The CAMCOG: A Useful Screening Instrument for Dementia in Stroke Patients

Abstract

Background and Purpose-Most mental screening tests focus on the detection of cognitive deficits compatible with Alzheimer's disease. Stroke patients who develop a dementia syndrome, however, constitute a more heterogeneous group with both cortical and subcortical disturbances. We assessed the diagnostic accuracy of the CAMCOG (the cognitive and self-contained part of the Cambridge Examination for Mental Disorders of the Elderly) and the Mini-Mental State Examination (MMSE) for dementia in patients with a recent stroke. Methods-In patients aged 55 and older who were admitted in the Rotterdam Stroke Databank, cognitive functioning was assessed between 3 and 9 months after the most recent stroke. The "gold standard" diagnosis of dementia was compatible with the criteria of the Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised. The CAMCOG and MMSE scores were obtained independent of the diagnostic procedure. Results-Of 300 consecutive patients, 71 (23.7%) were demented. Sixteen severely demented patients could not be tested and were excluded. The CAMCOG and MMSE scores were significantly related to dementia (both PϽ0.0001) in a logistic regression model. Receiver operating characteristic analysis showed that the CAMCOG was a more accurate screening instrument (area under the curve for CAMCOG, 0.95; for MMSE, 0.90). Two other clinical variables independently improved the diagnostic accuracy of the MMSE and CAMCOG: patients with a left hemispheric lesion had a lower (odds ratio, 0.3; 95% confidence interval, 0.1 to 0.7), and patients with hemorrhagic stroke had a greater chance of being demented (odds ratio, 3; 95% confidence interval, 1 to 10). The effect of left hemispheric lesion as an independent diagnostic factor could not be explained by selection or its association with aphasia alone. Conclusions-The CAMCOG is a feasible instrument for use in patients with a recent transient ischemic attack or stroke.It is a more accurate screening tool for dementia than the MMSE, especially when type and site of stroke are taken into account. (Stroke. 1998;29:2080-2086.)

The validity of the Addenbrooke’s Cognitive Examination-Revised (ACE-R) in acute stroke

“…Similar results have been reported in later studies (Blessed, Black, Butler & Kay, 1991;Huppert, Brayne, Gill, Paykel & Beardsall, 1995). De-Koning et al (1998) To summarise, the CAMCOG offers a more comprehensive assessment of cognitive functioning compared to the MMSE, and it has been shown to have superior diagnostic validity for the detection of dementia. However, the trade-off for this is longer administration time.…”

White matter hyperintensities, executive function and global cognitive performance in vascular mild cognitive impairment

“…Studies that analyzed CAMCOG as a screening tool for VCI showed excellent sensitivity and specificity 28 . Another aspect of our results also deserves to be addressed.…”

Early cognitive impairment predicts long-term depressive symptoms and quality of life after stroke

“…Until now, acute cognitive impairment after stroke has been studied mainly with global screening instruments intended to detect dementia, e.g. the Mini-Mental State Examination [28] or the CAMCOG [29]. Whereas antidepressant treatment has been shown to reduce cognitive impairment after stroke suggesting that depression causes a great deal of cognitive impairment after stroke (the so-called Fdementia of depression_ or Fpseudo-dementia_) [30,31], our results suggest that early cognitive impairment after stroke may also predict the presence of DS in the long term.…”