To review systematically studies investigating the convergent, criterion, and predictive validity of multi-domain cognitive screening instruments in the first four weeks after stroke.
Data sources:
Electronic databases (Pubmed, PsycINFO, CINAHL, Embase) were searched until June 2014.
Review methods:
Studies concerning screening for cognitive dysfunction in stroke patients using multi-domain instruments, within four weeks postinfarct or haemorrhagic stroke, using tests taking no longer than one hour. Convergent, criterion, and predictive validity were examined.
Results:
A total of 51 studies investigating 16 cognitive screening instruments were identified. None of the instruments covered all of the most affected cognitive domains. Only one study investigated the convergent validity of a multi-domain test during the (sub)acute phase after stroke. A total of 15 studies examined the criterion validity of cognitive measurements during the acute phase after stroke. The Montreal Cognitive Assessment and Higher Cortical Function Deficit Test had good criterion validity. A total of 24 studies examined the predictive ability of multi-domain cognitive instruments applied in the acute phase after stroke. The Cognistat, Montreal Cognitive Assessment, and Functional Independence Measure-cognitive showed good predictive validity. The Mini-Mental State Examination is the most widely used cognitive screening instrument, but shows insufficient criterion validity.
Conclusion:
None of the existing instruments fulfils all criteria. The Montreal Cognitive Assessment is the best candidate at present, provided items measuring speed of information processing are added, and further studies investigating the optimal cut-offs are conducted.
LesniakMBakTCzepielWSeniowJCzlonkowskaA. Frequency and prognostic value of cognitive disorders in stroke patients. Dem Ger Cog Dis2008; 26(4): 356–363.
2.
NysGMvan ZandvoortMJde KortPLJansenBPde HaanEHKappelleLJ. Cognitive disorders in acute stroke: prevalence and clinical determinants. Cerebrovas Dis2007; 23(5–6): 408–416.
3.
TatemichiTKDesmondDWSternYPaikMSanoMBagiellaE. Cognitive impairment after stroke: frequency, patterns, and relationship to functional abilities. J Neurol Neurosurg Psych1994; 57(2): 202–207.
4.
EdwardsDFHahnMGBaumCMPerlmutterMSSheedyCDromerickAW. Screening patients with stroke for rehabilitation needs: validation of the post-stroke rehabilitation guidelines. Neurorehabil Neural Repair2006; 20(1): 42–48.
5.
HochstenbachJBAndersonPGvan LimbeekJMulderTT. Is there a relation between neuropsychologic variables and quality of life after stroke?Arch Phys Med Rehabil2001; 82(10): 1360–1366.
6.
HommelMMiguelSTNaegeleBGonnetNJaillardA. Cognitive determinants of social functioning after a first ever mild to moderate stroke at vocational age. J Neurol Neurosurg Psych2009; 80(8): 876–880.
7.
Scholte op ReimerWJde HaanRJRijndersPTLimburgMvan den BosGA. The burden of caregiving in partners of long-term stroke survivors. Stroke1998; 29(8): 1605–1611.
8.
NysGMVan ZandvoortMJEDe KortPLM. The prognostic value of domain-specific cognitive abilities in acute first-ever stroke. Neurology2005; 64(5): 821–827.
9.
HachinskiVIadecolaCPetersenRC. National Institute of Neurological Disorders and Stroke-Canadian Stroke Network vascular cognitive impairment harmonization standards. Stroke2006; 37(9): 2220–2241.
10.
NysGMVan ZandvoortMJDe KortPL. Domain-specific cognitive recovery after first-ever stroke: a follow-up study of 111 cases. J Int Neuropsychol Soc2005; 11(7): 795–806.
11.
van der ZwaluwCSValentijnSANieuwenhuis-MarkRRasquinSMvan HeugtenCM. Cognitive functioning in the acute phase poststroke: a predictor of discharge destination?J Stroke Cerebrovasc Dis2011; 20(6): 549–555.
12.
NysGMvan ZandvoortMJde KortPLJansenBPKappelleLJde HaanEH. Restrictions of the Mini-Mental State Examination in acute stroke. Arch Clin Neuropsychol2005; 20(5): 623–629.
13.
MorrisKHackerVLincolnNB. The validity of the Addenbrooke’s Cognitive Examination-Revised (ACE-R) in acute stroke. Disabil Rehabil2012; 34(3): 189–195.
14.
MioshiEDawsonKMitchellJArnoldRHodgesJR. The Addenbrooke’s Cognitive Examination Revised (ACE-R): a brief cognitive test for dementia screening. Int J Geriatric Psych21; 2006: 1078–1085.
15.
HodgkinsonHM. Evaluation of a mental test score for assessment of mental impairment in the elderly. Age Ageing1972; 1: 233–238.
16.
SveenUWyllerTBLjunggrenAEBautz-HolterE. Predictive validity of early cognitive assessment in stroke rehabilitation. Scand J Occupat Ther1996; 3: 20–27.
AnkolekarSIRentonCSpriggNBathPM. The cog-4 subset of the national institutes of health stroke scale as a measure of cognition: relationship with baseline factors and functional outcome after stroke using data from the virtual international stroke trials archive. Stroke Res Treat2013; 2013: 562506.
19.
NoklebyLBolandEBergersenH. Screening for cognitive deficits after stroke: a comparison of three screening tools. Clin Rehabil2008; 22(12): 1095–1104.
20.
Turner-StokesLINyeinKTurner-StokesTGatehouseC. The UK FIM+FAM: development and evaluation. Functional Assessment Measure. Clin Rehabil1999; 13(4): 277–287.
21.
te Winkel-Witlox ACI, PostMWVisser-MeilyJMLindemanE. Efficient screening of cognitive dysfunction in stroke patients: comparison between the CAMCOG and the R-CAMCOG, Mini Mental State Examination and Functional Independence Measure-cognition score. Disabil Rehabil2008; 30(18): 1386–1391.
22.
HoffmannM. Higher cortical function deficits after stroke: an analysis of 1,000 patients from a dedicated cognitive stroke registry. Neurorehabil Neural Repair2001; 15(2): 113–127.
23.
KatzNItzkovichMAverbuchSElazarB. Loewenstein Occupational Therapy Cognitive Assessment (LOTCA) battery for brain-injured patients: reliability and validity. Am J Occup Ther1989; 43(3): 184–192.
24.
DwolatzkyTWhiteheadVDonigerGM. Validity of a novel computerized cognitive battery for mild cognitive impairment. BMC Geriatr2003; 2(3): 4.
25.
FolsteinMFFolsteinSEMcHughPR. Mini Mental State. A practical method for grading the cognitive state of patients for the clinician. J Psych Res1975; 12(3): 189–198.
26.
Lee TengEChang ChuiH. The Modified Mini Mental State (3MS) Examination. J Clin Psych1987; 48(8): 314–318.
27.
NasreddineZS1PhillipsNABédirianV. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc2005; 53(4): 695–699.
28.
RandolphC. Repeatable battery for the assessment of neuropsychological status (RBANS). San Antonio: Harcourt, TX: The Psychological Corporation, 1998.
29.
RandolphCTierneyMCMohrEChaseTN. The Repeatable Battery for the Assessment of Neuro-psychological Status (RBANS): preliminary clinical validity. J Clin Exp Neuropsychol1998; 20(3): 310–319.
30.
SødringKMILaakeKSveenUWyllerTBBautz-HolterE. Validation of the screening instrument for neuropsychological impairment in stroke. Physiother Res Int1998; 3(1): 15–26.
31.
PfeifferE. A short portable mental status questionnaire for the assessment of organic brain deficit in elderly patients. J Am Geriatr Soc1975; 23(10): 433–441.
32.
HerutiRJLuskyADanknerR. Rehabilitation outcome of elderly patients after a first stroke: effect of cognitive status at admission on the functional outcome. Arch Phys Med Rehabil2002; 83(6): 742–749.
33.
HinkleJL. Variables explaining functional recovery following motor stroke. J Neurosci Nurs2006; 38(1): 6–12.
34.
MassucciMPerdonLAgostiM. Prognostic factors of activity limitation and discharge destination after stroke rehabilitation. Am J Phys Med Rehabil2006; 85(12): 963–970.
35.
PopovicIMSericVDemarinV. Mild cognitive impairment in symptomatic and asymptomatic cerebrovascular disease. J Neurol Sci2007; 257(1–2): 185–193.
36.
ChanEKhanSOliverRGillSWerlingDCipolottiL. Underestimation of cognitive impairments by the Montral Cognitive Assessment (MoCA) in an acute stroke unit population. J Neurol Sci. 2014; 343(1–2): 176–9.
37.
LeeBHKimEJKuBD. Cognitive impairments in patients with hemispatial neglect from acute right hemisphere stroke. Cog Behav Neurol2008; 21(2): 73–76.
38.
LinJHLinRTTaiCTHsiehCLHsiaoSFLiuCK. Prediction of poststroke dementia. Neurol2003; 61(3): 343–348.
39.
BlackburnDBafadhelLRandallMHarknessK. Cognitive screening in the acute stroke setting. Age Ageing 203; 42: 113–116.
40.
LeesRCorbetSJohnstonCMoffittEShawGQuinnTJ. Test accuracy of short screening tests for diagnosis of delirium or cognitive impairment in an acute stroke unit setting. Stroke2013; 44(11): 3078–3083.
41.
LeesRLuaJMellingEMiaoYTanJQuinnTJ. Cog-4 has limited diagnostic test accuracy and validity for cognitive assessment in stroke survivors. J Stroke Cerebrovasc Dis2014; 23(6): 1604–1610.
JaillardANaegeleBTrabucco-MiguelSLeBasJFHommelM. Hidden dysfunctioning in subacute stroke. Stroke2009; 40(7): 2473–2479.
44.
NysGMvan ZandvoortMJvan der WorpHBKappelleLJde HaanEH. Neuropsychological and neuroanatomical correlates of perseverative responses in subacute stroke. Brain2006; 129(Pt 8): 2148–2157.
45.
Epstein-LubowGPBeeversCGBishopDSMillerIW. Family functioning is associated with depressive symptoms in caregivers of acute stroke survivors. Arch Phys Med Rehabil2009; 90(6): 947–955.
46.
ZweckerMLevenkrohnSFleisigYZeiligGOhryAAdunskyA. Mini-Mental State Examination, cognitive FIM instrument, and the Loewenstein Occupational Therapy Cognitive Assessment: relation to functional outcome of stroke patients. Arch Phys Med Rehabil2002; 83(3): 342–345.
47.
ShopinLShenhar-TsarfatySBen AssayagE. Cognitive assessment in proximity to acute ischemic stroke/transient ischemic attack: comparison of the montreal cognitive assessment test and mindstreams computerized cognitive assessment battery. Dem Geriatrics Cog Dis2013; 36(1–2): 36–42.
48.
BouffioulxEArnouldCThonnardJL. Satisfaction with activity and participation and its relationships with body functions, activities, or environmental factors in stroke patients. Arch Phys Med Rehabil2011; 92(9): 1404–1410.
49.
GiantinVSempliciniAFranchinA. Outcome after acute ischemic stroke (AIS) in older patients: effects of age, neurological deficit severity and blood pressure (BP) variations. Arch Gerontol Geriatrics2011; 52(3): e185–191.
50.
GillenRTennenHMcKeeTEGernert-DottPAffleckG. Depressive symptoms and history of depression predict rehabilitation efficiency in stroke patients. Arch Phys Med Rehabil2001; 82(12): 1645–1649.
51.
SaxenaSKNgTPKohGYongDFongNP. Is improvement in impaired cognition and depressive symptoms in post-stroke patients associated with recovery in activities of daily living?Acta Neurol Scand2007; 115(5): 339–346.
52.
DongYSharmaVKChanBP. The Montreal Cognitive Assessment (MoCA) is superior to the Mini-Mental State Examination (MMSE) for the detection of vascular cognitive impairment after acute stroke. J Neurol Sci2010; 299(1–2): 15–18.
53.
DongYVenketasubramanianNChanBP. Brief screening tests during acute admission in patients with mild stroke are predictive of vascular cognitive impairment 3–6 months after stroke. J Neurol Neurosurg Psych2012; 83(6): 580–585.
54.
BlakeHMcKinneyMTreeceKLeeELincolnNB. An evaluation of screening measures for cognitive impairment after stroke. Age Ageing2002; 31(6): 451–456.
55.
BourARasquinSBoreasALimburgMVerheyF. How predictive is the MMSE for cognitive performance after stroke?J Neurol2010; 257(4): 630–637.
56.
GodefroyOFicklARousselM. Is the Montreal Cognitive Assessment superior to the Mini-Mental State Examination to detect poststroke cognitive impairment? A study with neuropsychological evaluation. Stroke2011; 42(6): 1712–1716.
57.
TogliaJFitzgeraldKAO’DellMWMastrogiovanniARLinCD. The Mini-Mental State Examination and Montreal Cognitive Assessment in persons with mild subacute stroke: relationship to functional outcome. Arch Phys Med Rehabil2011; 92(5): 792–798.
SodringKMLaakeKSveenUWyllerTBBautz-HolterE. Validation of the screening instrument for neuropsychological impairment in stroke. Physiother Res Int1998; 3(1): 15–26.
60.
PerrySBMarchettiGFWagnerSWiltonW. Predicting caregiver assistance required for sit-to-stand following rehabilitation for acute stroke. J Neurol Phys Ther2006; 30(1): 2–11.
61.
DongYSlavinMJChanBP. Cognitive screening improves the predictive value of stroke severity scores for functional outcome 3-6 months after mild stroke and transient ischaemic attack: an observational study. BMJ Open2013; 3(9): e003105.
62.
PendleburySTWadlingSSilverLEMehtaZRothwellPM. Transient cognitive impairment in TIA and minor stroke. Stroke2011; 42(11): 3116–3121.
63.
PahlmanUGutierrez-PerezCSavborgMKnoppETarkowskiE. Cognitive function and improvement of balance after stroke in elderly people: the Gothenburg cognitive stroke study in the elderly. Disabil Rehabil2011; 33(21–22): 1952–1962.
64.
SachdevPSBrodatyHValenzuelaMJ. The neuropsychological profile of vascular cognitive impairment in stroke and TIA patients. Neurol2004; 62(6): 912–919.
65.
StororDLByrneGJ. Pre-morbid personality and depression following stroke. Int Psychogeriatrics2006; 18(3): 457–469.
66.
ThommessenBBautz-HolterELaakeK. Predictors of outcome of rehabilitation of elderly stroke patients in a geriatric ward. Clin Rehabil1999; 13(2): 123–128.
67.
ZinnSDudleyTKBosworthHBHoenigHMDuncanPWHornerRD. The effect of poststroke cognitive impairment on rehabilitation process and functional outcome. Arch Phys Med Rehabil2004; 85(7): 1084–1090.
68.
SalvadoriEPasiMPoggesiAChitiGInzitariDPantoniL. Predictive value of MoCA in the acute phase of stroke on the diagnosis of mid-term cognitive impairment. J Neurol2013; 260(9): 2220–2227.
69.
KerenOMotinMHeinemannAW. Relationship between rehabilitation therapies and outcome of stroke patients in Israel: a preliminary study. Israel Med Ass J2004; 6(12): 736–741.
70.
FongKNChanCCAuDK. Relationship of motor and cognitive abilities to functional performance in stroke rehabilitation. Brain Injury2001; 15(5): 443–453.
71.
SaxenaSKNgTPYongDFongNPKohG. Subthreshold depression and cognitive impairment but not demented in stroke patients during their rehabilitation. Acta Neurol Scand2008; 117(2): 133–140.
72.
LarsonEBKirschnerKBodeRKHeinemannAWClorfeneJGoodmanR. Brief cognitive assessment and prediction of functional outcome in stroke. Top Stroke Rehabil2003; 9(4): 10–21.
73.
PrescottRJGarrawayWMAkhtarAJ. Predicting functional outcome following acute stroke using a standard clinical examination. Stroke1982; 13(5): 641–647.
74.
PlantonMPeifferSAlbucherJF. Neuropsychological outcome after a first symptomatic ischaemic stroke with ‘good recovery’. Eur J Neurol2012; 19(2): 212–219.
75.
Van DijkEJDe LeeuwFE. Recovery after stroke: more than just walking and talking again. If you don’t look for it, you won’t find it. Eur J Neurol2012; 19(2): 189–190.
76.
LinJSO’ConnorERossomRCPerdueLAEckstromE. Screening for cognitive impairment in older adults: A systematic review for the U.S. Preventive Services Task Force. Ann Intern Med2013; 159(9): 601–612.
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