Prediction of post-stroke dementia using NINDS-CSN 5-minute neuropsychology protocol in acute stroke

Lim, Jae Sung; Oh, Mi Sun; Lee, Ju-Hun; Jung, San; Kim, Chul-Ho; Jang, Min Uk; Lee, Sang-Hwa; Kim, Yeo Jin; Kim, Yerim; Park, Jaeseol; Kang, Yeonwook; Yu, Kyung‐Ho; Lee, Byung‐Chul

doi:10.1017/s1041610216002520

Cited by 30 publications

(30 citation statements)

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“…A risk model approach could be used in stroke populations, incorporating some of these variables identified in this review to predict poststroke dementia. 35 A number of risk scores have been developed recently to predict poststroke dementia (3 months after stroke, area under the curve: 0.74) 36 and cognitive impairment (6 months after stroke, area under the curve: 0.83). 37 Our review, however, shows that cognitive decline seems to become more apparent over a longer followup period, and thus new models could be developed to predict poststroke cognitive impairment and dementia over longer time periods.…”

Section: Discussionmentioning

confidence: 99%

Longitudinal Effect of Stroke on Cognition: A Systematic Review

Tang

Amiesimaka

Harrison

et al. 2018

JAHA

144

114

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BackgroundStroke is associated with an increased risk of dementia; however, the impact of stroke on cognition has been found to be variable, such that stroke survivors can show decline, remain stable, or revert to baseline cognitive functioning. Knowing the natural history of cognitive impairment after stroke is important for intervention. The aim of this systematic review is to investigate the longitudinal course of cognitive function in stroke survivors.Methods and ResultsThree electronic databases (Medline, Embase, PsycINFO) were searched using OvidSP from inception to July 15, 2016. Longitudinal studies with ≥2 time points of cognitive assessment after stroke were included. In total, 5952 articles were retrieved and 14 were included. There was a trend toward significant deterioration in cognitive test scores in stroke survivors (8 studies). Cognitive stability (3 studies) and improvement (3 studies) were also demonstrated, although follow‐up time tended to be shorter in these studies. Variables associated with impairment included age, ethnicity, premorbid cognitive performance, depression, stroke location, and history of previous stroke. Associations with APOE*E4 (apolipoprotein E with the E4 allele) allele status and sex were mixed.ConclusionsStroke is associated with an increased risk of cognitive decline, but cognitive decline is not a consequence. Factors associated with decline, such as sociodemographic status, health‐related comorbidity, stroke history, and clinical features could be used in models to predict future risk of dementia after stroke. A risk model approach could identify patients at greatest risk for timely intervention to reduce the frequency or delay the onset of poststroke cognitive impairment and dementia.

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Section: Discussionmentioning

confidence: 99%

Longitudinal Effect of Stroke on Cognition: A Systematic Review

Tang

Amiesimaka

Harrison

et al. 2018

JAHA

144

114

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“…After deduplication, we screened 578 titles, reviewed 140 full papers, and included 21 studies (18 full papers and three conference abstracts) (Figure ). Numbers of participants included in studies ranged from n = 59 to n = 1850 (n = 6477 participants in total).…”

Section: Resultsmentioning

confidence: 99%

“…Settings and timing of assessment using the index test (SF‐MoCA) post stroke varied: the majority of papers administered the tests more than 3 months post stroke, one paper used the SF‐MoCA in the acute period following stroke (less than or equal to 2 weeks), and two papers in the setting of a stroke prevention clinic (therefore, some nonstroke patients were also included) (Table ).…”

Section: Resultsmentioning

confidence: 99%

“…Potential for bias in the other studies was generally around patient selection (n = 17) (inappropriate exclusions and nonconsecutive samples), use of index test (n = 11) (no pre‐specified cutoff), and the timing between the index test and reference standard not reported or ambiguous (n = 9) (Table S2). Eight papers were of particular concern (rated high or unclear risk of bas across three areas) . Study reporting was variable and no study reported all items recommended in STARDdem guidance (Table S3).…”

Section: Resultsmentioning

confidence: 99%

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Accuracy of the short‐form Montreal Cognitive Assessment: Systematic review and validation

McDicken

Elliott

Blayney

et al. 2019

Int J Geriat Psychiatry

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Introduction Short‐form versions of the Montreal Cognitive Assessment (SF‐MoCA) are increasingly used to screen for dementia in research and practice. We sought to collate evidence on the accuracy of SF‐MoCAs and to externally validate these assessment tools. Methods We performed systematic literature searching across multidisciplinary electronic literature databases, collating information on the content and accuracy of all published SF‐MoCAs. We then validated all the SF‐MoCAs against clinical diagnosis using independent stroke (n = 787) and memory clinic (n = 410) data sets. Results We identified 13 different SF‐MoCAs (21 studies, n = 6477 participants) with differing test content and properties. There was a pattern of high sensitivity across the range of SF‐MoCA tests. In the published literature, for detection of post stroke cognitive impairment, median sensitivity across included studies: 0.88 (range: 0.70‐1.00); specificity: 0.70 (0.39‐0.92). In our independent validation using stroke data, median sensitivity: 0.99 (0.80‐1.00); specificity: 0.40 (0.14‐0.87). To detect dementia in older adults, median sensitivity: 0.88 (0.62‐0.98); median specificity: 0.87 (0.07‐0.98) in the literature and median sensitivity: 0.96 (range: 0.72‐1.00); median specificity: 0.36 (0.14‐0.86) in our validation. Horton's SF‐MoCA (delayed recall, serial subtraction, and orientation) had the most favorable properties in stroke (sensitivity: 0.90, specificity: 0.87, positive predictive value [PPV]: 0.55, and negative predictive value [NPV]: 0.93), whereas Cecato's “MoCA reduced” (clock draw, animal naming, delayed recall, and orientation) performed better in the memory clinic (sensitivity: 0.72, specificity: 0.86, PPV: 0.55, and NPV: 0.93). Conclusions There are many published SF‐MoCAs. Clinicians and researchers using a SF‐MoCA should be explicit about the content. For all SF‐MoCA, sensitivity is high and similar to the full scale suggesting potential utility as an initial cognitive screening tool. However, choice of SF‐MoCA should be informed by the clinical population to be studied.

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“…Pendlebury et al are the first group to validate a short version of MoCA (i.e., NINDS-CSN 5-min protocol) in patients with stroke or transient ischemic attack (TIA), reporting that NINDS 5-min protocol was overall less effective to the full MoCA in screening MCI among patients with stroke or TIA [6]. Another study which used the clinical diagnosis criteria of the American Heart Association/American Stroke Association for post-stroke dementia as the reference standard, found that the NINDS-CSN 5-min protocol has an acceptable discriminative power (sensitivity 82%, specificity 67%), and therefore can be a useful significant predictor of post-stroke dementia (odds ratio [OR], 6.32) [8]. Other evidence, A study by Dong et al suggested that the NINDS-CSN 5-min protocol could predict the occurrence of late onset MCI (i.e.…”

Section: Introductionmentioning

confidence: 99%

Validity of the Chinese version of the Montreal Cognitive Assessment (MoCA) 5-minute protocol for patients with stroke

Feng¹,

Zhang²,

Zhou³

et al. 2019

Preprint

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Background and propose The aim of the present study is to examine the validity of 2 Chinese versions of the short-form Montreal Cognitive Assessment (MoCA) in patients with stroke. Methods A prospective observational study was conducted which included patients with stroke as compared to healthy controls. The Chinese version of the Montreal Cognitive Assessment 5-minute protocol (MoCA 5-min protocol), National Institute for Neurological Disorders and Stroke and Canadian Stroke Network 5-minute Protocol (NINDS-CSN 5-min protocol), and Neurobehavioural Cognitive Status Examination (NCSE) were administered to each participant.Results A total of 54 patients with stroke and 27 healthy controls were enrolled in this study. We identified patients with cognitive impairments using the NCSE, and found that the 5-min protocol was equivalent to the MoCA in differentiating patients with cognitive impairments from those without (area under the receiver operating characteristic curve, AUC, of 0.948 for the MoCA 5-min protocol v.s. 0.984 for MoCA, P = 0.097); however, the NINDS-CSN 5-min protocol was less effective than MoCA in differentiating patients with cognitive impairments from those without (AUC of 0.925 for the NINDS CSN 5-min protocol v.s. 0.984 for MoCA, P = 0.027). These three assessments demonstrated equal performance in differentiating patients with stroke from controls. ConclusionsThe Chinese version of the MoCA 5-min protocol can be used as a valid screening for patients with stroke.

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Prediction of post-stroke dementia using NINDS-CSN 5-minute neuropsychology protocol in acute stroke

Abstract: The NINDS-CSN 5-minute protocol is feasible to evaluate cognitive functions in patients with acute ischemic stroke. It might be a useful screening method for early identification of high-risk groups for PSD.

Cited by 30 publications

References 17 publications

Longitudinal Effect of Stroke on Cognition: A Systematic Review

Longitudinal Effect of Stroke on Cognition: A Systematic Review

Accuracy of the short‐form Montreal Cognitive Assessment: Systematic review and validation

Validity of the Chinese version of the Montreal Cognitive Assessment (MoCA) 5-minute protocol for patients with stroke

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