The BCoS cognitive profile screen: Utility and predictive value for stroke.

Abstract

Abstract:Objective: We examined the utility of the BCoS screen in discriminating cognitive profiles and recovery of function across stroke survivors. BCoS was designed for stroke-specific problems across 5 cognitive domains: controlled and spatial attention, language, memory, number processing and praxis. Methods: Based on specific inclusion criteria, this cross-section observational study analysed cognitive profiles of 657 sub-acute stroke patients, 331 of them reassessed at 9 months. Impairments on 32 measures were evaluated by comparison to 100 matched healthy controls.Measures of affect, apathy, and activities of daily living were also taken. Betweensubject group comparisons of mean performance scores and impairment rates, as well as within-subject examination of impairment rates over time were conducted. Logistic regressions and general linear modelling were used for multivariate analysis of domain level effects on outcomes. Results: Individuals with repeated stroke experienced significantly less cognitive recovery at 9 months than those with a first stroke (OR=6.18) despite similar initial level of cognitive performance. Individuals with left hemisphere lesions performed more poorly than those with right hemisphere lesions but both groups showed similar extent of recovery at 9 months (OR=0.62). BCoS also revealed lesion-side specific deficits as well as common areas of persistent problems. stroke-specific cognitive deficits. We validate the screen and then use it to predict functional recovery. We demonstrate differences in recovery for patients with first and second stroke, even when matched for their initial deficit. We also show how the cognitive profile for a patient, across several domains, helps to predict outcome. Response to Reviewers: Response to reviewers (comments are copied below and corresponding responses are followed by "-")Editor's comments 1) The imaging information was used as a method for inclusion and nothing else? -For the purpose of this paper, it is indeed used for inclusion of patients and categorisation of left lesion vs right lesion groups.2) Was the AES self or informant rated? -It was self rated. We have added this to the text.3) The use of "motivation" in the context of AES findings.-Thanks for your comment, we agree that we should adhere to the use of "apathy" to avoid confusion. We have amended the wordings accordingly.4) Patient effort to engage.-We have not formally measured the patients' effort in the assessment and therefore have included this as a limitation of the current study.5) Patient's ability to sustain attention for 30 mins as inclusion criteria.-This was based on clinical judgement of the treatment team in the research site whom we checked with as well as assessment by the researcher during the BCoS testing.Reviewer 1's comments Abstract 1) 2nd sentence: 5 'COGNITIVE?' domains -Added, thanks2) Talk about 'sub-acute' stroke -what does this mean exactly? How much time has passed since the stroke? 657 analysed, 331 reassessed at 9 months -half dropped out? Why so m...

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