Domain-specific versus generalized cognitive screening in acute stroke.
Domain-specific versus generalized cognitive screening in acute stroke.
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DOI：
10.1007/s00415-015-7964-4
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发表时间：
2016-02
影响因子：
6
通讯作者：
Humphreys GW
中科院分区：
文献类型：
--
作者：
Demeyere N;Riddoch MJ;Slavkova ED;Jones K;Reckless I;Mathieson P;Humphreys GW
中风后的认知评估通常是为痴呆症开发的简短形式的测试，其产生通过/失败分类（例如MoCA）。Oxford Cognitive Screen（OCS）提供了专为中风幸存者设计的特定领域的认知特征。本研究在症状特异性和临床实用性方面比较了MoCA和OCS在急性卒中中的应用。一项横断面研究，对200例卒中患者在卒中后3周内完成MoCA和OCS的连续样本进行了研究。记录人口统计学数据、病变侧和Barthel评分。从完成率方面评估了包容性，并评价了未完成的原因。计算了MoCA和OCS子域的认知障碍发生率，并讨论了卒中特异性、认知特征和测量独立性的差异。急性认知功能障碍的发生率很高：76%的患者在MoCA上受损，86%的患者在OCS中评估的认知领域中表现出至少一种损伤。总体而言，OCS比MoCA更敏感（87 vs 78%的敏感性），单独使用OCS可提供关于卒中后认知障碍（忽视、失用症和阅读/写作能力）的领域特异性信息。与MOCA不同的是，OCS并不受左半球损伤的支配，而是在不同的领域提供了不同的特征。OCS检测了MoCA中未评估的卒中后重要认知缺陷，它包括失语症和忽视患者，并且较少受到这些领域共发困难的混淆。
Cognitive assessments after stroke are typically short form tests developed for dementia that generates pass/fail classifications (e.g. the MoCA). The Oxford Cognitive Screen (OCS) provides a domain-specific cognitive profile designed for stroke survivors. This study compared the use of the MoCA and the OCS in acute stroke with respect to symptom specificity and aspects of clinical utility. A cross-sectional study with a consecutive sample of 200 stroke patients within 3 weeks of stroke completing MoCA and OCS. Demographic data, lesion side and Barthel scores were recorded. Inclusivity was assessed in terms of completion rates and reasons for non-completion were evaluated. The incidence of cognitive impairments on both the MoCA and OCS sub-domains was calculated and differences in stroke specificity, cognitive profiles and independence of the measures were addressed. The incidence of acute cognitive impairment was high: 76 % of patients were impaired on MoCA, and 86 % demonstrated at least one impairment on the cognitive domains assessed in the OCS. OCS was more sensitive than MoCA overall (87 vs 78 % sensitivity) and OCS alone provided domain-specific information on prevalent post-stroke cognitive impairments (neglect, apraxia and reading/writing ability). Unlike the MOCA, the OCS was not dominated by left hemisphere impairments but gave differentiated profiles across the contrasting domains. The OCS detects important cognitive deficits after stroke not assessed in the MoCA, it is inclusive for patients with aphasia and neglect and it is less confounded by co-occurring difficulties in these domains.