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Vascular
Cognitive
Impairment
and
Dementia:
Screening
and
Assessment
Canadian
Best
Practice
Recommendations
for
Stroke
Care
2012-2013
Update
Update
March
2013
Vascular
Cognitive
Impairment
and
Dementia
Review
2012
-
2013
Evidence
Summary
1)
Vascular
Cognitive
Impairment
and
Dementia
Evidence
Tables
Bejot,
2011
France
Observational
3201
first
stroke
Prevalence
of
24
The
diagnosis
of
Patients
with
poststroke
dementia
patients
dementia
(653
years
poststroke
dementia
differed
from
those
without
Prevalence
of
(20.4%)
had
was
based
on
a
poststroke
dementia.
They
were
early
dementia
simple
standardized
older
(77.3+10.8
years
versus
poststroke
after
first-ever
clinical
approach
71.7+15.4
years,
P<0.0001);
stroke:
a
24-year
dementia
(337
using
Diagnostic
and
had
a
higher
prevalence
of
several
population-based
women
and
316
Statistical
Manual
of
vascular
risk
factors,
including
study
men).)
Mental
Disorders,
hypertension,
diabetes,
atrial
Third
and
Fourth
fibrillation,
previous
myocardial
Editions
infarction,
and
history
of
transient
ischemic
attack;
and
were
more
likely
to
have
received
stroke
preventive
medications,
including
antiplatelet
agents
and
antihypertensive
treatment.
In
addition,
they
were
more
likely
to
have
hemiplegia
at
admission,
and
there
was
a
higher
prevalence
of
lacunar
stroke
but
a
lower
prevalence
of
intracerebral
hemorrhage,
subarachnoid
hemorrhage,
and
nonlacunar
noncardioembolic
ischemic
strokes
in
these
patients.
Racic,
2011
Bosnia
and
Observational
273
stroke
patients
Vascular
dementia
3
National
Institute
of
Forty-‐nine
(19.52%)
patients
met
poststroke
months
Health
National
the
criteria
for
vascular
dementia.
Herzegovin
Vascular
Institute
of
The
demented
patients
had
a
dementia:
clinical
a
Neurological
statistically
significant
presence
of
and
Disorders
and
Stroke
both
atrial
fibrillation
and
neuroradiological
(NIH-‐NINDS),
score
ventricular
arrhythmias
(p<0.01)
correlation
Mini
Mental
State
and
previous
stroke
(p
<0.05)
Examination
Score
compared
with
the
non-‐demented
(MMSE),
and
patients.
A
statistically
significant
Hachinski
Ischemic
difference
was
demonstrated
in
Score
(HIS)
the
presence
of
bilateral
lesions
in
the
demented
patients
(p<0.01).
Wadley,
2011
USA
Observational
23,
913
participants
Impaired
cognitive
Mean=
Six-‐Intern
Screen
A
total
of
1,937
participants
with
no
previous
screening
status
4.1
(SIS),
fluency
and
(8.1%)
declined
to
an
SIS
score
<4
Incident
cognitive
years
recall
tasks
at
their
most
recent
assessment,
stroke
or
dementia
+1.6
impairment
is
over
a
mean
of
4.1
(61.6)
years.
elevated
in
the
Residents
of
the
Southern
Stroke
stroke
belt:
the
Belt
in
the
USA
had
greater
REGARDS
study.
adjusted
odds
of
incident
cognitive
impairment
than
non-‐
Belt
residents
(odds
ratio,
1.18;
95%
confidence
interval,
1.07–
1.30).
All
demographic
factors
and
time
independently
predicted
impairment.
Wolfe,
2011
UK
Observational
3373
first
stroke
Disability
(Barthel
Up
to
Disability
(Barthel
The
highest
rate
of
disability
was
patients
Index
<15),
ten
Index
<15),
inactivity
observed
7
d
after
stroke
and
Estimates
of
inactivity
years
(Frenchay
Activities
remained
at
around
110
per
1,000
outcomes
up
to
(Frenchay
Index
<15),
cognitive
stroke
survivors
from
3
mo
to
10
ten
years
after
Activities
Index
impairment
y.
Rates
of
inactivity
and
cognitive
stroke:
analysis
<15),
cognitive
(Abbreviated
Mental
impairment
both
declined
up
to
1
from
the
impairment
Test
<8
or
Mini-‐ y
(280/1,000
and
180/1,000
prospective
south
(Abbreviated
Mental
State
Exam
survivors,
respectively).
Increased
London
stroke
Mental
Test
<8
or
<24),
anxiety
and
age
was
associated
with
higher
register
Mini-‐Mental
State
depression
(Hospital
rates
of
disability,
inactivity,
and
Exam
<24),
anxiety
Anxiety
and
cognitive
impairment.
and
depression
Depression
Scale
Savva,
2010
UK
Systematic
population
with
Incident
dementia
NA
NA
A
history
of
stroke
doubles
the
Review
stroke
compared
risk
of
incident
dementia
in
the
Epidemiological
with
the
population
older
population.
This
increase
is
studies
of
the
without
stroke
not
explained
by
demographic
or
effect
of
stroke
on
cardiovascular
risk
factors
or
by
incident
prestroke
cognitive
decline.
The
dementia:
a
excess
risk
of
incident
dementia
systematic
review
diminishes
with
time
after
stroke
and
may
be
higher
in
those
without
an
APOE
Є4
allele.
There
is
no
excess
risk
of
incident
dementia
in
those
aged
>85
years
with
a
history
of
stroke
compared
to
those
aged
>85
years
without
stroke
Pendlebury,
UK
Systematic
7511
patients
with
Pre-‐stroke
and
NA
The
pooled
prevalence
of
pre-‐
2009
review
and
symptomatic
stroke
Post-‐stroke
stroke
dementia
was
higher
dementia
(14.4%,
95%
CI
12.0–16.8)
in
meta-‐analysis
hospital-‐based
studies
than
in
Prevalence,
(prevalence
and
incidence,
and
population-‐based
studies
(9.1%,
risk
factors)
6.9–11.3).
Although
post-‐stroke
factors
associated
with
pre-stroke
(≤1
year)
dementia
rates
were
and
post-stroke
heterogeneous
overall,
93%
of
the
dementia:
a
variance
was
explained
by
study
systematic
review
methods
and
case
mix;
the
rates
and
meta-analysis
ranged
from
7.4%
(4.8–10.0)
in
population-‐based
studies
of
fi
rst-‐
ever
stroke
in
which
pre-‐stroke
dementia
was
excluded
to
41.3%
(29.6–53.1)
in
hospital-‐based
studies
of
recurrent
stroke
in
which
pre-‐stroke
dementia
was
included.
The
cumulative
incidence
of
dementia
after
the
first
year
was
little
greater
(3.0%,
1.3–4.7)
per
year
in
hospital-‐based
studies
than
expected
on
the
basis
of
recurrent
stroke
alone.
Medial
and
recognition.
Mok,
2004
Hong
Kong
Observational
75
stroke
patients;
Cognitive
3
Mini-‐Mental
State
Among
the
75
included
patients,
42
healthy
controls
impairment
and
months
Examination,
39
(52%)
complained
of
cognitive
Cognitive
determinants
of
Alzheimer’s
Disease
symptoms.
The
number
of
impairment
and
Assessment
Scale
patients
in
each
Clinical
dementia
cognitive
functional
(cognition
subscale),
rating
scale
(CDR)
grading
was
as
outcome
after
impairment
Mattis
Dementia
follows:
39
(52%)
had
a
CDR
of
0,
stroke
associated
Rating
Scale
26
(34.7%)
had
a
CDR
of
0.5,
10
with
small
vessel
(initiation/perseveren (13.3%)
had
a
CDR
of
>1.
Pre-‐
disease
ce
subscale;
MDRS
stroke
IQCODE
and
previous
I/P)
stroke
predicted
CDR>1.
The
NIHSS
was
associated
with
more
impaired
BI.
The
NIHSS
and
MDRS
I/P
contributed
most
to
impaired
IADL.
Patel,
2003
UK
Observational
163
first
ever
stroke
Cognitive
3
years
Mini-‐Mental
State
At
three
months,
1,
2
and
3
years
patients
with
follow-‐ impairment
after
Examination
(MMSE)
post
stroke,
the
prevalence
rates
Natural
history
of
up
stroke
for
cognition
of
cognitive
impairment
were
cognitive
(cognitive
39%,
35%,
30%
and
32%
impairment
after
impairment:
respectively.
Multivariable
stroke
and
factors
MMSE<24),
Barthel
analyses
showed
that
recovery
associated
with
and
Frenchay
activity
was
associated
with
smoking
(OR
its
recovery
indices
for
disability.
3.7;
95%
CI
1.2–11.8),
compromised
by
visuospatial
neglect
(OR
0.27;
95%
CI
0.08–
0.89),
and
had
a
near-‐significant
association
with
right
hemispheric
lesion
(OR
2.87;
95%
CI
0.94–
8.78).
Cognitive
recovery
was
associated
with
less
institutionalization
(p
=
0.032)
and
being
less
disabled,
on
Barthel
(p
=
0.001)
and
Frenchay
Activity
Indices
(p
=
0.028).
Tham,
2002
Singapore
Observational
252
patients
with
TIA
Prevalence
and
1
year
Vascular
Dementia
At
baseline,
56%
of
patients
were
or
non-‐disabling
natural
history
of
Battery
(assesses
six
‘cognitively
intact’,
40%
were
Progression
of
ischemic
stroke
cognitive
cognitive
domains:
‘cognitively
impaired
but
not
cognitive
impairment
attention,
language,
demented’
and
4%
were
impairment
after
poststroke
verbal
memory
(recall
‘demented’.
At
1-‐year
follow-‐up,
stroke:
one
year
and
recognition),
33%
patients
had
a
changed
results
from
a
visual
memory
(recall
classification
from
baseline.
While
longitudinal
study
and
recognition),
31%
of
those
who
were
of
Singaporean
visuoconstruction
and
‘cognitively
impaired
but
not
stroke
patients
visuomotor
speed).
demented’
at
baseline
improved
Dementia
was
to
‘cognitively
intact’,
10%
of
the
diagnosed
using
the
‘cognitively
intact’
group
DSM-‐IV
criteria.
deteriorated
to
‘cognitively
Patients
who
did
not
impaired
but
not
demented’
and
meet
the
DSM-‐IV
11%
deteriorated
from
criteria
but
were
‘cognitively
impaired
but
not
impaired
in
one
or
demented’
to
‘demented’.
more
cognitive
Cognitive
performance
at
baseline
domains
were
predicted
for
deterioration.
classified
as
‘cognitively
impaired
but
not
demented’.
Hoffmann,
South
Africa
Observational
1,000
stroke
patients
We
sought
to
NA
A
tiered,
hierarchic,
One
or
more
higher
cortical
2001
admitted
to
hospital
determine
the
cerebrovascular
function
abnormalities
was
frequency
and
investigative
protocol
detected
in
607
(63.5%)
of
955
Higher
cortical
extent
of
cognitive
and
a
battery
of
nondrowsy
patients.
The
most
function
deficits
disorders
after
predefined,
validated
numerous
categories
were
after
stroke:
an
stroke
and
their
bedside
higher
aphasias
(25.2%),
apraxias
analysis
of
1,000
relation
to
stroke
cortical
function
(14.5%),
amnesias
(11.6%),
and
patients
from
a
risk
factors,
deficit
(HCFD)
tests
frontal
network
syndromes
dedicated
syndromes,
lesion
with
comparison
to
(9.2%),
with
the
other
categories
cognitive
stroke
site,
and
etiology.
neuropsychological.
less
frequent
(3%).
Cognitive
registry
impairment
occurred
without
elementary
neurologic
deficits
(motor,
sensory,
or
visual
impairment)
in
137
(22.5%)
of
608.
Madureira,
Portugal
Observational
237
patients
Dementia
and
3
neuropsycho-‐
Disturbed
performance
on
at
least
2001
admitted
to
a
Stroke
cognitive
months
logical
evaluation
that
one
domain
was
detected
on
131
Unit
(mean
age
59;
impairment
included
the
Mini-‐ (55%)
patients:
27%
had
cognitive
Dementia
and
SD
=12.7).
poststroke
Mental
State
deficits
other
than
memory,
7%
cognitive
Examination
(MMSE),
had
focal
memory
deficit,
9%
had
Stroke-‐related dementia: rates, risk factors and implications for future research.
Stroke
is
a
risk
factor
for
dementia
and
dementia
predisposes
to
stroke.
Dementia
prevalence
in
subjects
with
stroke
is
comparable
to
that
seen
in
stroke-‐free
subjects
who
are
10
years
older.
However,
until
recently
the
prevalence,
time
course
and
risk
factors
for
dementia
in
relation
to
the
occurrence
of
stroke
was
unclear
owing
to
conflicting
reports
from
individual
studies.
Data
now
available
from
a
meta-‐analysis
of
studies
of
pre-‐
and
post-‐stroke
dementia,
show
that
heterogeneity
between
individual
studies
is
largely
explained
by
study
methods
and
case-‐mix.
Pooled
dementia
estimates
are
consistent
with
1-‐in-‐10
patients
being
demented
prior
to
first
stroke,
1-‐in-‐10
developing
new
dementia
soon
after
first
stroke,
and
over
1-‐in-‐3
being
demented
after
a
recurrent
stroke.
After
the
first
year,
cumulative
incidence
of
dementia
is
little
greater
than
expected
on
the
basis
of
recurrent
stroke
alone.
Medial
temporal
lobe
atrophy,
female
sex
and
family
history,
are
more
strongly
associated
with
pre-‐stroke
dementia,
whereas
the
characteristics
and
complications
of
the
stroke
and
the
presence
of
multiple
lesions
in
time
and
place
are
more
strongly
associated
with
post-‐stroke
dementia,
indicating
the
likely
impact
of
optimal
acute
stroke
care
and
secondary
prevention
in
reducing
the
burden
of
dementia.
Future
studies
are
needed
to
develop
a
predictive
risk
score
for
post-‐stroke
dementia,
to
evaluate
short
cognitive
screening
instruments
to
identify
high
risk
patients
with
milder
cognitive
impairment,
and
to
clarify
the
interaction
between
degenerative
and
vascular
processes
in
the
development
of
dementia.
b)
What
is
the
impact
of
Neuropsychological/Neurocognitive
deficits
on
stroke
outcome?
Study
Country
Study
Type
Population
Outcomes
Follow
Assessment
Prevalence
of
outcomes
up
tests
used/
discussed
Racic,
2011
Bosnia
and
Observational
273
stroke
patients
Vascular
dementia
3
months
National
Institute
of
The
mean
value
of
the
Barthel
Herzegovin poststroke
Health
National
index
in
non-‐demented
patients
Vascular
Institute
of
was
88.66
with
SD±12.65
and
the
dementia:
clinical
a
Neurological
confidence
interval
from
86.91
to
and
Disorders
and
Stroke
90.42.
A
statistically
significant
neuroradiological
(NIH-‐NINDS),
score
difference
was
demonstrated
in
correlation
Mini
Mental
State
the
Barthel
Index
between
the
Examination
Score
demented
and
non-‐demented
(MMSE),
and
patients
(t=7.491,
p<0.01).
Hachinski
Ischemic
Score
(HIS)
Toglia,
2011
USA
Observational
72
inpatients
with
To
compare
Median=
MMSE,
MoCA,
The
MoCA
classified
more
persons
stroke
(mean
age=
Montreal
Cognitive
8.5days
motor
FIM,
motor
as
cognitively
impaired
than
the
*Nyenhuis, 2007
Accurate
diagnosis
of
vascular
cognitive
impairment
(VCI)
is
important
but
may
be
difficult.
VCI
diagnoses
depend
on
determinations
of
the
presence
of
both
cognitive
impairment
and
cerebrovascular
disease
(CVD),
temporal
causal
links
between
cognitive
impairment
and
CVD,
and
the
presence
or
absence
of
other
potential
contributors
to
cognitive
impairment,
such
as
Alzheimer’s
disease
(AD).
Diagnostic
criteria
differ
across
currently
utilized
systems,
resulting
in
widely
differing
VCI
prevalence
rates.
Also,
current
systems
may
not
be
able
to
differentiate
“pure”
VCI
from
“mixed”
AD
and
CVD.
National
Institute
of
Neurological
Disorders
and
Stroke
harmonization
criteria
for
VCI
have
been
developed
for
study
and
validation
to
help
bridge
gaps
in
our
understanding
of
VCI
diagnosis.
VCI
management
begins
with
atherogenic
risk
factor
control.
Current
VCI
treatment
options
demonstrate
statistical
improvement
but
not
consistent
global
clinical
efficacy.
Future
clinical
trials
should
concentrate
on
both
primary
risk
factor
control
and
development
of
new
therapeutic
agents
to
treat
patients
already
diagnosed
with
VCI.
Hachinski, 2006
National Institute of Neurological Disorders and Stroke-‐ Canadian Stroke Network Vascular Cognitive Impairment Harmonization Standards
VCI
encompasses
a
large
range
of
cognitive
deficits,
from
relatively
mild
VCI
no
dementia
to
more
severe
vascular
dementia,
or
combined
cerebrovascular
disease
with
other
dementing
conditions,
such
as
AD.23
The
pattern
of
VCI
cognitive
deficits
may
include
all
cognitive
domains,
but
there
is
likely
to
be
a
preponderance
of
so-‐called
“executive”
dysfunction,
such
as
slowed
information
processing,
impairments
in
the
ability
to
shift
from
one
task
to
another,
and
deficits
in
the
ability
to
hold
and
manipulate
information
(ie,
working
memory).
Neuropsychological
protocols
must
therefore
be
both
sensitive
to
a
wide
range
of
abilities
and
especially
attuned
to
the
assessment
of
executive
function.
Timed
executive
function
tests
may
be
especially
sensitive
to
VCI-‐related
impairment
because
of
the
slowed
information
processing
noted
in
this
patient
sample.
60-‐minute,
30-‐minute,
and
5-‐minute
assessment
protocols
are
proposed.
d)
Imaging
Study
Country
Study
Type
Population
Outcomes
Follow
Assessment
Prevalence
of
outcomes
up
tests
used/
discussed
Understanding White Matter Disease: imaging-‐pathological correlations in vascular cognitive impairment
Most
strokes
are
covert
and
observed
incidentally
on
brain
scans,
but
their
presence
increases
risk
of
overt
stroke
and
dementia.
Amyloid
angiopathy,
associated
with
Alzheimer
Disease
(AD)
causes
stroke,
and
when
even
small
strokes
coexist
with
AD,
they
lower
the
threshold
for
dementia.
Diffuse
ischemic
white
matter
disease
impairs
executive
functioning,
information
processing
speed,
and
gait.
Neuroimaging
techniques,
such
as
tissue
segmentation,
Diffusion
Tensor
Imaging,
MR
Spectroscopy,
functional
MRI
and
amyloid
PET,
probe
microstructural
integrity,
molecular
biology,
and
activation
patterns,
providing
new
insights
into
brain-‐behavior
relationships.
MR-‐pathological
studies
of
periventricular
hyperintensity
(leukoaraiosis)
in
aging
and
dementia
reveal
arteriolar
tortuosity,
reduced
vessel
density,
and
occlusive
venous
collagenosis
which
causes
venous
insufficiency
and
vasogenic
edema.
Activated
microglia,
oligodendroglial
apoptosis,
clasmatodendritic
astrocytosis,
and
upregulated
hypoxia-‐markers
are
seen
on
immunohistochemistry.
Further
research
is
needed
to
understand
and
treat
this
chronic
subcortical
vascular
disease,
which
is
epidemic
in
our
aging
population.
Hachinski,
2006
National Institute of Neurological Disorders and Stroke-‐ Canadian Stroke Network Vascular Cognitive Impairment Harmonization Standards
The
main
role
of
neuroimaging
in
the
study
of
VCI
so
far
has
been
to
describe
the
brain,
not
diagnose
it.
Thus,
neuroimaging
plays
a
fundamentally
different
role
in
the
study
of
VCI
than
it
does
in
other
conditions.
This
focus
on
description
rather
than
diagnosis
results
from
the
facts
that
(1)
vascular
and
degenerative
pathology
frequently
coexist,
and
(2)
there
are
no
pathognomonic
radiological
features
of
VCI.
Different
researchers
have
used
a
variety
of
terms
and
definitions
to
describe
the
changes
in
the
brains
of
people
with
VCI,
making
comparison
between
studies
difficult;
this
in
turn
has
limited
the
understanding
of
e)
Cognitive
tests
Study
Country
Study
Type
Population
Outcomes
Follow
Assessment
Prevalence
of
outcomes
up
tests
used/
discussed
Cumming,
Internation Observational
294
stroke
patients
MoCA
feasability
3
The
MoCA
includes
Of
those
surviving
to
3
months,
2011
al
patients
(85%
months
sections
on
the
MoCA
was
completed
by
87%
ischemic)
with
mean
visuospatial/
with
mild
stroke,
79%
with
The
Montreal
executive,
naming,
moderate
stroke,
and
67%
with
age
of
70.6
years
(SD,
cognitive
attention,
language,
severe
stroke
on
admission.
12.8)
abstraction,
delayed
Mean
MoCA
score
was
21.1
(SD
assessment
short
cognitive
recall,
and
7.5)
out
of
30;
only
78
of
220
evaluation
in
a
orientation.
It
is
(35%)
patients
attained
the
large
stroke
trial
scored
out
of
30
“normal”
cutoff
(>26).
This
study
(extra
point
for
<13
demonstrates
that
administering
years’
education)
the
MoCA
at
3
months
poststroke
and
the
is
feasible.
recommended
“normal”
cutoff
is
>26.
Kornery- Canada
Survey
633
occupational
Type
and
NA
Clinicians
indicated
Respectively,
69%,
83%
and
31%
Bitensky,
therapists
in
Canada
frequency
of
using
56
different
of
occupational
therapists
cognition-‐related
assessments.
responding
to
the
acute
care,
2011
problem
inpatient
rehabilitation
and
identification,
community-‐based
vignettes
National
survey
of
assessment
and
recognized
cognition
as
a
Canadian
intervention
use.
potential
problem.
Standardised
occupational
assessment
use
was
prevalent:
therapists’
70%
working
in
acute
care,
77%
in
assessment
and
treatment
of
inpatient
rehabilitation
and
58%
in
cognitive
community-‐based
settings
impairment
post-
indicated
using
standardised
stroke
assessments:
81%,
83%
and
50%,
respectively,
indicated
using
general
cognitive
interventions.
The
Mini-‐Mental
State
Examination
was
often
used
Bour,
2010
The
Observational
194
consecutive
Cognitive
24
MMSE,
DSM-‐IV
The
MMSE
score
1
month
after
Netherlands
patients
admitted
functioning
(A
months
diagnostic
criteria
stroke
predicted
cognitive
How
predictive
is
with
supratentorial
score
lower
than
for
dementia,
functioning
at
later
follow-‐up
the
MMSE
for
stroke
(age>
40,
the
10th
percentile
standardized
Dutch
visits.
It
could
not
predict
cognitive
of
the
score
of
the
translation
of
the
deterioration
or
improvement
in
adequate
post-‐stroke
performance
after
norm
group
MMSE
and
a
cognitive
functioning
over
time.
stroke?
fluency
in
dutch
and
defined
a
deficit
on
neuropsychological
The
cut-‐off
score
in
the
screening
an
initial
post-‐stroke
a
cognitive
test
battery
for
1
cognitive
disturbed
domain
MMSE
>15)
domain)
consisting
of
the
was
27/28
with
a
sensitivity
of
following
tests:
0.72.
The
cut-‐off
score
in
the
CAMCOG,
Concept
screening
for
at
least
4
impaired
Shifting
Test,
Stroop
domains
and
dementia
were
Colour
Word
Test,
26/27
and
23/24
with
a
sensitivity
Auditory
Verbal
of
0.82
and
0.96,
respectively.
The
Learning
test
and
results
indicated
that
the
MMSE
the
Groninger
has
modest
qualities
in
screening
Intelligence
Test
for
mild
cognitive
disturbances
and
is
adequate
in
screening
for
moderate
cognitive
deficits
or
dementia
in
stroke
patients
1
month
after
stroke.
Poor
performance
on
the
MMSE
is
predictive
for
cognitive
impairment
in
the
long
term.
However,
it
cannot
be
used
to
predict
further
cognitive
deterioration
or
improvement
over
time.
Gottesman,
USA
Observational
200
patients
with
Lesion
size,
stroke
NA
NIHSS-‐Plus
The
NIHSS
predicted
DWI
volume
2010
acute
non-‐dominant
severity,
in
a
univariate
analysis,
as
did
hemispheric
stroke
perceptual
deficits
total
line
cancellation
and
a
visual
The
NIHSS-PLUS:
perception
task.
In
a
multivariate
improving
model,
using
log-‐transformed
cognitive
variables,
the
NIHSS
(p=0.0002),
assessment
with
line
cancellation
errors
(p=0.02)
the
NIHSS
and
visual
perception
(p=0.004)
each
improved
prediction
of
total
function
deficits
EFPT
to
stroke
stroke
function
deficits.
Performance
on
at
the
acute
stage
survivors
in
the
the
EFPT
one-‐week
post
stroke
of
stroke
acute
phase
of
was
very
similar
to
what
was
stroke
to
detect
found
in
a
prior
study
validating
executive
function
the
EFPT
in
stroke
survivors
at
6-‐
deficits
months
post-‐onset.
Yip,
2010
China
Observational/
66
poststroke
Cognitive
7
days
MMSE
(Chinese
The
internal
consistency
of
the
validation
study
patients
(>60y)
impairment
version),
Intelligent
ICAS
(Cronbach’s
ά=0.878)
and
its
Validation
of
the
cognitive
test–re-‐test
reliability
(ά=0.789;
intelligent
assessment
system
p<0.001)
were
demonstrated.
The
cognitive
(ICAS)
cut-‐off
score
for
the
ICAS
to
assessment
determine
cognitive
impairment
system
(ICAS)
for
was
found
to
be
3.02,
with
a
stroke
survivors
sensitivity
of
80.5%
and
specificity
of
96%.
The
ICAS
also
showed
good
correlation
with
MMSE-‐CV
(ρ=0.757;
p<0.001).
Douglas,
2007
Canada
Survey
247
occupational
Standardised
and
NA
Respondents
Therapists
used
more
bottom-‐up
therapists
in
Canada
non-‐standardised
reported
using
75
assessments
that
were
Cognitive
assessments
used
standardised
and
standardized,
identified
deficits,
assessments
for
by
occupational
non-‐standardised
and
easy
to
administer.
They
used
older
adults:
therapists
to
measures.
more
top-‐down
assessments
that
which
ones
are
evaluate
cognition
were
non-‐standardised,
predicted
used
by
Canadian
function,
and
fit
with
their
therapists
and
theoretical
approach.
why
Van
The
Observational
57
patients
with
first
Functional
12-‐24
neuropsychological
In
the
early
stage
44
(77%),
Zandvoort,
Netherlands
ischaemic
stroke
(age
outcome
after
months
screening
battery
patients
could
complete
82%
of
19-‐80,
mRS
2-‐4)
stroke
(intellectual
the
administered
tasks.
At
second
2005
functioning,
evaluation,
test
performances
language,
memory,
improved,
but
a
stable
test
profile
Early
perception
and
was
found
with
respect
to
neuropsycholgical
visuospatial
abnormalities
on
the
different
evaluation
in
construction),
BI
and
tasks
(P
<
0.0001).
Moreover,
patients
with
mRS,
36-‐item
short
initial
sum
scores
of
all
composite
ischaemic
stroke
form
of
the
Medical
cognitive
domains
including
f)
What
are
the
differences
between
the
tools
used
to
assess
VCI?
(ie.
Sensitivity,
efficacy,
etc)
Study
Country
Study
Type
Population
Outcomes
Follo Assessment
tests
Prevalence
of
outcomes
w
up
used/
discussed
Dong,
2012
Singapore
International
239
Patients
with
Cognitive
6
MOCA,
MMSE,
60
(25%)
patients
had
Moderate-‐
ischaemic
stroke
and
outcomes
were
months
Neuropsychological
severe
VCI.
The
overall
Brief
screening
transient
ischaemic
dichotomised
as
Battery
discriminant
validity
for
detection
tests
during
acute
attack
were
assessed
either
no-‐mild
of
moderate-‐severe
cognitive
admission
in
with
both
MoCA
and
(impairment
in
<2
impairment
was
similar
for
MoCA
patients
with
mild
MMSE
within
14
days
cognitive
domains)
(ROC
0.85
(95%
CI
0.79
to
0.90)
stroke
are
after
index
stroke
or
moderate-‐ and
MMSE
(ROC
0.83
(95%
CI
0.77
predictive
of
severe
to
0.89)),
p=0.96).
Both
MoCA
vascular
cognitive
(impairment
in
<3
(21/22)
and
MMSE
(25/26)
had
impairment
3-‐6
cognitive
domains)
similar
discriminant
indices
at
vascular
cognitive
their
optimal
cutoff
points;
Pendlebury,
UK
Observational
413
patients
with
Cognitive
Up
to
5
MMSE,
MoCA
(MMSE
Although
MMSE
and
MoCA
scores
2010
stroke
or
TIA
abnormalities
after
years
<27
and
MoCA
<26
were
highly
correlated
(r2=0.80,
stroke
or
TIA
were
taken
to
P<0.001),
MMSE
scores
were
Underestimation
indicate
cognitive
skewed
toward
higher
values,
of
cognitive
impairment)
whereas
MoCA
scores
were
impairment
by
normally
distributed:
median
and
mini-mental
state
interquartile
range
28
(26
to
29)
examination
and
23
(20
to
26),
respectively.
versus
the
Two
hundred
ninety-‐one
of
413
Montreal
(70%)
patients
had
MoCA
<26
of
cognitive
whom
162
had
MMSE
>27,
assessment
in
whereas
only
5
patients
had
patients
with
MoCA
>26
and
MMSE
<27
transient
(P<0.0001).
In
patients
with
ischemic
attack
MMSE
>27,
MoCA
<26
was
and
stroke:
a
associated
with
higher
Rankin
2)
Assessment
Tools
Kettle
The
Kettle
Clients
The
task
of
preparing
two
5-‐20
No
studies
have
Convergent:
1
study
reported
A
Test
Test
with
stroke
hot
beverages
is
broken
minutes
examined
the
internal
excellent
correlation
with
the
prelimin
measures
who
were
down
into
13
discrete
consistency
of
the
Functional
Independence
Measure
ary
cognitive
living
steps
that
can
be
Kettle
Test.
No
studies
(FIM)
Cognitive
scale
and
version
skills
in
a
independe evaluated.
have
examined
the
adequate
correlation
with
the
of
the
functional
ntly
in
the
test-‐retest
reliability
of
Mini-‐Mental
Status
Examination
Kettle
context.
community
the
Kettle
Test.
No
(MMSE),
Clock
Drawing
Test
and
Test
prior
to
studies
have
examined
the
Behavioural
Inattention
Test
manual
stroke
the
intra-‐rater
(BIT)
Star
Cancellation
subtest.
can
be
reliability
of
the
Kettle
Known
groups:
The
Kettle
Test
was
obtaine
Test.
1
study
examined
able
to
discriminate
clients
with
d
from:
the
inter-‐rater
stroke
from
healthy
controls.
http://w
reliability
of
the
Kettle
ww.reh
Test
and
reported
abmeas
excellent
inter-‐rater
ures.org
/Lists/R
ehabMe
asures/
DispFor
m.aspx?
ID=939
Mini- Screens for While The MMSE consists of 11 approx. Out of 9 studies Criterion: The MMSE can The
Montreal
Measures
Can
be
The
items
of
the
MoCA
5-‐10
Only
1
study
has
Criterion:
Concurrent.
Excellent
The
Cognitive
Mild
used
in
examine
attention
and
minutes
examined
the
internal
correlations
with
the
Mini
Mental
MoCA
is
Assessme Cognitive
patients
concentration,
executive
consistency
of
the
State
Examination
(MMSE)
have
availabl
nt
Tool
Impairment
with
stroke
functions,
memory,
MoCA
and
reported
been
reported.
Construct:
Known
e
for
(MoCA)
and
any
language,
excellent
levels
of
groups.
One
study
reported
that
free
for
individual
visuoconstructional
skills,
internal
consistency.
the
MoCA
can
distinguish
between
educati
who
is
conceptual
thinking,
Only
1
study
has
patients
with
mild
cognitive
onal
experiencin calculations,
and
examined
the
test-‐ impairment
and
healthy
controls.
and
g
memory
orientation.
retest
reliability
of
the
clinical
difficulties
MoCA,
and
reported
purpose
but
scores
excellent
test-‐retest
s
at:
within
the
http://w
normal
ww.moc
range
on
atest.or
the
MMSE
g.
NINDS- designed
to
Stroke
The
60
minute
assessment
60,
30,
NA
One
group
has
tested
the
validity
NA
CSN
measure
patients
tests:
executive/activation
or
5
in
ischemic
stroke
patients.
1.
All
Harmoniz vascular
function,
visuospatial,
minute
three
protocol
scores
are
ation
VCI
cognitive
language/lexical
retrieval,
versions
significantly
lower
than
in
patients
Neuropsy impairement
memory
and
learning,
and
availabl than
in
matched
controls
(F
chology
in
stroke
neuropsychiatric/depressiv e
statistics
range
from
15.7
to
50.5;
Protocols
patients
e
symptoms.
The
30
all
p
values
<
.000;
eta2
values
minute
assessment
tests
a
range
from
.14
to
.31).
2.
ROC
subset
of
the
60
minute
analyses
shows
the
60M
Executive
assessment
including:
subtest
to
be
the
most
sensitive
semantic
and
phonemic
and
specific,
followed
by
the
fluency,
Digit
Symbol-‐ Memory,
Language,
and
Spatial
Repeatabl brief
NA
The
content
of
the
RBANS
25
min
NA
in
a
stroke
We
present
a
rare
case
of
stroke
in
The
e
Battery
neurocognitiv consists
of
neurocognitive
population
a
22-‐year-‐old
psychiatric
patient,
RBANS
for
the
e
battery
test
paradigms
including
who
received
neuropsychological
is
Assessme with
four
tests
for:
immediate
evaluations
before
and
after
distribut
nt
of
alternate
memory,
sustaining
a
right
middle
cerebral
ed
by
Neuropsy forms,
visuopatial/constructional,
artery
(MCA)
stroke.
The
RBANS
Pearson
chological
measuring
language,
attention,
and
demonstrated
sensitivity
to
post-‐ ,
and
Status
immediate
delayed
memory.
stroke
changes
despite
pre-‐stroke
can
be
(RBANS)
and
delayed
cognitive
impairments
and
a
ordered
memory,
complex
psychiatric
overlay,
with
online
attention,
the
Visuospatial/Constructional
at
language,
index
being
one
of
the
most
http://p
and
sensitive
indicators
of
right
earsona
visuospatial
hemisphere
dysfunction.
Line
ssess.co
skills
Orientation
fell
from
normal
to
m/haiw
defective
levels;
these
findings
eb/cultu
References
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Azevedo
da
Costa
F,
Damasceno
Bezerra
IF,
de
Araujo
Silve
DL,
de
Oliveira
R,
da
Rocha
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Cognitive
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by
MMSE
in
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M,
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P,
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M,
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M,
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K,
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a
valuable
tool
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the
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neurodevelopmental,
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