Assessing Cognition after Stroke. Who Misses Out? A Systematic Review

Wall, Kylie; Isaacs, Megan L.; Copland, David A.; Cumming, Toby

doi:10.1111/ijs.12506

Cited by 26 publications

(37 citation statements)

References 62 publications

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“…Assessing non-linguistic cognitive skills in aphasia is challenging, which results in people with aphasia being excluded from studies that have validated cognitive assessments in stroke (Wall et al, 2015 Chapter 4: Using Technology to Overcome the Language Barrier:…”

Section: Explored Visuospatial Skills In 23mentioning

confidence: 99%

“…Pen-and-paper screening tools and assessments are used more frequently than alternative methods for assessing cognition post-stroke (Lees et al, 2012;Wall et al, 2015). Such tools are often linguistically-loaded, and aphasic deficits may confound nonlinguistic cognitive performance (de Koning, 2009;Gorelick et al, 2011).…”

Section: Introductionmentioning

confidence: 99%

“…Such tools are often linguistically-loaded, and aphasic deficits may confound nonlinguistic cognitive performance (de Koning, 2009;Gorelick et al, 2011). Consequently, patients with aphasia are often excluded from studies validating cognitive assessments and exploring cognitive outcomes in stroke (Pendlebury et al, 2015;Sachdev et al, 2004;Wall et al, 2015).…”

Section: Introductionmentioning

confidence: 99%

“…Pen-and-paper tests are the most common method to assess cognition in stroke (Lees et al, 2012;Wall et al, 2015). This method has robust psychometric rigor (Lezak, Howieson, Loring, Hannay, & Fischer, 2004), but access barriers exist for specific stroke subgroups.…”

Section: Introductionmentioning

confidence: 99%

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Assessing Cognition Post-Stroke using Virtual Reality Technology

Wall¹

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Up to 70% of stroke survivors experience cognitive impairments. Assessing cognitive skills after stroke is critical to diagnose, to educate, and to tailor rehabilitation to maximise functional outcomes. The neuropsychological tests used to assess cognition are typically pen-and-paper based, which are often dependent on language skills for completion.Language impairments observed in stroke survivors with aphasia may confound non-linguistic cognitive performance in these pen-and-paper tests. The primary objective of this research was to develop a clinimetrically sound cognitive assessment for stroke survivors with or without aphasia.A systematic review was conducted to determine whether studies that evaluated cognitive assessments in stroke included participants that represented the stroke population.Approximately two-thirds of the studies excluded individuals with communication problems, with a similar percentage of studies excluding individuals with cognitive impairments. This review highlighted the need for new and more feasible methods to assess cognition in the wider stroke population; particularly those with aphasia or cognitive impairment.We developed a non-immersive virtual reality cognitive assessment for individuals with stroke (with or without aphasia) -the Cognitive Assessment for Aphasia App (C3A). This "aphasia-friendly" assessment incorporated computerised audio and visual feedback, practice opportunities, and intuitive functional tasks to minimise dependency on language skills for completion. Developing the C3A required the input from a multidisciplinary clinical and research team and stroke survivors. We targeted cognitive domains that are commonly affected in stroke and that influence functional outcomes. The C3A included a simple reaction time task to assess psychomotor skills and attention, a visual search task to assess visuospatial skills, a sequence copy task to assess visual memory, and a kitchen task to assess executive functioning.A total of 97 participants were recruited (36 with aphasia, 29 stroke non-aphasia, 32 controls) from acute and inpatient rehabilitation settings and the community. All participants were assessed on the C3A and a battery of standard pen-and-paper cognitive tests typically used in stroke. Participants with aphasia and controls undertook the auditory comprehension sub-tests of the Comprehensive Aphasia Test. C3A performance iii measures included latency and errors. Following successful trials of the C3A we sought to determine its feasibility and validity in stroke and controls.Before analysing the C3A results, the association between language performance and the pen-and-paper cognitive tests in participants with aphasia and controls was explored. The association between language and a real-life measure of cognition (the Kettle Test) was also tested. All cognitive tests were significantly associated with auditory comprehension and naming performance (with up to 78% of variance explained), except for Star Cancellation and the Kettle Test. To measure non-lingu...

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Section: Explored Visuospatial Skills In 23mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Assessing Cognition Post-Stroke using Virtual Reality Technology

Wall¹

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“…Although the MoCA has been proposed as the more sensitive screening measure of post-stroke cognitive function (Dong et al, 2010, Pendlebury et al, 2010, Freitas et al, 2012 there are limitations on the types of patients who can participate in this type of assessment and also the type of patients that were included in the validation studies for these measures (Wall et al, 2015). Many studies using these measures exclude patients with aphasia and those who functionally cannot complete the writing or reading tasks, such as those with dominant limb hemiparesis or visual disturbance.…”

Section: Cognition and Post-stroke Cognitive Impairmentmentioning

confidence: 99%

Investigating the ability of post-stroke EEG measures of brain dysfuntion to inform early prediction of cognitive impairment or depression outcomes

Schleiger¹

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Cognitive assessment in stroke: feasibility and test properties using differing approaches to scoring of incomplete items

Lees

Broomfield

et al. 2016

Int J Geriatr Psychiatry

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Objectives Cognitive screening is recommended in stroke, but test completion may be complicated by stroke related impairments. We described feasibility of completion of three commonly used cognitive screening tools and the effect on scoring properties when cognitive testing was entirely/partially incomplete. Methods We performed a cross‐sectional study, recruiting sequential stroke patient admissions from two University Hospital stroke rehabilitation services. We assessed Folstein's mini‐mental state examination (MMSE), Montreal cognitive assessment (MoCA) and Addenbrooke's cognitive examination (ACE‐III). The multidisciplinary team gave an independent diagnostic formulation. We recorded numbers fully/partially completing tests, assistance and time required for testing. We calculated test discrimination metrics in relation to clinical assessment using four differing statistical approaches to account for incomplete testing. Results We recruited 51 patients. Direct assistance to complete cognitive tests was required for 33 (63%). At traditional cut‐offs, the majority screened “positive” for cognitive impairment (ACE‐III: 98%; MoCA: 98%; MMSE: 81%). Comparing against a clinical diagnosis, ACE‐III and MoCA had excellent sensitivity but poor specificity. Partial completion of cognitive tests was common (ACE‐III: 14/51, MMSE: 22/51; MoCA: 20/51 fully complete); greatest non completion was for test items that required copying or drawing. Adapting analyses to account for these missing data gave differing results; MMSE sensitivity ranged from 0.66 to 0.85, and specificity ranged from 0.44 to 0.71 depending on the approach employed. Conclusions For cognitive screening in stroke, even relatively brief tools are associated with substantial incompletion. The way these missing data are accounted for in analyses impacts on apparent test properties. When choosing a cognitive screening tool, feasibility should be considered and approaches to handling missing data made explicit. Copyright © 2016 John Wiley & Sons, Ltd.

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Assessing Cognition after Stroke. Who Misses Out? A Systematic Review

Abstract: Our findings indicate that cognitive assessments are not tested in representative stroke samples. Research is needed to identify valid and reliable cognitive assessments that are feasible in a wider range of stroke survivors.

Cited by 26 publications

References 62 publications

Assessing Cognition Post-Stroke using Virtual Reality Technology

Assessing Cognition Post-Stroke using Virtual Reality Technology

Investigating the ability of post-stroke EEG measures of brain dysfuntion to inform early prediction of cognitive impairment or depression outcomes

Cognitive assessment in stroke: feasibility and test properties using differing approaches to scoring of incomplete items

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