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Stiekema APM, Vreven LWA, Hummel RSO, Mott AS, Verrijt SJGM, Chin Kwie Joe R, Alberto NAS, Ravindran PK, Thommes C, van der Kwaak A, Staals J, van Heugten CM. The Montreal Cognitive Assessment detects cognitive deficits that go unnoticed during clinical observation in the acute phase after stroke. Brain Inj 2024; 38:687-691. [PMID: 38615342 DOI: 10.1080/02699052.2024.2341039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 04/04/2024] [Indexed: 04/16/2024]
Abstract
BACKGROUND Detecting cognitive impairments early after stroke is essential for appropriate referrals. Although recommended in stroke guidelines, early cognitive screening is not always implemented. We assessed whether the Montreal Cognitive Assessment (MoCA) adds diagnostic value compared to clinical observation alone. In addition, discharge destinations for stroke patients with and without cognitive deficits detected with the screening tool or the treatment team were explored. METHODS Forty-four stroke patients were screened with the MoCA during stroke unit admission. Their charts were studied for cognitive impairments reported by the stroke care team, who were blinded to screening scores. Proportions of detected cognitive deficits were compared between screening (score <26) and patient charts. Discharge destination distribution (home vs. rehabilitation) was explored. RESULTS The proportion of cognitively impaired patients indicated by the MoCA (84%) and reported in patients' charts (25%) differed significantly (p < 0.001). The distribution of discharge destination did not suggest an association with the detection of cognitive deficits by the treatment team or the cognitive screening. CONCLUSIONS The MoCA detects more cognitive deficits than clinical impression alone, emphasizing the importance of standard screening for cognitive impairments in acute stroke patients. Ultimately, systematic screening may enhance discharge planning and improve long-term outcomes.
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Affiliation(s)
- Annemarie P M Stiekema
- School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Department of Psychiatry and Neuropsychology, Maastricht University Medical Centre, Maastricht, The Netherlands
- Limburg Brain Injury Centre, Maastricht University, Maastricht, The Netherlands
| | - Lara W A Vreven
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - River S O Hummel
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Anne S Mott
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Sasha J G M Verrijt
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Rachel Chin Kwie Joe
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Nakharí A S Alberto
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Pawan K Ravindran
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Chiara Thommes
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Anouk van der Kwaak
- Department of Neurology and School for Cardiovascular Diseases (CARIM), Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Julie Staals
- Department of Neurology and School for Cardiovascular Diseases (CARIM), Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Caroline M van Heugten
- School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Department of Psychiatry and Neuropsychology, Maastricht University Medical Centre, Maastricht, The Netherlands
- Limburg Brain Injury Centre, Maastricht University, Maastricht, The Netherlands
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
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Gangaram-Panday SG, Zhou Y, Gillebert CR. Screening for post-stroke neurocognitive disorders in diverse populations: A systematic review. Clin Neuropsychol 2024; 38:588-611. [PMID: 37480233 DOI: 10.1080/13854046.2023.2237676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 07/12/2023] [Indexed: 07/23/2023]
Abstract
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.
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Affiliation(s)
- Shonimá G Gangaram-Panday
- Brain and Cognition, Leuven Brain Institute, KU Leuven, Leuven, Belgium
- Psychology, Anton de Kom University of Suriname, Paramaribo, Suriname
| | - Yanyao Zhou
- Psychology, University of Hong Kong, Hong Kong
| | - Céline R Gillebert
- Brain and Cognition, Leuven Brain Institute, KU Leuven, Leuven, Belgium
- TRACE Center for Translational Health Research, KU Leuven, Leuven, Belgium
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3
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Mueller J, Cammermeyer G. Patient-specific cognitive profiles in the detection of dementia subtypes: A proposal. Alzheimers Dement 2023; 19:4743-4752. [PMID: 37037456 DOI: 10.1002/alz.13049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 02/21/2023] [Accepted: 02/23/2023] [Indexed: 04/12/2023]
Abstract
Many physicians rely on sum score cognitive screening tests to evaluate patients for cognitive decline. Because the vast majority of cognitively impaired patients never receive more extensive testing, the results of these screening tests impact patients and their family members profoundly. No previous study has examined whether the metrics used by the popular Mini-Mental State Examination, Montreal Cognitive Assessment, and Saint Louis University Mental Status tests reliably identify single-domain deficits or allow clinicians to adequately track disease progression. We compare side by side the metrics used by these three tests to highlight the differences in the ways they measure domain impairments. We then contrast the sum score approach to cognitive screening with brief domain-specific tests that use extended metrics in each domain examined. Last, we suggest that moderate-to-severe domain-specific deficits on these tests should lead physicians to anticipate specific functional problems and alert family members.
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Affiliation(s)
- Jonathan Mueller
- Department of Psychiatry, Saint Francis Memorial Hospital, San Francisco, California, USA
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Zhu Q, Chen L, Xu Q, Xu J, Zhang L, Wang J. Association between obstructive sleep apnea and risk for post-stroke anxiety: A Chinese hospital-based study in noncardiogenic ischemic stroke patients. Sleep Med 2023; 107:55-63. [PMID: 37119621 DOI: 10.1016/j.sleep.2023.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 03/11/2023] [Accepted: 04/13/2023] [Indexed: 05/01/2023]
Abstract
OBJECTIVE This study explored the role of obstructive sleep apnea (OSA) in post stroke anxiety (PSA) in noncardiogenic ischemic stroke patients. METHODS 180 patients with noncardiogenic ischemic stroke were consecutively enrolled from January 2019 to December 2019. All patients underwent polysomnography (PSG) to assess for OSA. OSA severity was identified based on the apnea hypopnea index (AHI), i.e., no OSA (AHI <5), mild OSA (5 = AHI <15), and moderate to severe OSA (AHI ≥15). Neuropsychological assessments were performed at acute phase and 6 months later to evaluate anxiety (Chinese version of the Zung self-rating anxiety scale [SAS], and Beck Anxiety Inventory [BAI]), depression (Patient Health Questionnaire-9, [PHQ-9]), and cognition (Mini-mental state examination, [MMSE], and Montreal Cognitive Assessment, [MOCA]). Clinical diagnoses of PSA were made based on interviews and the anxiety scales. The correlations between PSA and OSA were investigated in Logistic regression analysis. RESULTS The prevalence of acute-phase and 6-month PSA were 27 (15%) and 52 (28.9%) respectively. Moderate to severe OSA and post-stroke depression (PSD) were the influencing factors of acute-phase PSA. 6-Month PSA was not associated with OSA but was associated with acute-phase anxiety, education status and MOCA. Logistic regression analysis including respiratory and sleeping parameters showed that AHI and micro-arousal index contributed to acute-phase PSA. CONCLUSIONS Acute-phase PSA was associated with OSA severity, potentially through OSA-caused sleep discontinuity. While 6-month PSA was associated with acute-phase anxiety, highlighting the need for integration of screening for and management of OSA and PSA at acute phase.
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Affiliation(s)
- Qiongbin Zhu
- Department of Neurology, Sir Run Run Shaw Hospital, Affiliated with School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Leihui Chen
- Department of Internal Medicine, The Wuyun Mountain Hospital of Hangzhou(The Health Promotion Institute of Hangzhou), Hangzhou, Zhejiang, China
| | - Qinglin Xu
- Department of Neurology, Sir Run Run Shaw Hospital, Affiliated with School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Jiahui Xu
- Department of Neurology, Sir Run Run Shaw Hospital, Affiliated with School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Lisan Zhang
- Department of Neurology, Sir Run Run Shaw Hospital, Affiliated with School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.
| | - Jin Wang
- Department of Neurology, Sir Run Run Shaw Hospital, Affiliated with School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.
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Economou A, Varlokosta S, Kontari P, Papageorgiou SG. The nonverbal BriefScreen: A cognitive screening method for patients with limited language and motor abilities. APPLIED NEUROPSYCHOLOGY. ADULT 2023; 30:186-193. [PMID: 33980090 DOI: 10.1080/23279095.2021.1920414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Dementia and significant cognitive decline are frequent sequelae of stroke, but are difficult to evaluate when aphasia and/or motor impairment are present. The linguistic and motor requirements of commonly employed screening tests render them problematic for use post-stroke. The present study examines the validity of the Nonverbal BriefScreen, a brief screening method with limited verbal and motor requirements, in groups of patients with known cognitive impairment using the MMSE as a gold standard. Participants were 137 healthy middle aged and older community dwellers, 21 patients with MCI/early dementia and 35 patients with different types of dementia. The sensitivity and specificity of the Nonverbal BriefScreen were calculated for various cutoff scores, with the MMSE as comparison. The Nonverbal BriefScreen was effective in discriminating between healthy controls and patients with dementia, as well as between healthy controls and all patients, with areas under the ROC curve similar to that of the MMSE. ROC analyses with a smaller sample of 35 age-matched healthy controls showed adequate discriminant ability to detect cognitive impairment. The Nonverbal BriefScreen was shown to be a valid method for screening for cognitive impairment that could be employed as a screening method for patients with limited language.
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Affiliation(s)
- Alexandra Economou
- Department of Psychology, School of Philosophy, National and Kapodistrian University of Athens, Athens, Greece
| | - Spyridoula Varlokosta
- Department of Linguistics, School of Philology, National and Kapodistrian University of Athens, Athens, Greece
| | - Panagiota Kontari
- School of Psychology, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Sokratis G Papageorgiou
- Memory, Cognitive Disorders and Rare Dementias Outpatient Unit, 1st Department of Neurology, Eginition University Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Cheng Y, Zhang Y, Zhang Y, Wu YH, Zhang S. Reliability and validity of the Rowland Universal Dementia Assessment Scale for patients with traumatic brain injury. APPLIED NEUROPSYCHOLOGY. ADULT 2022; 29:1160-1166. [PMID: 33321049 DOI: 10.1080/23279095.2020.1856850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Objective and accurate cognitive assessment scales are essential for guiding cognitive rehabilitation following traumatic brain injury (TBI). The aim of this study was to evaluate the reliability and validity of the Rowland Universal Dementia Assessment Scale (RUDAS) for TBI and to verify the clinical application value. Fifty patients with TBI and 32 matched controls were assessed using the Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), and a newly developed Chinese version of RUDAS. These scales were then compared for internal consistency, inter-rater reliability, test‒retest reliability, content validity, construct validity, and diagnostic efficacy. Among the TBI group, the RUDAS demonstrated acceptable internal consistency (Cronbach's α = 0.733), high inter-rater reliability (intraclass correlation coefficients [ICCs] of 0.910‒0.999), and high test‒retest reliability (total score ICC = 0.938). The correlation coefficients between RUDAS total score and individual subscores were all > 0.5 except for body orientation (r = 0.363), indicating generally good content validity. Total RUDAS scores were moderately correlated with both MMSE total scores (r = 0.701, p < 0.001) and MoCA total scores (r = 0.778, p < 0.001), indicating good construct validity. Receiving operating characteristic curve analysis yielded comparable areas under the curve for diagnostic efficacy (RUDAS, 0.844; MMSE, 0.769; MoCA, 0.824; all p > 0.05). A RUDAS score cutoff of 23.5 distinguished TBI patients from controls with 60% sensitivity and 100% specificity. Therefore, the RUDAS demonstrates both good reliability and validity for evaluating cognitive impairments in TBI patients.
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Affiliation(s)
- Yun Cheng
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, China.,Department of Rehabilitation Medicine, School of Clinical Medicine, Soochow University, Soochow, China
| | - Yu Zhang
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Yi Zhang
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Ye-Huan Wu
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Shuang Zhang
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, China.,Department of Rehabilitation Medicine, School of Clinical Medicine, Soochow University, Soochow, China
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Prediction of post-stroke cognitive impairment by Montreal Cognitive Assessment (MoCA) performances in acute stroke: comparison of three normative datasets. Aging Clin Exp Res 2022; 34:1855-1863. [PMID: 35441928 PMCID: PMC9283135 DOI: 10.1007/s40520-022-02133-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 03/29/2022] [Indexed: 11/30/2022]
Abstract
Background Cognitive assessment in acute stroke is relevant for identifying patients at risk of persistent post-stroke cognitive impairment (PSCI). Despite preliminary evidence on MoCA accuracy, there is no consensus on its optimal score in the acute stroke setting to predict PSCI. Aims (1) To explore whether the application of different normative datasets to MoCA scores obtained in the acute stroke setting results in variable frequency of patients defined as cognitively impaired; (2) to assess whether the normality cut-offs provided by three normative datasets predict PSCI at 6–9 months; (3) to calculate alternative MoCA cut-offs able to predict PSCI. Methods Consecutive stroke patients were reassessed at 6–9 months with extensive neuropsychological and functional batteries for PSCI determination. Results Out of 207 enrolled patients, 118 (57%) were followed-up (mean 7.4 ± 1.7 months), and 77 of them (65%) received a PSCI diagnosis. The application of the normality thresholds provided by the 3 normative datasets yielded to variable (from 28.5% to 41%) rates of patients having an impaired MoCA performance, and to an inadequate accuracy in predicting PSCI, maximizing specificity instead of sensitivity. In ROC analyses, a MoCA score of 22.82, adjusted according to the most recent normative dataset, achieved a good diagnostic accuracy in predicting PSCI. Conclusions The classification of acute stroke patients as normal/impaired based on MoCA thresholds proposed by general population normative datasets underestimated patients at risk of persistent PSCI. We calculated a new adjusted MoCA score predictive of PSCI in acute stroke patients to be further tested in larger studies.
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Maze Control Training on Kinesthetic Awareness in Patients with Stroke: A Randomized Controlled Trial. Rehabil Res Pract 2022; 2022:5063492. [PMID: 35251715 PMCID: PMC8894050 DOI: 10.1155/2022/5063492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 02/01/2022] [Accepted: 02/02/2022] [Indexed: 11/23/2022] Open
Abstract
Objective To determine the influence of adding maze control training to the selected conventional physical therapy on kinesthetic awareness in patients with chronic stroke. Methods Thirty adult patients of both genders with chronic cerebral stroke were assigned to control and experimental groups randomly: the control group (A) received the selected conventional physical therapy rehabilitation program, while the experimental group (B) received the same program as group A in addition to the maze control training. Measurements for sway index, risk of fall, and knee proprioception before and after 8 weeks of treatment (24 sessions; three times per week). Results There were significant decreases of both sway index and risk of fall in both groups (p ≤ 0.001 in all measures), significant improvements of the knee proprioception in 30° and 75° in the experimental group (p value = 0.016 and ≤0.001, respectively). The in-between groups' comparison showed significant differences corresponding to both the sway index and risk of fall (p ≤ 0.001), and a significant difference in 75° (p ≤ 0.001). Conclusion Adding maze control training to the selected conventional physical therapy improved the kinesthetic awareness in patients with chronic stroke.
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Liu X, Zhou M, Zhao J, Gao Y, Wang Y, Zhou J, Wan L, Nie G, Wang Y. Functional Independence and Disability Evaluation in Stroke Patients: Optimal Cutoff Scores for a Pictorial-Based Longshi Scale, Barthel Index, and Modified Rankin Scale. Front Neurol 2022; 13:710852. [PMID: 35222236 PMCID: PMC8866832 DOI: 10.3389/fneur.2022.710852] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 01/17/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction The modified Rankin Scale (mRS) and Barthel Index (BI) are widely used to measure functional outcomes worldwide. The Longshi Scale (LS), a novel pictorial-based instrument, was designed to improve the simplicity and convenience of measuring functional outcomes in the Chinese context. However, the disagreements in functional outcomes assessed by the mRS, BI, and LS are misleading, particularly in stroke patients. This study aimed to identify the optimal cutoff scores of LS and BI according to the mRS in Chinese stroke patients with different levels of functional disability. Methods The mRS, BI, and LS were applied to evaluate functional independence and disability in 7364 stroke patients in a multi-center cross-sectional study. Stroke patients were categorized into bedridden, domestic, and community groups in advance using the LS, indicating severe, moderate, and mild functional disability, respectively. The optimal cut-off scores of the LS and BI according to the mRS were identified via sensitivity, specificity, and Youden's index and stratified by different levels of functional disability determined by LS. We also plotted the receiver operator characteristic (ROC) curves of sensitivity and specificity and determined the area under the curve (AUC). Results In the bedridden group, LS and BI cutoff scores with the highest Youden's index were 5 and 10 for mRS 4, and the AUCs for the ROC curve were 0.848 and 0.863 for mRS 4. In the domestic group, LS and BI cutoff scores with the highest Youden's index were 5 and 65 for mRS 3, and the AUCs for the ROC curve were 0.796 and 0.826 for mRS 3. In the community group, LS cutoff scores with the highest sum of sensitivity and specificity were 9, 9, and 8 for mRS grades 0, 1, and 2, respectively, while the BI cutoff scores with the highest sum of sensitivity and specificity were 100, 100, and 95, respectively, while the AUCs for the ROC curve were 0.697 and 0.735 for mRS 2, 0.694 and 0.716 for mRS 1, and 0.628, and 0.660 for mRS 0. Conclusions The mRS is more precise to determine mild functional disability, whereas BI can provide more specific information on moderate and severe levels in stroke patients. Although LS was a less precise was to determine moderate and severe levels than BI, it is much simpler and more convenient to be applied to a large-scale population.
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Affiliation(s)
- Xiangxiang Liu
- Department of Rehabilitation, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
- Department of Rehabilitation, Shenzhen Dapeng New District Nan'ao People's Hospital, Shenzhen, China
| | - Mingchao Zhou
- Department of Rehabilitation, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Jingpu Zhao
- Department of Rehabilitation, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Yan Gao
- Department of Rehabilitation, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Yao Wang
- Department of Rehabilitation, Shenzhen Dapeng New District Nan'ao People's Hospital, Shenzhen, China
| | - Jing Zhou
- Department of Rehabilitation, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Li Wan
- Department of Rehabilitation, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Guohui Nie
- Department of Rehabilitation, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
- Department of Rehabilitation, Shenzhen Dapeng New District Nan'ao People's Hospital, Shenzhen, China
- Guohui Nie
| | - Yulong Wang
- Department of Rehabilitation, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
- Department of Rehabilitation, Shenzhen Dapeng New District Nan'ao People's Hospital, Shenzhen, China
- *Correspondence: Yulong Wang
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Essers B, Van Gils A, Lafosse C, Michielsen M, Beyens H, Schillebeeckx F, Veerbeek JM, Luft AR, Kos D, Verheyden G. Evolution and prediction of mismatch between observed and perceived upper limb function after stroke: a prospective, longitudinal, observational cohort study. BMC Neurol 2021; 21:488. [PMID: 34906100 PMCID: PMC8672498 DOI: 10.1186/s12883-021-02493-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 11/09/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A previously shown 'mismatch' group of patients with good observed upper limb (UL) motor function but low perceived UL activity at six months post stroke tends to use the affected UL less in daily life than would be expected based on clinical tests, and this mismatch may also be present at 12 months. We aimed to confirm this group in another cohort, to investigate the evolution of this group from six to 12 months, and to determine factors on admission to inpatient rehabilitation and at 6 months that can discriminate between mismatch and good match groups at 12 months. METHODS Persons after stroke were recruited on rehabilitation admission and re-assessed at six and 12 months. Observed UL function was measured with the upper extremity subscale of the Fugl-Meyer Assessment (FMA-UE) and perceived UL activity by the hand subscale of the Stroke Impact Scale 3.0 (SIS-Hand). We defined mismatch as good observed UL function (FMA-UE > 50/66) but low perceived activity (SIS-Hand≤75/100). Potential discriminators at admission and 6 months (demographic characteristics, stroke characteristics, UL somatosensory function, cognitive deficits, mental function and activity) were statistically compared for match and mismatch groups at 12 months. RESULTS We included 60 participants (female: 42%) with mean (SD) age of 65 (12) years. We confirmed a mismatch group of 11 (18%) patients at 6 months, which increased to 14 (23%) patients at 12 months. In the mismatch group compared to the good match group at 12 months, patients had a higher stroke severity and more somatosensory impairments on admission and at 6 months. CONCLUSIONS We confirmed a group of patients with good observed UL function but low perceived activity both at six and at 12 months post stroke. Assessment of stroke severity and somatosensory impairments on admission into rehabilitation could determine mismatch at 12 months and might warrant intervention. However, large differences in clinical outcomes between patients in the mismatch group indicate the importance of tailoring training to the individual needs.
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Affiliation(s)
- Bea Essers
- Department of Rehabilitation Sciences, KU Leuven, Tervuursevest 101 box 1501, 3001, Leuven, Belgium.
| | - Annick Van Gils
- Department of Rehabilitation Sciences, KU Leuven, Tervuursevest 101 box 1501, 3001, Leuven, Belgium
| | - Christophe Lafosse
- Department of Allied Health and Department of Research, Rehabilitation Hospital RevArte, Antwerp, Belgium
| | - Marc Michielsen
- Rehabilitation Campus Sint Ursula, Jessa Hospital, Hasselt, Belgium
| | - Hilde Beyens
- Department of Physical Medicine and Rehabilitation, University Hospitals Leuven, Leuven, Belgium
| | - Fabienne Schillebeeckx
- Department of Physical Medicine and Rehabilitation, University Hospitals Leuven, Leuven, Belgium
| | | | - Andreas R Luft
- Division of Vascular Neurology and Neurorehabilitation, Department of Neurology, University of Zurich and University Hospital Zurich, Zurich, Switzerland
- Cereneo, Center for Neurology and Rehabilitation, Vitznau, Switzerland
| | - Daphne Kos
- Department of Rehabilitation Sciences, KU Leuven, Tervuursevest 101 box 1501, 3001, Leuven, Belgium
| | - Geert Verheyden
- Department of Rehabilitation Sciences, KU Leuven, Tervuursevest 101 box 1501, 3001, Leuven, Belgium
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Khaw J, Subramaniam P, Abd Aziz NA, Ali Raymond A, Wan Zaidi WA, Ghazali SE. Current Update on the Clinical Utility of MMSE and MoCA for Stroke Patients in Asia: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18178962. [PMID: 34501552 PMCID: PMC8431226 DOI: 10.3390/ijerph18178962] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 08/10/2021] [Accepted: 08/19/2021] [Indexed: 11/16/2022]
Abstract
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.
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Affiliation(s)
- Julia Khaw
- Clinical Psychology and Behavioral Health Program, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur 50300, Malaysia; (J.K.); (S.E.G.)
| | - Ponnusamy Subramaniam
- Clinical Psychology and Behavioral Health Program, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur 50300, Malaysia; (J.K.); (S.E.G.)
- Centre for Healthy Ageing and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur 50300, Malaysia
- Correspondence:
| | - Noor Azah Abd Aziz
- Department of Family Medicine, Universiti Kebangsaan Malaysia Medical Centre, Bandar Tun Razak, Kuala Lumpur 56000, Malaysia;
| | - Azman Ali Raymond
- Neurology Unit, Department of Internal Medicine, Universiti Teknologi MARA, Shah Alam, Selangor 40450, Malaysia;
| | - Wan Asyraf Wan Zaidi
- Neurology Unit, Department of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Bandar Tun Razak, Kuala Lumpur 56000, Malaysia;
| | - Shazli Ezzat Ghazali
- Clinical Psychology and Behavioral Health Program, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur 50300, Malaysia; (J.K.); (S.E.G.)
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Ahmed U, Karimi H, Gilani SA, Ahmad A. Translation and validation of the stroke impact scale 3.0 into urdu for Pakistan. NeuroRehabilitation 2021; 49:391-402. [PMID: 34420984 DOI: 10.3233/nre-210064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The Stroke Impact Scale version 3.0 (SIS 3.0) is a self-reported outcome measure designed to assess quality of life (QoL) following a stroke. Although the psychometric properties of the SIS 3.0 are identified as superior to the generic QoL scales, it has not been translated and tested in Pakistan. OBJECTIVE To validate the Urdu version of the SIS 3.0 (USIS 3.0) for Pakistan. METHODS A prospective cohort of 116 patients with mild to moderate stroke reported their recovery using the USIS 3.0. The patients were concurrently assessed on the established tools to assess the validity and were re-evaluated to determine the test-retest reliability, precision, minimal detectable change (MDC), and minimal clinically important difference (MCID). RESULTS The reliability and internal consistency of USIS were satisfactory except for the emotion domain. The correlations of USIS with the established tools were strong. The discriminant validity was also significant across the levels of the modified Rankin scale (MRS). Only hand function and communication domains exhibited significant floor and ceiling effects, respectively. Regarding weighted K, values ranged from 0.53 to 0.88. CONCLUSIONS The USIS 3.0 has satisfactory psychometric properties and can be used in clinical and research settings for stroke survivors.
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Affiliation(s)
- Umair Ahmed
- University Institute of Physical Therapy, The University of Lahore, Pakistan
| | - Hossein Karimi
- University Institute of Physical Therapy, The University of Lahore, Pakistan
| | - Syed Amir Gilani
- Faculty of Allied Health Sciences, The University of Lahore, Pakistan
| | - Ashfaq Ahmad
- Faculty of Allied Health Sciences, The University of Lahore, Pakistan
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Slenders J, Van den Berg-Vos R, Visser-Meily J, van Heugten C, Kwa V. Screening and follow-up care for cognitive and emotional problems after transient ischaemic attack and ischaemic stroke: a national, cross-sectional, online survey among neurologists in the Netherlands. BMJ Open 2021; 11:e046316. [PMID: 34385237 PMCID: PMC8362736 DOI: 10.1136/bmjopen-2020-046316] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND After stroke, many patients experience cognitive and/or emotional problems. While national guidelines recommend screening for these problems, actual screening rates might be limited. OBJECTIVE This study aimed to examine the clinical practice at neurology departments regarding screening, information provision and follow-up care for cognitive and emotional problems after transient ischaemic attack (TIA) and ischaemic stroke. METHODS A nationwide, cross-sectional, online survey was conducted between October 2018 and October 2019 among neurologists in all hospitals in the Netherlands. RESULTS Neurologists in 78 hospitals were invited to join the survey, and 52 (67%) of them completed it. Thirty-one (59%) neurologists reported that screening for cognitive problems after TIA and ischaemic stroke was mostly or always performed. When cognitive screening was performed, 42 (84%) used validated screening instruments. Twenty-nine (56%) of the respondents reported that screening for emotional problems was mostly or always performed. When emotional screening was performed, 31 (63%) reported using validated screening instruments. Timing of screening and information provision was highly variable, and the majority reported that there was no protocol for follow-up care when cognitive or emotional problems were found. CONCLUSIONS This study demonstrates that clinical practice at neurology departments is highly variable regarding screening, information provision and follow-up care for cognitive and emotional problems in patients after TIA or ischaemic stroke. Approximately half of the participating neurologists reported that screening was performed only sometimes or never for cognitive and emotional problems after TIA and ischaemic stroke.
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Affiliation(s)
| | - Renske Van den Berg-Vos
- Neurology, OLVG, Amsterdam, The Netherlands
- Neurology, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Johanna Visser-Meily
- Department of Rehabilitation, Physical Therapy Science & Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - Caroline van Heugten
- Department of Neuropsychology & Psychopharmacology, Maastricht University, Maastricht, The Netherlands
- School for Mental Health & Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
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Martin NH, Cornish B, Browning S, Simister R, Werring DJ, Cipolotti L, Chan E. The neuropsychology needs of a hyper-acute stroke unit. J Neurol Sci 2021; 423:117382. [PMID: 33714086 DOI: 10.1016/j.jns.2021.117382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 02/03/2021] [Accepted: 02/26/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND AND AIM Guidelines recommend routine assessment and management of mood and cognition after stroke, but little is known about the value or feasibility of providing neuropsychology input during the hyper-acute period. We aimed to identify and describe the extent and nature of neuropsychological needs and to investigate the feasibility of providing direct neuropsychology input within a hyper-acute setting. METHODS Over a 7-month period, Multidisciplinary Team (MDT) members of a central London Hyper-Acute Stroke Unit (HASU) identified stroke patients who they believed would benefit from neuropsychology input, and categorised the nature of neuropsychology intervention required. We examined the demographic and clinical characteristics of the patients identified and the type of intervention required. RESULTS 23% of patients (101/448) were identified as requiring neuropsychology input. Patients deemed to require input were younger, more likely to be male and more functionally disabled than those not requiring input. Cognitive assessment was the main identified need (93%) followed by mood (29%) and family support (9%). 30% of patients required two types of intervention. During a pilot of neuropsychology provision, 17 patients were seen; 15 completed a full cognitive assessment. All patients assessed presented with cognitive impairment despite three being deemed cognitively intact (> standardised cut-off) using a cognitive screening tool. CONCLUSION We showed that direct neuropsychology input on a HASU is necessary for complex and varied interventions involving cognition, mood and family support. Furthermore, input is feasible and useful in detecting cognitive impairment not revealed by screening instruments.
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Affiliation(s)
- Naomi H Martin
- Department of Neuropsychology, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK.
| | - Bronwyn Cornish
- Occupational Therapy Department, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK.
| | - Simone Browning
- Comprehensive Stroke Service, University College London Hospitals NHS Trust, London, UK; Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, National Hospital for Neurology and Neurosurgery, Russell Square House, London, UK.
| | - Robert Simister
- Comprehensive Stroke Service, University College London Hospitals NHS Trust, London, UK; Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, National Hospital for Neurology and Neurosurgery, Russell Square House, London, UK.
| | - David J Werring
- Comprehensive Stroke Service, University College London Hospitals NHS Trust, London, UK; Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, National Hospital for Neurology and Neurosurgery, Russell Square House, London, UK.
| | - Lisa Cipolotti
- Department of Neuropsychology, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK; Comprehensive Stroke Service, University College London Hospitals NHS Trust, London, UK; Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, National Hospital for Neurology and Neurosurgery, Russell Square House, London, UK.
| | - Edgar Chan
- Department of Neuropsychology, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK; Comprehensive Stroke Service, University College London Hospitals NHS Trust, London, UK; Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, National Hospital for Neurology and Neurosurgery, Russell Square House, London, UK.
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D'Souza CE, Greenway MRF, Graff-Radford J, Meschia JF. Cognitive Impairment in Patients with Stroke. Semin Neurol 2021; 41:75-84. [PMID: 33418591 DOI: 10.1055/s-0040-1722217] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Despite substantial advances in stroke care, vascular cognitive impairment remains a prominent source of disability. Unlike sensorimotor impairments, cognition often continues to decline after stroke. An aging population will increase the prevalence of vascular cognitive impairment, with stroke playing an important role. Ten percent of patients presenting with stroke have pre-stroke dementia; an additional 10% will develop incident dementia with a first stroke, and 30% with a recurrent stroke. While stroke increases the risk of cognitive impairment, the presence of cognitive impairment also impacts acute stroke treatment and increases risk of poor outcome by nearly twofold. There is substantial overlap in the clinical and pathological aspects of vascular and degenerative dementias in many patients. How they relate to one another is controversial. The treatment of vascular cognitive impairment remains supportive, focusing on treating vascular risk factors. Cognitive rehabilitation after stroke is an area of active research, and existing pharmacologic treatments have limited benefit. Heightened awareness of cognitive impairment in the setting of stroke is imperative for prognostication and management, impetus for research and, ultimately, the discovery of efficacious treatments.
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Affiliation(s)
- Caitlin E D'Souza
- Department of Neurology, Mayo Clinic Florida, Jacksonville, Florida.,Department of Neurology, Baptist Health, Jacksonville, Florida
| | | | | | - James F Meschia
- Department of Neurology, Mayo Clinic Florida, Jacksonville, Florida
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Comparison of Oxford Cognitive Screen and Montreal Cognitive Assessment feasibility in the stroke unit setting. A pilot study. CEREBRAL CIRCULATION - COGNITION AND BEHAVIOR 2021; 2:100021. [PMID: 36324706 PMCID: PMC9616334 DOI: 10.1016/j.cccb.2021.100021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 06/27/2021] [Accepted: 06/28/2021] [Indexed: 11/22/2022]
Abstract
MoCA and OCS are brief tools to assess cognition in stroke patients. We found good agreement between MoCA and OCS measures. MoCA and OCS were feasible in the stroke unit setting. Qualitative information related to the patients and setting were registered. We found high level of acceptability by patients for both tests.
Background : Cognitive status evaluation is not routine in the acute stroke setting and there is no consensus on which neuropsychological tool is more feasible and informative. The aim of this pilot study was to compare the feasibility and acceptability of two brief cognitive tests, the Montreal Cognitive Assessment (MoCA) and the Oxford Cognitive Screen (OCS), in acute stroke, with a focus on patients' experience, administration time, and the cognitive data obtained. Methods : Patients with a diagnosis of ischemic or hemorrhagic stroke or of transient ischemic attack admitted to two stroke units were included. The sample consisted of 34 participants (mean age ±SD 71.1 ± 16.1 years, 25 males). Within five days of onset, patients were evaluated by means of the MoCA and OCS by a trained neuropsychologist. Results Both tests were feasible in the stroke unit setting and had a high level of acceptability by patients. MoCA test was fully completed by 25 patients, OCS by 21 patients. The OCS administration time was longer than that of the MoCA. However, OCS was perceived less demanding than MoCA by patients. Twenty patients completed both the MoCA and the OCS entirely, and only 2 of them did not show any impairment in both tests. Seventeen patients showed at least an impaired domain on the OCS and 15 patients presented with a MoCA global score below cut-off for cognitive impairment. Conclusions Our preliminary study did not show a superiority of the OCS over the widely used MoCA, and suggests the need for further validation in larger samples of stroke patients, exploring tests accuracy in detecting cognitive post-stroke impairment.
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Stolwyk RJ. Cognitive Screening Following Stroke: Are We Following Best Evidence‐based Practice in Australian Clinical Settings? AUSTRALIAN PSYCHOLOGIST 2020. [DOI: 10.1111/ap.12191] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Screening Versus Brief Domain-specific Tests to Assess Long-term Postoperative Cognitive Dysfunction After Concomitant Aortic Valve Replacement and Coronary Artery Bypass Grafting. J Cardiovasc Nurs 2020; 34:511-516. [PMID: 31365446 DOI: 10.1097/jcn.0000000000000596] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although postoperative cognitive dysfunction is a relevant complication after surgery, assessment for the condition is not routine in clinical practice. OBJECTIVE The aim of this study was to compare the use of screening versus brief domain-specific cognitive tests in assessing long-term cognitive dysfunction after concomitant aortic valve replacement and coronary artery bypass grafting. METHODS In this observational prospective study, we evaluated 70 patients preoperatively and after 1, 6, and 12 months using 2 screening tests (Mini-Mental State Examination and Clock Drawing Test) and 2 brief domain-specific cognitive tests (Trail Making Test to evaluate attention and executive function, and Semantic and Phonological Tests to evaluate verbal fluency). RESULTS The brief domain-specific cognitive tests detected significant postoperative worsening in performances (up to 19% on the Trail Making Test and 15.4% on verbal fluency tests at 6 months). Postoperative mild attention/executive dysfunction or inferior normal performance was detected with the maximums being seen at 6 months (44.6%, P < .001). Performances on screening tests did not significantly change during the study period. CONCLUSIONS A brief domain-specific cognitive evaluation could be routinely implemented in perioperative care practice to detect postoperative cognitive dysfunction.
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Domensino AF, van Haastregt JCM, Winkens I, van Bennekom CAM, van Heugten CM. Feasibility of a minimal dataset for adults with acquired brain injury in Dutch healthcare practice. PLoS One 2020; 15:e0235085. [PMID: 32569269 PMCID: PMC7307757 DOI: 10.1371/journal.pone.0235085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 06/08/2020] [Indexed: 11/18/2022] Open
Abstract
Objective Data collection in the field of acquired brain injury (ABI) lacks uniformity due to the broad spectrum of available measurement instruments, leading to incomparability of data and the need for patients to ‘repeat their story’. To pursue uniform data collection, an ABI-specific minimal dataset (MDS-ABI) is currently under development. The current study aimed to assess the feasibility (performance according to protocol, user opinion, potential implementation barriers, and suggested improvements) of the MDS-ABI in clinical settings. Methods A mixed-methods approach was used in a range of healthcare sectors for persons with ABI. Clinicians of several relevant disciplines within these sectors were asked to administer the MDS-ABI to five patients. Subsequently, feasibility according to clinicians was assessed by means of a paper questionnaire about every administration and an online questionnaire about the feasibility in general. Feasibility according to patients was assessed with a paper questionnaire and think aloud interviews. Results Thirteen clinicians and 50 patients were included. In general, the MDS-ABI performed according to protocol. Both clinicians and patients were overall satisfied with the content of the MDS-ABI. The Cumulative Illness Rating Scale was regarded incomprehensible, leading to missing data. Further, clinicians indicated that the MDS-ABI would not be suitable for all ABI-patients, as some are incapable of self-report due to potential cognitive problems, communicative problems, fatigue, perceptual problems, or impaired awareness of deficits. Conclusion The MDS-ABI is a promising tool for obtaining core information on ABI-patients. The MDS-ABI will be adjusted according to the suggestions. For patients who are incapable of self-report, a proxy-reported version of the self-reported part was developed.
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Affiliation(s)
- Anne-Fleur Domensino
- School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Center, Maastricht, The Netherlands
- Limburg Brain Injury Center, Maastricht, The Netherlands
- * E-mail: ,
| | - Jolanda C. M. van Haastregt
- Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Ieke Winkens
- Limburg Brain Injury Center, Maastricht, The Netherlands
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Coen A. M. van Bennekom
- Department of Research and Development, Heliomare Rehabilitation Center, Wijk aan Zee, The Netherlands
- Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, location AMC, The Netherlands
| | - Caroline M. van Heugten
- School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Center, Maastricht, The Netherlands
- Limburg Brain Injury Center, Maastricht, The Netherlands
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
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Recombinant Human Growth Hormone Ameliorates Cognitive Impairment in Stroke Patients. J Comput Assist Tomogr 2020; 44:255-261. [PMID: 32195805 DOI: 10.1097/rct.0000000000000990] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE We aimed to determine the effects of recombinant human growth hormone (rhGH) replacement on cognitive function in subjects with poststroke cognitive impairment using resting-state functional magnetic resonance imaging. METHODS We included 60 patients with a first-ever stroke for 3 months and a diagnosis of cognitive impairment who were randomized 1:1 to receive either rhGH subcutaneously or placebo injection for 6 months. All subjects were required to receive the same rehabilitative therapy program. Both groups were subjected to pretreatment and posttreatment neuropsychological assessment using the Montreal Cognitive Assessment, serum neurotrophic factors, biomarkers of glucose and lipid metabolism, and functional magnetic resonance imaging during 6 months of the study period. The pattern of brain activity was determined by examining the functional connectivity and amplitude of low-frequency fluctuations (ALFF) of blood oxygen level dependent signal. RESULTS Forty-three (82.7%) completed the study. Treatment with rhGH reduced levels of triglycerides and low-density lipoprotein cholesterol but did not significantly altered plasma concentrations of glucose and glycated hemoglobin. We found a significant increase in serum insulin-like growth factor 1 levels (32.6%; P < 0.001) in the rhGH-treated group compared with that in the controls. After 6 months of rhGH treatment, mean Montreal Cognitive Assessment score improved from 16.31 (5.32) to 21.19 (6.54) (P < 0.001). The rhGH group showed significant increased area of activation with increased ALFF values in the regions of the frontal lobe, putamen, temporal lobe, and thalamus (P < 0.05), relative to the baseline conditions. The correlation analysis revealed that the ALFF and functional connectivity of default mode network was positively correlated with the ΔMoCA score and ΔIGF-1 levels; that is, the more the scale score increased, the higher the functional connection strength. No undesirable adverse effects were observed. CONCLUSIONS The rhGH replacement has a significant impact on global and domain cognitive functions in poststroke cognitive impairment.
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Chan E, Garritsen E, Altendorff S, Turner D, Simister R, Werring DJ, Cipolotti L. Additional Queen Square (QS) screening items improve the test accuracy of the Montreal Cognitive Assessment (MoCA) after acute stroke. J Neurol Sci 2019; 407:116442. [PMID: 31677556 DOI: 10.1016/j.jns.2019.116442] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 08/28/2019] [Accepted: 08/30/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND The Montreal Cognitive Assessment (MoCA) is a popular cognitive screening tool used in stroke, but lacks sensitivity for detecting impairment in stroke-relevant domains of processing speed, non-verbal memory and executive functions. Our aim was to assess whether the test accuracy of the MoCA can be improved with additional tailored screening items targeting these three domains. METHODS We included 196 patients admitted to an acute stroke unit at the National Hospital for Neurology and Neurosurgery, Queen Square (QS), London. Participants completed the MoCA as well as a series of additional QS-screening items designed to assess speed of processing, non-verbal memory and executive functions. Performance on the MoCA and QS screening items was compared with performance on "gold standard" neuropsychological assessment. RESULTS In our sample, 22% of patients were classified as "cognitively intact" on the traditional MoCA alone (≥ 25). However, when tested on the QS-screening items, 40% of these patients failed on speed of processing, 56% failed on non-verbal memory and 26% failed on executive functions. Compared with neuropsychological assessment, the QS-screening items had good sensitivity (QS-Speed: 0.85; QS-Vis: 0.71; QS-EF: 0.73) and modest specificity (QS-Speed: 0.59; QS-Vis: 0.39; QS-EF: 0.54), regardless of stroke lateralisation. CONCLUSION Additional screening items detected impairments in speed of processing, non-verbal memory and executive functions over and above those captured using the standard MoCA. The use of these QS-screening items improves the detection of post-stroke cognitive deficits in domains not adequately covered by the standard MoCA.
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Affiliation(s)
- Edgar Chan
- National Hospital for Neurology and Neurosurgery, Dept. of Neuropsychology, London, United Kingdom; UCL Queen Square Institute of Neurology, Stroke Research Centre, London, United Kingdom.
| | - Eva Garritsen
- UCL Queen Square Institute of Neurology, Stroke Research Centre, London, United Kingdom
| | - Samantha Altendorff
- National Hospital for Neurology and Neurosurgery, Dept. of Neuropsychology, London, United Kingdom
| | - David Turner
- Comprehensive Stroke Service, University College London Hospital, London, United Kingdom
| | - Robert Simister
- UCL Queen Square Institute of Neurology, Stroke Research Centre, London, United Kingdom; Comprehensive Stroke Service, University College London Hospital, London, United Kingdom
| | - David J Werring
- UCL Queen Square Institute of Neurology, Stroke Research Centre, London, United Kingdom; Comprehensive Stroke Service, University College London Hospital, London, United Kingdom
| | - Lisa Cipolotti
- National Hospital for Neurology and Neurosurgery, Dept. of Neuropsychology, London, United Kingdom; UCL Queen Square Institute of Neurology, Stroke Research Centre, London, United Kingdom
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Comparing face-to-face and videoconference completion of the Montreal Cognitive Assessment (MoCA) in community-based survivors of stroke. J Telemed Telecare 2019; 27:484-492. [DOI: 10.1177/1357633x19890788] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction Videoconferencing may help address barriers associated with poor access to post-stroke cognitive screening. However, the equivalence of videoconference and face-to-face administrations of appropriate cognitive screening tools needs to be established. We compared face-to-face and videoconference administrations of the Montreal Cognitive Assessment (MoCA) in community-based survivors of stroke. We also evaluated whether participant characteristics (e.g. age) influenced equivalence. Methods We used a randomised crossover design (two-week interval). Participants were recruited through community advertising and use of a stroke-specific database. Both sessions were conducted by the same researcher in the same location. Videoconference sessions were conducted using Zoom. A repeated-measures t-test, intraclass correlation coefficient (ICC), Bland–Altman plot and multivariate regression modelling were used to establish equivalence. Results Forty-eight participants (26 men, Mage = 64.6 years, standard deviation ( SD) = 10.1; Mtime since stroke = 5.2 years, SD = 4.0) completed the MoCA face-to-face and via videoconference on average 15.8 ( SD = 9.7) days apart. Participants did not perform systematically better in a particular condition, and no participant variable predicted difference in MoCA performance. However, the ICC was low (0.615), and the Bland–Altman plot indicated wide limits of agreement, indicating variability between sessions. Discussion Our findings provide preliminary evidence to support the use of videoconference to administer the MoCA following stroke. However, further research into the test–retest reliability of scores derived from the MoCA is needed in this population. Administering the MoCA via videoconference holds potential to ensure that all stroke survivors undergo cognitive screening, in line with recommended clinical practice.
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Saa JP, Tse T, Baum C, Cumming T, Josman N, Rose M, Carey L. Longitudinal evaluation of cognition after stroke - A systematic scoping review. PLoS One 2019; 14:e0221735. [PMID: 31465492 PMCID: PMC6715188 DOI: 10.1371/journal.pone.0221735] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 08/13/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Cognitive impairment affects up to 80 percent of the stroke population, however, both the available evidence about post-stroke cognition and the measures used to evaluate it longitudinally have not been well described. The aims of this systematic scoping review were: to identify and characterize studies evaluating cognition longitudinally after stroke; to summarize the cognitive instruments used and the domains they target; and to organize cognitive domains assessed using the International Classification of Functioning, Disability and Health (ICF). METHODS We used a systematic scoping approach to search for peer-reviewed articles involving adults with stroke that evaluated cognition longitudinally. Screening of titles, abstracts, and full reports was completed independently by two reviewers, across six electronic databases (PubMed, PsycInfo, Medline, Cinahl Plus, Embase, and Web of Science). Cognitive domains were mapped to an ICF function independently by the same two reviewers, using a previously tested, standardized approach. RESULTS A total of 5,540 records were found; 257 were included, representing a total pooled sample of 120,860 stroke survivors. Of these studies, 200 (78%) provided specific cognitive outcomes from the longitudinal evaluations, 57 (22%) reported model predictions, and 77 (30%) included interventions. Cognition was evaluated with 356 unique instruments, targeting 95 distinct cognitive domains, and 17 mental functions from the ICF. The Mini-Mental State Examination was the most frequently used instrument (117 reports, 46%). Other tools used longitudinally were the Trail Making Test (17% of reports), tests of verbal fluency (14%), the Functional Independence Measure (14%), the Montreal Cognitive Assessment (13%), the Digit Span (11%), and the Stroop test (10%). Global cognition was evaluated in 170 reports (66%), followed by higher-level cognitive functioning (29%), memory (28%), language (21%), attention (21%), and perceptual skills (14%). Studies using functional (or performance-based) cognitive assessments over time were scarce (< 1%). CONCLUSION Our findings indicate that whilst there is a substantial number of studies available that report longitudinal evaluations of cognition after stroke, there is large variability in the measures used and the cognitive domains they target. Nonetheless, the available data for evaluation of cognition over time after stroke can be organized and described systematically.
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Affiliation(s)
- Juan Pablo Saa
- Occupational Therapy, School of Allied Health, Human Services and Sport, College of Science Health and Engineering, La Trobe University, Melbourne, Australia
- Neurorehabilitation and Recovery, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia
- Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia
- * E-mail:
| | - Tamara Tse
- Occupational Therapy, School of Allied Health, Human Services and Sport, College of Science Health and Engineering, La Trobe University, Melbourne, Australia
| | - Carolyn Baum
- Occupational Therapy, Washington University School of Medicine, Saint Louis, Missouri, United States of America
- George Warren Brown School of Social Work, Washington University in Saint Louis, Saint Louis, Missouri, United States of America
| | - Toby Cumming
- Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia
| | - Naomi Josman
- Department of Occupational Therapy, University of Haifa, Haifa, Israel
| | - Miranda Rose
- Speech Pathology, School of Allied Health, Human Services and Sport, College of Science Health and Engineering, La Trobe University, Melbourne, Australia
| | - Leeanne Carey
- Occupational Therapy, School of Allied Health, Human Services and Sport, College of Science Health and Engineering, La Trobe University, Melbourne, Australia
- Neurorehabilitation and Recovery, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia
- Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia
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Finsterer J, Scorza FA, Scorza CA. Low Heteroplasmy Rates of Pathogenic mtDNA Variants Do Not Predict Aging. J Gerontol A Biol Sci Med Sci 2019; 74:1025-1026. [PMID: 30561522 DOI: 10.1093/gerona/gly215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Josef Finsterer
- Neurological Department, Krankenanstalt Rudolfstiftung, Vienna, Austria
| | - Fulvio A Scorza
- Disciplina de Neurociência, Escola Paulista de Medicina-Universidade Federal de São Paulo (EPM-UNIFESP), São Paulo, Brazil
| | - Carla A Scorza
- Disciplina de Neurociência, Escola Paulista de Medicina-Universidade Federal de São Paulo (EPM-UNIFESP), São Paulo, Brazil
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van Heugten C, Caldenhove S, Crutsen J, Winkens I. An overview of outcome measures used in neuropsychological rehabilitation research on adults with acquired brain injury. Neuropsychol Rehabil 2019; 30:1598-1623. [DOI: 10.1080/09602011.2019.1589533] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Caroline van Heugten
- Department of Neuropsychology & Psychopharmacology, Faculty of Psychology & Neuroscience, Maastricht University, Maastricht, Netherlands
- School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Center, Maastricht, Netherlands
- Limburg Center for Brain Injury, Maastricht, Netherlands
| | - Stephanie Caldenhove
- Department of Neuropsychology & Psychopharmacology, Faculty of Psychology & Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Joke Crutsen
- Department of Neuropsychology & Psychopharmacology, Faculty of Psychology & Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Ieke Winkens
- Department of Neuropsychology & Psychopharmacology, Faculty of Psychology & Neuroscience, Maastricht University, Maastricht, Netherlands
- Limburg Center for Brain Injury, Maastricht, Netherlands
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Merriman NA, Sexton E, McCabe G, Walsh ME, Rohde D, Gorman A, Jeffares I, Donnelly NA, Pender N, Williams DJ, Horgan F, Doyle F, Wren MA, Bennett KE, Hickey A. Addressing cognitive impairment following stroke: systematic review and meta-analysis of non-randomised controlled studies of psychological interventions. BMJ Open 2019; 9:e024429. [PMID: 30819706 PMCID: PMC6398645 DOI: 10.1136/bmjopen-2018-024429] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE Cognitive impairment is a pervasive outcome of stroke, reported in over half of patients 6 months post-stroke and is associated with increased disability and a poorer quality of life. Despite the prevalence of post-stroke cognitive impairment, the efficacy of existing psychological interventions for the rehabilitation of cognitive impairment following stroke has yet to be established. The aim of this study is to identify psychological interventions from non-randomised studies that intended to improve post-stroke cognitive function and establish their efficacy. DESIGN Systematic review and meta-analysis of non-randomised studies of psychological interventions addressing post-stroke cognitive impairment. DATA SOURCES Electronic searches were performed in the Pubmed, EMBASE and PsycINFO databases, the search dating from inception to February 2017. ELIGIBILITY CRITERIA All non-randomised controlled studies and quasi-randomised controlled trials examining psychological interventions to improve cognitive function following stroke were included, such as feasibility studies, pilot studies, experimental studies, and quasi-experimental studies. The primary outcome was cognitive function. The prespecified secondary outcomes were functional abilities in daily life and quality of life. METHODS The current meta-analyses combined the findings of seven controlled studies, examining the efficacy of psychological interventions compared with treatment-as-usual controls or active controls, and 13 one-group pre-post studies. RESULTS Results indicated an overall small effect on cognition across the controlled studies (Hedges' g=0.38, 95% CI=0.06 to 0.7) and a moderate effect on cognition across the one-group pre-post studies (Hedges' g=0.51, 95% CI=0.3 to 0.73). Specific cognitive domains, such as memory and attention also demonstrated a benefit of psychological interventions. CONCLUSIONS This review provides support for the potential of psychological interventions to improve overall cognitive function post-stroke. Limitations of the study, in terms of risk of bias and quality of included studies, and future research directions are explored. PROSPERO REGISTRATION NUMBER CRD42017069714.
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Affiliation(s)
- Niamh A Merriman
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Eithne Sexton
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Grainne McCabe
- Library, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Mary E Walsh
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
- School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Daniela Rohde
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Ashleigh Gorman
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Isabelle Jeffares
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Nora-Ann Donnelly
- Social Research Division, Economic and Social Research Institute, Dublin, Ireland
| | - Niall Pender
- Department of Psychology, Beaumont Hospital, Dublin, Ireland
| | - David J Williams
- Department of Geriatric and Stroke Medicine, Beaumont Hospital, Dublin, Ireland
- Department of Geriatric and Stroke Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Frances Horgan
- School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Frank Doyle
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Maev-Ann Wren
- Social Research Division, Economic and Social Research Institute, Dublin, Ireland
| | - Kathleen E Bennett
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Anne Hickey
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
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Cerebral microbleeds are associated with cognitive decline early after ischemic stroke. J Neurol 2019; 266:1091-1094. [PMID: 30761422 DOI: 10.1007/s00415-019-09236-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 02/02/2019] [Accepted: 02/05/2019] [Indexed: 01/23/2023]
Abstract
BACKGROUND AND PURPOSE The present study aimed to investigate whether cerebral microbleeds (CMB) are associated with vascular cognitive decline (VCD) already in the early course after ischemic stroke, and-if so-whether distinct cognitive domains are affected more preferentially by CMB. METHODS In a prospective cohort study, cognitive performance was examined in 33 stroke patients showing ≥ 1 CMB on MRI. Matched for age, gender, clinical and radiological characteristics, 33 stroke survivors without CMB served as a control group. Neuropsychological testing was performed in both groups six months after the index event using the Consortium to Establish a Registry for Alzheimer's Disease (CERAD)-plus test battery. RESULTS CMB-positive stroke patients showed more severe cognitive decline in mini mental state test compared to the control group (p = 0.024). Regarding the episodic memory, CMB-positive patients reached lower scores in Word-List-Learning- (p = 0.009) and the Word-List-Recognition-test (p = 0.006), whereas the findings in Word-List-Recall-test were similar in both groups. While semantic fluency is not more affected in CMB-positive than in CMB-negative patients, those with CMB reveal a significantly impaired phonemic fluency (p = 0.007). Concerning the visuospatial abilities, stroke patients with CMB showed restricted recall of recently learned visual information. Only slight differences between both groups were found in any test investigating the participants' executive functions. CONCLUSION Cognitive abilities are more severely impaired in CMB-positive stroke patients compared to CMB-free controls, whereby memory-associated functions are most affected. CMB might be associated with post-stroke cognitive decline, particularly with impaired memory and phonemic fluency.
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Simpson S, Kaehne A, Martlew J, Kelly C. Exploring the effectiveness of a screening measure to identify subtle cognitive and functional problems in a sample of acquired brain injury patients admitted to a neurological hospital in the UK: A feasibility study. COGENT PSYCHOLOGY 2019. [DOI: 10.1080/23311908.2019.1667191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Affiliation(s)
- S. Simpson
- The Walton Centre NHS Foundation Trust, Liverpool, UK
| | | | - J. Martlew
- The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - C. Kelly
- Edge Hill University, Ormskirk, UK
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Nakaoku Y, Oishi N, Hase Y, Hase M, Saito S, Mitsueda T, Matsui M, Toyoda K, Nagatsuka K, Kalaria RN, Fukuyama H, Ihara M, Takahashi R. Montreal Cognitive Assessment score correlates with regional cerebral blood flow in post-stroke patients. Clin Neurol Neurosurg 2018; 174:68-74. [DOI: 10.1016/j.clineuro.2018.09.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 08/28/2018] [Accepted: 09/03/2018] [Indexed: 12/21/2022]
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Mole JA, Demeyere N. The relationship between early post-stroke cognition and longer term activities and participation: A systematic review. Neuropsychol Rehabil 2018; 30:346-370. [DOI: 10.1080/09602011.2018.1464934] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Joseph A. Mole
- Oxford Institute of Clinical Psychology Training, University of Oxford, Oxford, UK
- Cognitive Neuropsychology Centre, Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Nele Demeyere
- Cognitive Neuropsychology Centre, Department of Experimental Psychology, University of Oxford, Oxford, UK
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Diagnostic test accuracy of the Montreal Cognitive Assessment in the detection of post-stroke cognitive impairment under different stages and cutoffs: a systematic review and meta-analysis. Neurol Sci 2018; 39:705-716. [DOI: 10.1007/s10072-018-3254-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 01/13/2018] [Indexed: 10/18/2022]
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Jaywant A, Toglia J, Gunning FM, O'Dell MW. The diagnostic accuracy of the Montreal Cognitive Assessment in inpatient stroke rehabilitation. Neuropsychol Rehabil 2017; 29:1163-1176. [PMID: 28920528 DOI: 10.1080/09602011.2017.1372297] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The Montreal Cognitive Assessment (MoCA) is a commonly used screening measure for cognitive impairment; however, the diagnostic accuracy and optimal cutoff points in inpatients with mild stroke severity is unknown. We examined the diagnostic accuracy of the MoCA in an acute inpatient stroke rehabilitation unit (N = 95). The criterion neuropsychological assessment was the 30-minute National Institute of Neurological Disorders and Stroke-Canadian Stroke Network battery, modified to include the Symbol-Digit Modalities Test and Trail Making Test A & B. The MoCA had moderately strong diagnostic accuracy in receiver operating curve analyses, with areas under the curve ranging from .80 to .89 depending on the threshold for defining cognitive impairment. Sensitivity ranged from .72 to .87, and was generally greater than specificity, which ranged from .60 to .81. The optimal cutoff on the MoCA for detecting mild or greater cognitive impairment was <25/30. The optimal cutoff using more conservative definitions of cognitive impairment ranged from <23-24/30. Exploratory analyses of MoCA subgroups ("normal," "mildly impaired," and "functionally impaired") differed in the frequency and magnitude of impairment on the criterion neuropsychological assessment. These findings inform the clinical use of the MoCA in individuals with mild stroke in an inpatient rehabilitation setting.
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Affiliation(s)
- Abhishek Jaywant
- a Department of Rehabilitation Medicine , Weill Cornell Medicine , New York , NY , USA.,b Department of Psychiatry , Weill Cornell Medicine , New York , NY , USA.,d NewYork-Presbyterian Hospital/Weill Cornell Medical Center , New York , NY , USA
| | - Joan Toglia
- a Department of Rehabilitation Medicine , Weill Cornell Medicine , New York , NY , USA.,c School of Health and Natural Sciences , Mercy College , Dobbs Ferry , NY , USA.,d NewYork-Presbyterian Hospital/Weill Cornell Medical Center , New York , NY , USA
| | - Faith M Gunning
- b Department of Psychiatry , Weill Cornell Medicine , New York , NY , USA.,d NewYork-Presbyterian Hospital/Weill Cornell Medical Center , New York , NY , USA
| | - Michael W O'Dell
- a Department of Rehabilitation Medicine , Weill Cornell Medicine , New York , NY , USA.,d NewYork-Presbyterian Hospital/Weill Cornell Medical Center , New York , NY , USA
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Lilja G, Blennow Nordström E. What you ask for is what you get: A practical approach for early cognitive screening and the potential for individualized support after cardiac arrest. Resuscitation 2017; 116:A5-A6. [PMID: 28501591 DOI: 10.1016/j.resuscitation.2017.05.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 05/03/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Gisela Lilja
- Lund University, Skane University Hospital, Department of Clinical Sciences, Neurology, Lund, Sweden.
| | - Erik Blennow Nordström
- Lund University, Skane University Hospital, Department of Clinical Sciences, Neurology, Lund, Sweden
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Toglia J, Askin G, Gerber LM, Taub MC, Mastrogiovanni AR, O'Dell MW. Association Between 2 Measures of Cognitive Instrumental Activities of Daily Living and Their Relation to the Montreal Cognitive Assessment in Persons With Stroke. Arch Phys Med Rehabil 2017; 98:2280-2287. [PMID: 28478128 DOI: 10.1016/j.apmr.2017.04.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 03/28/2017] [Accepted: 04/08/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To explore the relation between a computer adaptive functional cognitive questionnaire and a performance-based measure of cognitive instrumental activities of daily living (C-IADL) and to determine whether the Montreal Cognitive Assessment (MoCA) at admission can identify those with C-IADL difficulties at discharge. DESIGN Prospective cohort study. SETTING Acute inpatient rehabilitation unit of an academic medical center. PARTICIPANTS Inpatients (N=148) with a diagnosis of stroke (mean age, 68y; median, 13d poststroke) who had mild cognitive and neurological deficits. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Admission cognitive status was assessed by the MoCA. C-IADL at discharge was assessed by the Executive Function Performance Test (EFPT) bill paying task and Activity Measure of Post-Acute Care (AM-PAC) Applied Cognition scale. RESULTS Greater cognitive impairment on the MoCA was associated with more assistance on the EFPT bill paying task (ρ=-.63; P<.01) and AM-PAC Applied Cognition scale (ρ=-.43; P<.01). This relation was nonsignificant for higher MoCA scores and EFPT bill paying task scores. The AM-PAC Applied Cognition scale and the EFPT bill paying task had low agreement in classifying functional performance (Cohen's κ=.20). A receiver operating characteristic curve identified optimal MoCA cutoff scores of 20 and 21 for classifying EFPT bill paying task status and AM-PAC Applied Cognition scale status, respectively. For values above 20 and 21, sensitivity increased whereas specificity decreased for classifying functional deficits. Approximately one third of the participants demonstrated C-IADL deficits on at least 1 C-IADL measure at discharge despite having a MoCA score of ≥26 at admission. CONCLUSIONS Questionnaire and performance-based methods of assessment appear to yield different estimates of C-IADL. Low MoCA scores (<20) are more likely to identify those with C-IADL deficits on the EFPT bill paying task. The results suggest that C-IADL should be assessed in those who have mild or no cognitive difficulties at admission.
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Affiliation(s)
- Joan Toglia
- School of Health and Natural Sciences, Mercy College, Dobbs Ferry, NY; Department of Rehabilitation Medicine, NewYork-Presbyterian/Weill Cornell Medical Center, New York, NY.
| | - Gulce Askin
- Department of Healthcare Policy & Research, Weill Cornell Medical College, New York, NY
| | - Linda M Gerber
- Department of Healthcare Policy & Research, Weill Cornell Medical College, New York, NY
| | | | - Andrea R Mastrogiovanni
- Department of Rehabilitation Medicine, NewYork-Presbyterian/Weill Cornell Medical Center, New York, NY
| | - Michael W O'Dell
- Department of Rehabilitation Medicine, NewYork-Presbyterian/Weill Cornell Medical Center, New York, NY; Weill Cornell Medicine, New York, NY
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Tan HH, Xu J, Teoh HL, Chan BPL, Seet RCS, Venketasubramanian N, Sharma VK, Chen CLH, Dong Y. Decline in changing Montreal Cognitive Assessment (MoCA) scores is associated with post-stroke cognitive decline determined by a formal neuropsychological evaluation. PLoS One 2017; 12:e0173291. [PMID: 28346532 PMCID: PMC5367691 DOI: 10.1371/journal.pone.0173291] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 02/17/2017] [Indexed: 11/18/2022] Open
Abstract
Objectives We aimed to examine changes in the Montreal Cognitive Assessment (MoCA) and Mini-Mental State Examination (MMSE) scores within a one-year period after stroke/transient ischemic attack (TIA) in associating cognitive decline determined by a formal neuropsychological test battery. Methods Patients with ischemic stroke/TIA received MoCA and MMSE at baseline within 14 days after stroke/TIA, at 3–6 months and 1-year follow-ups. The scores of MoCA and MMSE were considered to have declined if there were a reduction of ≥2 points in the respective scores measured across two time points. The decline in neuropsychological diagnosis transitional status was defined by a category transition from no cognitive impairment or any cognitive impairment to a more severe cognitive impairment or dementia. Results 275 patients with a mean age of 59.8 ± 11.6 years, and education of 7.7 ± 4.3 years completed all the assessments at baseline, 3–6 months and 1-year follow-ups. A decline in MoCA scores from 3–6 months to 1 year was associated with higher risk of decline in diagnosis transitional status (odd ratio = 3.21, p = 0.004) in the same time period whereas there was no association with a decline in MMSE scores. Conclusions The decline in MoCA scores from 3–6 months to 1 year after stroke/TIA has three times higher risk for decline in the diagnosis transitional status. The decline of MoCA scores (reduction ≥ 2points) is associated with the decline in neuropsychological diagnosis transitional status.
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Affiliation(s)
- Hui Hui Tan
- Division of Neurology, Department of Medicine, Yong Loo Lin School of Medicine, National University Health System, Singapore
| | - Jing Xu
- Singapore Clinical Research Institute, Singapore
| | - Hock Luen Teoh
- Division of Neurology, Department of Medicine, Yong Loo Lin School of Medicine, National University Health System, Singapore
| | - Bernard Poon-Lap Chan
- Division of Neurology, Department of Medicine, Yong Loo Lin School of Medicine, National University Health System, Singapore
| | - Raymond Chee Seong Seet
- Division of Neurology, Department of Medicine, Yong Loo Lin School of Medicine, National University Health System, Singapore
| | - Narayanaswarmy Venketasubramanian
- Memory Ageing and Cognition Center, Department of Pharmacology, Yong Loo Lin School of Medicine, National University Health System, Singapore
- Neuroscience Centre, Raffles Hospital, Singapore
| | - Vijay Kumar Sharma
- Division of Neurology, Department of Medicine, Yong Loo Lin School of Medicine, National University Health System, Singapore
| | - Christopher Li-Hsian Chen
- Memory Ageing and Cognition Center, Department of Pharmacology, Yong Loo Lin School of Medicine, National University Health System, Singapore
| | - YanHong Dong
- Division of Neurology, Department of Medicine, Yong Loo Lin School of Medicine, National University Health System, Singapore
- Centre for Healthy Brain Ageing (CHeBA) and Dementia Collaborative Research Centre – Assessment and Better Care, School of Psychiatry, UNSW Medicine, The University of New South Wales, Sydney, New South Wales, Australia
- * E-mail:
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Chan E, Altendorff S, Healy C, Werring DJ, Cipolotti L. The test accuracy of the Montreal Cognitive Assessment (MoCA) by stroke lateralisation. J Neurol Sci 2016; 373:100-104. [PMID: 28131163 DOI: 10.1016/j.jns.2016.12.028] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 11/22/2016] [Accepted: 12/16/2016] [Indexed: 12/15/2022]
Abstract
BACKGROUND The Montreal Cognitive Assessment (MoCA) is an increasingly popular screening tool for detecting cognitive impairment post-stroke. However its' test accuracy by stroke lateralisation is as yet unknown. AIM Our aim was to investigate whether the test accuracy of the MoCA differs by stroke lateralisation across different cognitive domains. METHODS We retrospectively examined the cognitive profiles of 228 subacute stroke patients (86 Left, 142 Right), comparing MoCA-total and domain-specific scores with performance on detailed neuropsychological assessment. RESULTS The prevalence of cognitive impairment detected on neuropsychological assessment was high and relatively comparable between the right and left hemisphere stroke groups (91% and 93% respectively). Notably however, 29% of the right stroke group and 6% of the left stroke group achieved a "cognitively-intact" MoCA score (≥25). A high proportion of right stroke patients who had an overall MoCA-intact score were found to be impaired in intellectual functioning, processing speed, executive functions and non-verbal memory on neuropsychological assessment. Furthermore, a high proportion of patients who scored full-marks within a MoCA-specified domain, irrespective of their overall score, were found to have impairment on corresponding neuropsychological assessment for both stroke groups. CONCLUSIONS Particular care needs to be taken in interpreting MoCA-intact performance for right hemisphere patients due to its poor sensitivity to right hemisphere deficits. Scoring maximum points within a MoCA-specified domain also does not necessarily indicate intact cognitive functioning in that domain. Clinicians should consider supplementing their MoCA assessment with additional tools to increase the test accuracy of detecting relevant cognitive impairments post-stroke.
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Affiliation(s)
- Edgar Chan
- Neuropsychology Department, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK; Stroke Research Group, UCL Institute of Neurology, London, UK.
| | - Samantha Altendorff
- Neuropsychology Department, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Colm Healy
- Neuropsychology Department, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - David J Werring
- Stroke Research Group, UCL Institute of Neurology, London, UK
| | - Lisa Cipolotti
- Neuropsychology Department, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK; Dipartimento di Scienze Psicologiche, Pedagogiche e della Formazione, Università degli Studi di Palermo, Palermo, Italy
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Nijsse B, Visser-Meily JMA, van Mierlo ML, Post MWM, de Kort PLM, van Heugten CM. Temporal Evolution of Poststroke Cognitive Impairment Using the Montreal Cognitive Assessment. Stroke 2016; 48:98-104. [PMID: 27899753 DOI: 10.1161/strokeaha.116.014168] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 10/07/2016] [Accepted: 11/02/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE The Montreal Cognitive Assessment (MoCA) is nowadays recommended for the screening of poststroke cognitive impairment. However, little is known about the temporal evolution of MoCA-assessed cognition after stroke. The objective of this study was to examine the temporal pattern of overall and domain-specific cognition at 2 and 6 months after stroke using the MoCA and to identify patient groups at risk for cognitive impairment at 6 months after stroke. METHODS Prospective cohort study in which 324 patients were administered the MoCA at 2 and 6 months post stroke. Cognitive impairment was defined as MoCA<26. Differences in cognitive impairment rates between 2 and 6 months post stroke were analyzed in different subgroups. Patients with MoCA score <26 at 2 months, who improved by ≥2 points by 6 months, were defined as reverters. Logistic regression analyses were used to identify determinants of (1) cognitive impairment at 6 months post stroke and (2) reverter status. RESULTS Between 2 and 6 months post stroke, mean MoCA score improved from 23.7 (3.9) to 24.7 (3.5), P<0.001. Prevalence of cognitive impairment at 2 months was 66.4%, compared with 51.9% at 6 months (P<0.001). More comorbidity and presence of cognitive impairment at 2 months were significant independent predictors of cognitive impairment 6 months post stroke. No significant determinants of reverter status were identified. CONCLUSIONS Although cognitive improvement is seen ≤6 months post stroke, long-term cognitive deficits are prevalent. Identifying patients at risk of cognitive impairment is, therefore, important as well as targeting interventions to this group.
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Affiliation(s)
- Britta Nijsse
- From the Department of Neurology, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands (B.N., P.L.M.d.K.); Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and Hoogstraat Rehabilitation, The Netherlands (J.M.A.V.-M., M.L.v.M., M.W.M.P.); Department of Rehabilitation Medicine, University Medical Center Groningen, The Netherlands (M.W.M.P.); and Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (C.M.v.H.) and Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience (C.M.v.H.), Maastricht University, The Netherlands
| | - Johanna M A Visser-Meily
- From the Department of Neurology, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands (B.N., P.L.M.d.K.); Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and Hoogstraat Rehabilitation, The Netherlands (J.M.A.V.-M., M.L.v.M., M.W.M.P.); Department of Rehabilitation Medicine, University Medical Center Groningen, The Netherlands (M.W.M.P.); and Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (C.M.v.H.) and Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience (C.M.v.H.), Maastricht University, The Netherlands.
| | - Maria L van Mierlo
- From the Department of Neurology, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands (B.N., P.L.M.d.K.); Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and Hoogstraat Rehabilitation, The Netherlands (J.M.A.V.-M., M.L.v.M., M.W.M.P.); Department of Rehabilitation Medicine, University Medical Center Groningen, The Netherlands (M.W.M.P.); and Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (C.M.v.H.) and Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience (C.M.v.H.), Maastricht University, The Netherlands
| | - Marcel W M Post
- From the Department of Neurology, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands (B.N., P.L.M.d.K.); Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and Hoogstraat Rehabilitation, The Netherlands (J.M.A.V.-M., M.L.v.M., M.W.M.P.); Department of Rehabilitation Medicine, University Medical Center Groningen, The Netherlands (M.W.M.P.); and Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (C.M.v.H.) and Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience (C.M.v.H.), Maastricht University, The Netherlands
| | - Paul L M de Kort
- From the Department of Neurology, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands (B.N., P.L.M.d.K.); Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and Hoogstraat Rehabilitation, The Netherlands (J.M.A.V.-M., M.L.v.M., M.W.M.P.); Department of Rehabilitation Medicine, University Medical Center Groningen, The Netherlands (M.W.M.P.); and Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (C.M.v.H.) and Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience (C.M.v.H.), Maastricht University, The Netherlands
| | - Caroline M van Heugten
- From the Department of Neurology, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands (B.N., P.L.M.d.K.); Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and Hoogstraat Rehabilitation, The Netherlands (J.M.A.V.-M., M.L.v.M., M.W.M.P.); Department of Rehabilitation Medicine, University Medical Center Groningen, The Netherlands (M.W.M.P.); and Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (C.M.v.H.) and Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience (C.M.v.H.), Maastricht University, The Netherlands
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Willer L, Pedersen PM, Forchhammer HB, Christensen H. Cognitive assessment at bedside for iPad: A preliminary validation of a novel cognitive test for stroke patients. Eur Stroke J 2016; 1:294-301. [PMID: 31008291 DOI: 10.1177/2396987316665233] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 07/30/2016] [Indexed: 11/16/2022] Open
Abstract
Introduction Cognitive impairments are frequent in stroke. Cognitive testing is important for research, prognostication and planning in sub-acute stroke, but poses difficulties due to aphasia, hemineglect, hemiplegia and fatigue. We present the first steps towards a validation of a novel iPad-based test battery: Cognitive Assessment at Bedside for iPad (CABPad). Patients and methods Stroke patients and age matched healthy controls were tested with CABPad including tests for aphasia, neglect, episodic memory, attention span, executive function, working memory, mental speed, anosognosia, motor speed and depression. A re-test was performed after 1 month. Furthermore, a group of stroke patients was tested with CABPad and traditional neuropsychological tests. Results Fifty-four patients and 48 healthy controls were included in the first phase. Fifty-three patients (98%) were able to complete at least one test and 50 (92%) all tests at the first test point. Mean test duration in patients was 39 min (range 30-60). We found significant differences in test results at baseline between the two groups. Episodic memory mean difference: 8.5 (95% confidence interval: 4.3, 12.7). Symbol Digit Coding mean difference: 16.3 (95% confidence interval: 10.8, 21.7). The second phase included 16 patients. We found adequate to excellent correlation in the majority of the tests. The CABPad Speech Comprehension test and the Auditory Word Recognition subtest of the Western Aphasia Battery correlated with r = 0.82, p < 0.001. Conclusion CABPad is useful for cognitive testing in stroke patients. It is easy to use for the examiner and patients alike. Immobile patients can be tested at bedside, irrespectively of upper extremity paresis, and the assessment can be performed in a relatively short timespan.
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Affiliation(s)
- Lasse Willer
- Department of Neurology, Bispebjerg University Hospital, Denmark
| | - Palle Møller Pedersen
- Department of Neurology, Rigshospitalet-Glostrup University Hospital, Denmark.,Cognisoft ApS
| | - Hysse B Forchhammer
- Department of Neurology, Rigshospitalet-Glostrup University Hospital, Denmark
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Tobler-Ammann BC, de Bruin ED, Brugger P, de Bie RA, Knols RH. The Zürich Maxi Mental Status Inventory (ZüMAX): Test-Retest Reliability and Discriminant Validity in Stroke Survivors. Cogn Behav Neurol 2016; 29:78-90. [PMID: 27336805 DOI: 10.1097/wnn.0000000000000094] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To examine discriminant validity and test-retest reliability of the Zürich maxi mental status inventory (ZüMAX) in patients with stroke. BACKGROUND The ZüMAX is a novel domain-specific cognitive assessment tool to screen for disturbances in neuropsychological function. The test can be used in stroke rehabilitation to estimate severity of cognitive impairment. Because evidence for validity and reliability is lacking, the tool's clinical use is limited. METHODS We administered the ZüMAX in a test-retest design to 33 community-dwelling stroke survivors, and once to 35 healthy controls matched for age and sex. RESULTS We found significant group differences in subscores for the cognitive domains of executive functions and language as well as total score (P=0.001 to 0.004); we did not find group differences for the domains of praxia (defined as the ability to perform purposeful actions), visual perception and construction, or learning and memory. Test-retest reliability of the total score was good (intraclass correlation coefficient=0.81), with the individual domain subscores ranging from poor to fair (0.59 to 0.79). The ZüMAX could detect changes in patients with low smallest detectable differences in executive functions, language, and praxia (0.05 to 1.49) and total score (0.09). CONCLUSION The ZüMAX has moderate to good test-retest reliability. Furthermore, the tool might discriminate between healthy persons and chronic stroke survivors on three of five subscales. The ZüMAX shows promise in measuring neuropsychological disturbances in stroke survivors; however, further trials are required with larger samples.
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Affiliation(s)
- Bernadette C Tobler-Ammann
- *Physiotherapy and Occupational Therapy Research Center, Directorate of Research and Education, University Hospital Zürich, Zürich, Switzerland ∥Neuropsychology, Department of Neurology, University Hospital Zürich, Zürich, Switzerland ‡Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, Eidgenössische Technische Hochschule (ETH) Zürich (Swiss Federal Institute of Technology), Zürich, Switzerland †Department of Epidemiology, Care and Public Health Research Institute (CAPHRI) School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands §Centre for Evidence Based Physiotherapy, Maastricht University, Maastricht, The Netherlands
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Demeyere N, Riddoch MJ, Slavkova ED, Jones K, Reckless I, Mathieson P, Humphreys GW. Domain-specific versus generalized cognitive screening in acute stroke. J Neurol 2015; 263:306-315. [PMID: 26588918 PMCID: PMC4751179 DOI: 10.1007/s00415-015-7964-4] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Revised: 10/07/2015] [Accepted: 10/08/2015] [Indexed: 12/18/2022]
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.
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Affiliation(s)
- Nele Demeyere
- Cognitive Neuropsychology Centre, Department of Experimental Psychology, University of Oxford, Oxford, OX1 3UD, UK.
| | - M J Riddoch
- Cognitive Neuropsychology Centre, Department of Experimental Psychology, University of Oxford, Oxford, OX1 3UD, UK
| | - E D Slavkova
- Cognitive Neuropsychology Centre, Department of Experimental Psychology, University of Oxford, Oxford, OX1 3UD, UK
| | - K Jones
- Acute Stroke Unit, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK
| | - I Reckless
- Acute Stroke Unit, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK
| | - P Mathieson
- Acute Stroke Unit, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK
| | - G W Humphreys
- Cognitive Neuropsychology Centre, Department of Experimental Psychology, University of Oxford, Oxford, OX1 3UD, UK
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Cronberg T, Lilja G. Cognitive decline after cardiac arrest--It is more to the picture than hypoxic brain injury. Resuscitation 2015; 91:A3-4. [PMID: 25857424 DOI: 10.1016/j.resuscitation.2015.03.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 03/04/2015] [Indexed: 11/27/2022]
Affiliation(s)
- Tobias Cronberg
- Department of Clinical Sciences, Division of Neurology, Lund University, Lund, Sweden; Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden.
| | - Gisela Lilja
- Department of Clinical Sciences, Division of Neurology, Lund University, Lund, Sweden; Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden
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