A Short Screening Instrument for Poststroke Dementia

Abstract

Background and Purpose-The CAMCOG is a feasible cognitive screening instrument for dementia in patients with a recent stroke. A major disadvantage of the CAMCOG, however, is its lengthy and relatively complex administration for screening purposes. We therefore developed the Rotterdam CAMCOG (R-CAMCOG), based on the original version.Our aim was to reduce the estimated administration time to 15 minutes or less and to retain or perhaps even improve its diagnostic accuracy. Methods-We analyzed the item scores on the CAMCOG of 300 consecutive stroke patients, after exclusion of patients with a severe aphasia or lowered consciousness level, who were entered in the Rotterdam Stroke Databank. The diagnosis of dementia was made independent of the R-CAMCOG score, on the basis of clinical examination and neuropsychological test results. The R-CAMCOG was constructed in 3 steps. First, items with floor and ceiling effects were removed. Next, subscales with no additional diagnostic value were excluded. Finally, we removed items that did not contribute to the homogeneity of the subscales. The diagnostic accuracy of the R-CAMCOG and the original CAMCOG was determined by means of the area under the receiver operating characteristic (ROC) curve. Results-In the 3 steps, the number of items was reduced from 59 to 25, divided over the subscales orientation, memory (recent, remote, and learning), perception, and abstraction. The subscale orientation did not reach significance in a logistic regression model but was included in the R-CAMCOG because of its high face validity in dementia screening.Internal validation with ROC analysis suggests that the R-CAMCOG and the CAMCOG are equally accurate in screening for poststroke dementia (area under the curve was 0.95 for both tests). Conclusions-The R-CAMCOG has overcome the disadvantages of the original CAMCOG. It is a promising, short, and easy-to-administer screening instrument for poststroke dementia. It seems to be sufficiently accurate for this purpose, but the test has yet to be validated in a separate, independent study. (Stroke. 2000;31:1502-1508.)

Adaptive Cognitive Testing in Cerebrovascular Disease and Vascular Dementia

“…Using the CAT estimates, the original CAMCOG total scores could be predicted well. Also, the cutoff point with optimal sensitivity and specificity that we found is consistent with the optimal cutoff point as previously found [15] and differs only in one point from that reported originally [5] . Furthermore, the overall accuracy of the CAT was slightly lower than the accuracy of the CAMCOG [15] and the accuracy of the memory section of the CAMCOG in the detection of AD [6] .…”

“…Also, the cutoff point with optimal sensitivity and specificity that we found is consistent with the optimal cutoff point as previously found [15] and differs only in one point from that reported originally [5] . Furthermore, the overall accuracy of the CAT was slightly lower than the accuracy of the CAMCOG [15] and the accuracy of the memory section of the CAMCOG in the detection of AD [6] . These findings are consistent with our previous findings concerning the CAT administration of the C-47 in a sample of AD patients [12] , and are important as they pertain to patients with a different etiology, i.e.…”

“…Inclusion and exclusion criteria and the research procedure are described elsewhere [7,14,15] . In brief, patients were enrolled if they were 55 years of age or older, had no conditions compromising routine testing (e.g.…”

Test Accuracy of Cognitive Screening Tests for Diagnosis of Dementia and Multidomain Cognitive Impairment in Stroke

“…Comparing 6 acute studies 20,21,31,37,38,43 and 6 nonacute studies 22,30,34,39,46,50 ; gave a relative sensitivity, 0.73 (95% CI, 0.58-0.93) and relative specificity, 1.12 (95% CI, 1.01-1.25). These data suggest that accuracy varies with assessment timing and context, with acute testing yielding higher sensitivity and lower specificity.…”

“…We tabulated summary descriptors for studies using clinical diagnosis reference standard (n=11 articles) 22,24,34,[37][38][39]43,47,49,51,52 and those using detailed neuropsychological assessment (n=21 ; Tables 1-2). 21,23,[25][26][27][28][29][30][31][32][33]35,36,[40][41][42][44][45][46]48,50 There was considerable heterogeneity in study population: setting and test strategy.…”