Psychometric properties of cognitive screening for patients with cerebrovascular diseases A systematic review

Abstract

ABSTRACT. Screening instruments are ideal for acute clinical settings because they are easy to apply, fast, inexpensive and sensitive for specific samples. However, there is a need to verify the psychometric properties of screening in stroke patients. Objective: This study investigated the psychometric properties (methodological procedures) of cognitive screening for patients with cerebrovascular diseases. Methods: A systematic review of papers published on PsycINFO, Web of Knowledge, PubMed and Science Direct (2005 to 2016) was performed. Results: A total of 55 articles remained after applying exclusion criteria. The samples ranged from 20 to 657 patients. Most articles evaluated elderly individuals with four to 13 years of education who had experienced ischemic or hemorrhagic stroke. There was a tendency to find evidence of validity for criteria and to analyze the sensitivity/specificity of the instruments. Although the studies frequently used the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA) to seek evidence of validity and reliability, the use of these instruments among stroke patients has been criticized due to their psychometric properties and the neuropsychological functions evaluated. Conclusion: Although there is no gold standard screen for assessing adults post-stroke, instruments devised specifically for this population have shown promise. This review helps both researchers and clinicians to select the most appropriate screen for identifying cognitive impairment in adults post-stroke.

Diagnostic accuracy of cognitive screening tools under different neuropsychological definitions for poststroke cognitive impairment

“…Both MMSE and MoCA are commonly used cognitive screening scales in stroke patients (Rodrigues et al., 2019). This study showed a ceiling effect of the MMSE, which was also reported in previous observations (Trzepacz, Hochstetler, Wang, Walker, & Saykin, 2015).…”

Cognitive impairment in patients with cerebrovascular disease: A white paper from the links between stroke ESO Dementia Committee

“…they miss about one fifth of cognitively impaired patients, a proportion which increases in mild PSCI. In addition, their specificity is also lower than 100%, 28,30,32 indicating that mildly decreased scores might be observed in subjects with normal comprehensive assessment. Score interpretation needs to take into account the first language, education level (for both tests) and age (for MoCA) 28,33 ; their scores might also be influenced by sensorymotor deficit, deficits in language and perception (hemi-neglect).…”

Cognitive impairment before and after intracerebral haemorrhage: a systematic review

“…Few of these studies included comprehensive neuropsychological or neuroimaging assessment and analysis. This consortium and a more recent review on the psychometric properties of cognition measures used in all stroke types [60] acknowledge the challenges in harmonizing neuropsychological data where the criteria for defining cognitive impairment and assessment measures used remain heterogeneous. Addressing the differences in cognitive impairment profiles between ischaemic and haemorrhagic stroke is beyond the scope of this review.…”