as to identify the prognostic value of domain-specific cognitive abilities on the recovery of ADLs when discharged.

Methods

A total of 153 hospitalized stroke patients were included in this prospective study. Cognitive function was assessed by OCS-P when participants were admitted to the hospital. The ADLs were measured at admission and discharge, and recovery was estimated by the improvement between admission and discharge. A diagnostic model using logistic regression was constructed to identify the prognostic value of domain-specific cognitive abilities for ADLs. The efficacy and accuracy of the diagnostic model were assessed by receiver operating characteristic (ROC) and Hosmer-Lemeshow's goodness of fit test. The diagnostic model was validated by 10-fold cross-validation and presented as a nomogram.

Results

The score of OCS-P was 60(49.75, 69). The most frequently impaired cognitive domain was number writing (60.8%), followed by verbal memory (52.9%). Multivariate logistic regression showed executive dysfunction was a risk prognostic factor of ADLs recovery (P < 0.001, OR = 3.176 [95% CI, 1.218∼8.278]). The ROC curve of the diagnostic model was 0.839, with a good diagnostic efficacy. Hosmer–Lemeshow test showed diagnostic model had good calibration ability (χ² = 8.939.3, P=0.347 > 0.05). The average error rate after adjustment of 10-fold cross-validation was 20.93%, within the acceptable range.

Conclusions

Post-stroke patients generally suffered from multidimensional cognitive impairments. Executive dysfunction screened with OCS-P at clinical admission was a reliable and accessible predictive factor ADLs recovery in patients with PSCI. Early targeted rehabilitation programs are suggested to make them as earlier as possible, especially for those having executive dysfunction while hospitalized.

Current Update on the Clinical Utility of MMSE and MoCA for Stroke Patients in Asia: A Systematic Review

Objective: Primary care clinicians in Asia employed the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) to aid dementia diagnosis post-stroke. Recent studies questioned their clinical utility in stroke settings for relying on verbal abilities and education level, as well as lack of consideration for aphasia and neglect. We aimed to review the clinical utility of the MMSE and MoCA for stroke patients in Asia and provide recommendations for clinical practice. Methods: PubMed, Scopus, Web of Science, and Science Direct were searched for relevant articles. Included studies were assessed for risk of bias. RevMan 5.4 was used for data synthesis (sensitivity and specificity) and covariates were identified. Results: Among the 48 full-text articles reviewed, 11 studies were included with 3735 total subjects; of these studies, 7 (77%) were conducted in China, 3 (27%) in Singapore, and 1 (9%) in South Korea. Both the MMSE and MoCA generally showed adequate sensitivity and specificity. Education was identified as a covariate that significantly affected detection accuracy. Due to heterogeneity in cutoff scores, methodologies, and languages, it was not feasible to suggest a single cutoff score. One additional point is recommended for MoCA for patients with <6 years of education. Conclusion: Clinicians in Asia are strongly recommended to consider the education level of stroke patients when interpreting the results of the MMSE and MoCA. Further studies in other Asian countries are needed to understand their clinical value in stroke settings.

Memory recovery in relation to default mode network impairment and neurite density during brain tumor treatment

OBJECTIVE

The aim of this study was to test brain tumor interactions with brain networks, thereby identifying protective features and risk factors for memory recovery after resection.

METHODS

Seventeen patients with diffuse nonenhancing glioma (ages 22-56 years) underwent longitudinal MRI before and after surgery, and during a 12-month recovery period (47 MRI scans in total after exclusion). After each scanning session, a battery of memory tests was performed using a tablet-based screening tool, including free verbal memory, overall verbal memory, episodic memory, orientation, forward digit span, and backward digit span. Using structural MRI and neurite orientation dispersion and density imaging (NODDI) derived from diffusion-weighted images, the authors estimated lesion overlap and neurite density, respectively, with brain networks derived from normative data in healthy participants (somatomotor, dorsal attention, ventral attention, frontoparietal, and default mode network [DMN]). Linear mixed-effect models (LMMs) that regressed out the effect of age, gender, tumor grade, type of treatment, total lesion volume, and total neurite density were used to test the potential longitudinal associations between imaging markers and memory recovery.

RESULTS

Memory recovery was not significantly associated with either the tumor location based on traditional lobe classification or the type of treatment received by patients (i.e., surgery alone or surgery with adjuvant chemoradiotherapy). Nonlocal effects of tumors were evident on neurite density, which was reduced not only within the tumor but also beyond the tumor boundary. In contrast, high preoperative neurite density outside the tumor but within the DMN was associated with better memory recovery (LMM, p value after false discovery rate correction [Pfdr] < 10-3). Furthermore, postoperative and follow-up neurite density within the DMN and frontoparietal network were also associated with memory recovery (LMM, Pfdr = 0.014 and Pfdr = 0.001, respectively). Preoperative tumor and postoperative lesion overlap with the DMN showed a significant negative association with memory recovery (LMM, Pfdr = 0.002 and Pfdr < 10-4, respectively).

CONCLUSIONS

Imaging biomarkers of cognitive recovery and decline can be identified using NODDI and resting-state networks. Brain tumors and their corresponding treatment affecting brain networks that are fundamental for memory functioning such as the DMN can have a major impact on patients' memory recovery.

Development of the English Listening and Reading Computerized Revised Token Test Into Cantonese: Validity, Reliability, and Sensitivity/Specificity in People With Aphasia and Healthy Controls

Purpose This study reports the psychometric development of the Cantonese versions of the English Computerized Revised Token Test (CRTT) for persons with aphasia (PWAs) and healthy controls (HCs). Method The English CRTT was translated into standard Chinese for the Reading-Word Fade version (CRTT-R-_WF-Cantonese) and into formal Cantonese for the Listening version (CRTT-L-Cantonese). Thirty-two adult native Cantonese PWAs and 42 HCs were tested on both versions of CRTT-Cantonese tests and on the Cantonese Aphasia Battery to measure the construct and concurrent validity of CRTT-Cantonese tests. The HCs were retested on both versions of the CRTT-Cantonese tests, whereas the PWAs were randomly assigned for retesting on either version to measure the test-retest reliability. Results A two-way, Group × Modality, repeated-measures analysis of variance revealed significantly lower scores for the PWA group than the HC group for both reading and listening. Other comparisons were not significant. A high and significant correlation was found between the CRTT-R-_WF-Cantonese and the CRTT-L-Cantonese in PWAs, and 87% of the PWAs showed nonsignificantly different performance across the CRTT-Cantonese tests based on the Revised Standardized Difference Test. The CRTT-R-_WF-Cantonese provided better aphasia diagnostic sensitivity (100%) and specificity (83.30%) values than the CRTT-L-Cantonese. Pearson correlation coefficients revealed significant moderate correlations between the Cantonese Aphasia Battery scores and the CRTT-Cantonese tests in PWAs, supporting adequate concurrent validity. Intraclass correlation coefficient showed high test-retest reliability (between .82 and .96, p < .001) for both CRTT-Cantonese tests for both groups. Conclusions Results support that the validly translated CRTT-R-_WF-Cantonese and CRTT-L-Cantonese tests significantly differentiate the reading and listening comprehension of PWAs from HCs and provides acceptable concurrent validity and high test-retest reliability for both tests. Furthermore, favorable PWA versus HC sensitivity and specificity cutoff scores are presented for both CRTT-Cantonese listening and reading tests.

Aphasia in Alzheimer's Disease and Other Dementias (ADOD): Evidence From Chinese

Speech and language impairments (aphasia) are typical of patients with Alzheimer's Disease and other dementias (ADOD) and in some pathologies are diagnostic e.g. Primary Progressive Aphasia (PPA). One question concerns the reliability and validity of symptomatology across typologically different languages. A review of aphasia in ADOD across languages suggests a similar pattern of word comprehension, naming and word finding difficulties but also evidence of language specific features in symptomatology e.g. processing of tone in Chinese languages. Given differences in linguistic impairments across languages, it is recommended that screening for aphasia in community and epidemiological studies use a Short ScreeningTest (SST) that can be delivered across dialects and languages in indigenous languages and also multilingual populations.

The Dutch version of the Oxford Cognitive Screen (OCS-NL): normative data and their association with age and socio-economic status

The Oxford Cognitive Screen (OCS) is a screening tool designed for stroke patients, assessing attention, executive functions, language, praxis, numeric cognition and memory. Here we present norms for the two parallel versions of the Dutch OCS (OCS-NL, acquired in 246 participants for version A and a subset of 179 participants for version B. We evaluated the association of age and socio-economic status (i.e. education, income, occupation) with OCS-NL performance There were no systematic performance differences between income groups, nor between manual and non-manual workers. There were small differences between education groups. The association of education and performance did not vary across subtests. The association of age and performance varied across subtests, with the strongest associations for the naming, praxis, verbal memory and executive task. Thus, OCS-NL norms do not need to be stratified on income and occupation and age-specific norms are recommended for some subtests.

Impact of visuospatial neglect post-stroke on daily activities, participation and informal caregiver burden: A systematic review

OBJECTIVES

Visuospatial neglect (VSN) is a common cognitive disorder after stroke. The primary aim of this systematic review was to provide an overview of the impact of VSN in 3 aspects: (1) activities of daily living (ADL), (2) participation, and (3) caregiver burden. The second aim was to investigate the differences in studies focusing on populations with mean age<65 versus≥65 years.

METHODS

PubMed, EMBASE, Web of Science, Cochrane Library, Emcare, PsychINFO, Academic Search Premier and CENTRAL were searched systematically. Quality was assessed with the Mixed Methods Appraisal Tool.

RESULTS

Of the 115 included studies, 104 provided outcomes on ADL, 15 on participation (4 studies with mean age≥65), and 2 on caregiver burden (1 study with mean age≥65). Quality assessment yielded scores ranging from 0 to 100%. VSN had a negative impact on ADL (i.e., independence during ADL and performance in self-care, household tasks, reading, writing, walking, wheelchair navigation) and participation (i.e., driving, community mobility, orientation, work). The impact of VSN on fulfilling social roles was unclear. VSN had a negative effect on caregiver burden. We found no clear age-related differences.

CONCLUSIONS AND IMPLICATIONS

VSN has a negative impact not only on patients' independence but particularly on the performance of ADL. Despite the far fewer studies of VSN as compared with ADL, VSN also seems to hamper participation and increase caregiver burden, but further research is needed. Because of the large impact, VSN should be systematically and carefully assessed during rehabilitation. A considerable number of different instruments were used to diagnose VSN. Diagnosing VSN at more than one level [function (i.e., pen-and-paper test), activities, and participation] is strongly recommended. Consensus is needed on how to assess VSN and its negative impact for research and rehabilitation practice.

SYSTEMATIC REVIEW REGISTRATION NO

PROSPERPO Registration No. CRD42018087483.

Modified semantic feature analysis for anomia: a single case study

Semantic feature analysis (SFA) is a treatment approach designed for patients with lexical retrieval difficulty caused by semantic deficits. During training, a structured framework (e.g. requiring the patient to name the category, function, and colour of the target items) is usually provided to facilitate the patient in thinking of the semantic features of the target items. Nevertheless, the use of a structured framework potentially limits the variety of semantic features activated for lexical retrieval. This study investigated the effectiveness of modified SFA training to address this potential limitation. An odd-man-out task was carried out in the modified SFA training with an anomic patient with impaired access to the phonological output lexicon. The task aimed to encourage a detailed comparison of semantic features among items in the same category. It is hypothesized that activations of more distinctive semantic features belonging to the target items will result in greater extent of generalizations in the lexical processing. The patient's abilities in naming semantic features at the beginning and at the end of each treatment session were compared. Besides, accuracy and error patterns in oral and written naming in the initial and post-treatment assessment were also compared. The results showed a significant increase in the number of semantic features retrieved within treatment sessions. Moreover, a significant improvement in oral picture naming was also observed subsequent to the modified SFA training. Finally, the results of the error analyses further supported that the modified SFA was effective in promoting overall lexical processing. The findings indicated that both quantity and distinctiveness of concepts activated in the semantic system are essential to effective lexical retrieval. Theoretical and clinical implications were also discussed.

A Danish version of the Oxford cognitive screen: a stroke-specific screening test as an alternative to the MoCA

Cognitive deficits are common following stroke and have many negative consequences. They must be identified to provide appropriate interventions and care. In Denmark, the Montreal Cognitive Assessment (MoCA), a dementia screening tool, is commonly used to screen for cognitive deficits following stroke, despite its limitations in this context. This study aimed to make the Oxford Cognitive Screen (OCS), a stroke-specific cognitive screening tool, available in Danish and to provide population appropriate normative data. Additionally, the study aimed to evaluate the appropriateness of the MoCA cutoff of 25/26 currently used in Denmark. A sample of healthy Danish participants aged 36-89 was assessed using the Danish OCS and MoCA. Mean performance and 5th percentile cutoffs were calculated for both tests. OCS results were similar to results from European studies. For the MoCA, 5th percentile corresponded to 22.35, suggesting that the cutoff currently used in Denmark is inappropriate.

Validation of the Spanish version of the Oxford Cognitive Screen (S-OCS): psychometric properties of a short cognitive stroke-specific screening tool

OBJECTIVE:

The aim of this study is to examine the psychometric properties of the Spanish version of the Oxford Cognitive Screen in a subacute stroke population.

PARTICIPANTS AND SETTING:

Fifty-seven subacute stroke outpatients and 54 healthy individuals were recruited in Alicante province, Spain.

MAIN MEASURE:

The Oxford Cognitive Screen.

OTHER MEASURES:

The Montreal Cognitive Assessment, the Barcelona test, and the Barthel Index.

DESIGN:

A validation study was conducted to analyze the inter-rater, intra-rater, test-retest, and internal consistency of the Spanish version of the Oxford Cognitive Screen. Concurrent validity was assessed using the Montreal Cognitive Assessment and the Barcelona test, and divergent validity using the Barthel index. Discriminant indices such as the sensitivity, specificity, predictive values, and optimal cut-offs were also estimated.

RESULTS:

The subtests of the Spanish version of the Oxford Cognitive Screen showed excellent estimates for the inter-reliability (intraclass correlation coefficient (ICC) = 0.790 to 1.000; r_s = 0.693 to 1.000), and acceptable-good for intra-reliability (ICC = 0.181 to 0.990) and test-retest reliability ( r_s = 0.173 to 0.971). Internal consistency was also excellent (standardized Cronbach's α = 0.907). Spearman correlations for the concurrent validity were low-strong ( r_s = -0.193 to 0.95) and low-moderate ( r_s = -0.091 to 0.443) for divergent validity. The optimal cut-offs estimated for the subtests of the Spanish version of the Oxford Cognitive Screen showed good-high specificity (66.7%-100%) and positive predictive value (67.9%-100%), and low-good sensitivity (14.8%-83.3%) and moderate-good negative predictive value (53.5%-76.6%). Discriminant power as measured by the area under the curve indicated acceptable-good values (0.397 to 0.894).

CONCLUSION:

Our findings support that the Spanish version of the Oxford Cognitive Screen is a reliable and valid tool for screening cognitive impairments in subacute stroke patients.

Oxford Cognitive Screen - Brazilian Portuguese version (OCS-Br) A pilot study

Cognitive impairment is very common in stroke patients and underdiagnosed. Symptoms such as language, praxis, visuospatial, visuoconstructive and memory impairment are prominent. The screening cognitive tests available do not address some specific characteristics of stroke patients and have major limitations in relation to the most impaired cognitive domains.

Validity and reliability of two alternate versions of the Montreal Cognitive Assessment (Hong Kong version) for screening of Mild Neurocognitive Disorder

Objective

Repeated testing using the Montreal Cognitive Assessment (MoCA) increases risks for practice effects which may bias measurements of cognitive change. The objective of this study is to develop two alternate versions of the MoCA (Hong Kong version; HK-MoCA) and to investigate the validity and reliability of the alternate versions in patients with DSM-5 Mild Neurocognitive Disorder (Mild NCD) and cognitively healthy controls.

Methods

Concurrent validity and inter-scale agreement were examined by Pearson correlation of the total scores between the original and alternate versions and the Bland-Altman Method. Criterion validity of the two alternate versions in differentiating patients with Mild NCD was tested using receiver operating characteristic curve (ROC) analysis. One-month test-retest and inter-rater reliability were examined in 20 participants. Internal consistency of the alternate versions was measured by the Cronbach’s α.

Results

30 controls (age 73.4 [4.5] years, 60% female) and 30 patients (age 75.4 [5.5] years, 73% female) with Mild NCD were recruited. Both alternate versions significantly correlated with the original version (r = 0.79–0.87, p<0.001). Mean differences of 0.17 and -0.40 points were found between the total scores of the alternate with the original versions with a consistent level of agreement observed throughout the range of cognitive abilities. Both alternate versions significantly differentiated patients with Mild NCD from healthy controls (area under ROC 0.922 and 0.724, p<0.001) and showed good one-month test-retest reliability (intra-class correlation [ICC] = 0.92 and 0.82) and inter-rater reliability (ICC = 0.99 and 0.87) and high internal consistency (Cronbach α = 0.79 and 0.75).

Conclusion

The two alternate versions of the HK-MoCA are useful for Mild NCD screening.

Psychometric Properties of the Chinese (Putonghua) Version of the Oxford Cognitive Screen (OCS-P) in Subacute Poststroke Patients without Neglect

Background

Oxford Cognitive Screen is designed for assessing cognitive functions of poststroke patients. This study was aimed to assess the psychometric properties of the Chinese (Putonghua) version of the Oxford Cognitive Screen-Putonghua (OCS-P) for use among poststroke patients without neglect.

Methods

Expert review panel evaluated content validity of the Chinese-translated items. After pilot tested the translated items, the patients and healthy participants completed the OCS-P as well as the Montreal Cognitive Assessment (MoCA-ChiB) and Goldenberg's test. A group of patients completed OCS-P for the second time within seven days. Data analyses included confirmatory factor analysis, item difficulty and item-total correlation, inter- and intrarater reliability, internal consistency, and between-group discrimination.

Results

One hundred patients and 120 younger (n = 60) or older (n = 60) healthy participants completed all the tests. Modifications were required for items in the “Picture Naming”, “Orientation”, and “Sentence Reading” subscales. Confirmatory factor analysis revealed a three-factor structure for the OCS-P subscales. The internal consistency coefficients for the three identified test dimensions were 0.30 to 0.52 (Cronbach's alpha). Construct validity coefficients between the OCS-P and MoCA-ChiB subscales were 0.45 < r < 0.79 (p < 0.001) and the “Praxis” subscale of OCS-P and Goldenberg's test was r = 0.72 (p < 0.001). The interrater reliability coefficients for the subscales were in general higher than the intrarater reliability coefficients. The “Picture Naming” and “Numerical Cognition” subscales were the most significant (p = 0.003) for differentiating patient participants from their older healthy counterpart.

Conclusion

This study generated satisfactory evidence on the content validity, substantive validity, construct validity, inter- and intrarater reliability, and known-group discrimination of the OCS-P. They support its application among poststroke patients who speak Putonghua. Future studies could review the existing five-dimension domains for improving its structural validity and internal consistency as well as generate evidence of the OCS-P for use among the poststroke patients with neglect.