Accuracy of the Informant Questionnaire on Cognitive Decline in the Elderly for Detecting Preexisting Dementia in Transient Ischemic Attack and Stroke

Nieuwkerk, Astrid C. van; Pendlebury, Sarah T.; Rothwell, Peter M.

doi:10.1161/strokeaha.120.031961

Cited by 13 publications

(14 citation statements)

References 37 publications

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“…Our findings are consistent with those of Nieuwkerk et al 21 who found an IQCODE-SF AUROC of 0.94 for pre-stroke dementia assessment. Similarly, IQCODE-SF scores have previously been associated with periventricular WMH, medial temporal atrophy, and global atrophy in an atrial fibrillation population.…”

Section: Discussionsupporting

confidence: 93%

“…Our findings are consistent with those of Nieuwkerk et al 21 . who found an IQCODE‐SF AUROC of 0.94 for pre‐stroke dementia assessment.…”

Section: Discussionsupporting

confidence: 93%

“…Thus, for situations where clinicians or researchers are not able to help informants score the questionnaire, for example, a postal assessment, AD8 may be a better choice. Indeed, there were 6 (4%) instances in which informants apparently misunderstood how to complete the IQCODE‐SF in our study, while a prior study suggested an even higher error rate of almost 11% 21 …”

Section: Discussioncontrasting

confidence: 60%

“…The IQCODE‐SF has twice as many items as the AD8 and involves a more extensive evaluation of executive impairments. Executive impairments are amongst the most commonly observed in a stroke population 24 and previous studies 21 have demonstrated that the executive components of the IQCODE‐SF are the most discriminating in a stroke population.…”

Section: Discussionmentioning

confidence: 97%

“…Indeed, there were 6 (4%) instances in which informants apparently misunderstood how to complete the IQCODE-SF in our study, while a prior study suggested an even higher error rate of almost 11%. 21 Where the AD8 is used in stroke, it may perform better if the threshold for a positive test is changed to a higher cut-off. It is not uncommon for screening tools developed in a non-stroke setting to need adjustment for use in stroke.…”

Section: Clinical Recommendationsmentioning

confidence: 99%

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Comparative validity of informant tools for assessing pre‐stroke cognitive impairment

Taylor‐Rowan

McGuire

Hafdi³

et al. 2022

Int J Geriat Psychiatry

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Objectives Various informant‐based questionnaires are used in clinical practice to screen for pre‐stroke cognitive problems. However, there is no guidance on which tool should be preferred. We compared the validity of the two most commonly used informant‐based tools. Methods We recruited consecutively admitted stroke patients. Patients' informants completed the Informant Questionnaire for Cognitive Decline in the Elderly Short Form (IQCODE‐SF, 16‐item) and Ascertain Dementia 8 (AD8). We assessed construct validity (accuracy) against a semi‐structured clinical interview for dementia or mild cognitive impairment (MCI), describing test accuracy metrics and comparing area under ROC curves (AUROC). We described criterion validity by evaluating associations between test scores and neuroimaging markers of dementia and overall ‘brain frailty’. Finally, we described prognostic validity comparing ROC curves for 18‐month clinical outcomes of dementia, death, stroke, and disability. Results One‐hundred‐thirty‐seven patient‐informant dyads were recruited. At usual clinical cut‐points, the IQCODE‐SF had comparable sensitivity to the AD8 (both = 92%) for pre‐stroke dementia, but superior specificity (IQCODE‐SF: 82% vs. AD8: 58%). Youden index suggested that the optimal AD8 threshold for diagnosis of dementia is ≥4. The IQCODE‐SF demonstrated stronger associations with markers of generalised and medial‐temporal lobe atrophy, neurovascular disease, and overall brain frailty. IQCODE‐SF also demonstrated greater accuracy for predicting future dementia (IQCODE‐SF AUROC = 0.903, 95% CI = 0.798–1.00; AD8 AUROC = 0.821, 95% CI = 0.664–0.977). Conclusions Both IQCODE‐SF and AD8 are valid measures of pre‐stroke dementia. Higher cut points for AD8 may improve performance in the acute stroke setting. Based on consistent superiority across a range of validity analyses, IQCODE‐SF may be preferable to AD8 for pre‐stroke dementia screening.

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Section: Discussionsupporting

confidence: 93%

“…Our findings are consistent with those of Nieuwkerk et al 21 . who found an IQCODE‐SF AUROC of 0.94 for pre‐stroke dementia assessment.…”

Section: Discussionsupporting

confidence: 93%

Section: Discussioncontrasting

confidence: 60%

Section: Discussionmentioning

confidence: 97%

Section: Clinical Recommendationsmentioning

confidence: 99%

See 3 more Smart Citations

Comparative validity of informant tools for assessing pre‐stroke cognitive impairment

Taylor‐Rowan

McGuire

Hafdi³

et al. 2022

Int J Geriat Psychiatry

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Mediation of Age and Thrombectomy Outcome by Neuroimaging Markers of Frailty in Patients With Stroke

Benali,

Singh,

Fladt

et al. 2024

JAMA Netw Open

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ImportanceAge is a leading predictor of poor outcomes after brain injuries like stroke. The extent to which age is associated with preexisting burdens of brain changes, visible on neuroimaging but rarely considered in acute decision-making or trials, is unknown.ObjectivesTo explore the mediation of age on functional outcome by neuroimaging markers of frailty (hereinafter neuroimaging frailty) in patients with acute ischemic stroke receiving endovascular thrombectomy (EVT).Design, Setting, and ParticipantsThis cohort study was a post hoc analysis of the Safety and Efficacy of Nerinetide (NA-1) in Subjects Undergoing Endovascular Thrombectomy for Stroke (ESCAPE-NA1) randomized clinical trial, which investigated intravenous (IV) nerinetide in patients who underwent EVT within a 12-hour treatment window. Patients from 48 acute care hospitals in 8 countries (Canada, US, Germany, Korea, Australia, Ireland, UK, and Sweden) were enrolled between March 1, 2017, and August 12, 2019. Markers of brain frailty (brain atrophy [subcortical or cortical], white matter disease [periventricular or deep], and the number of lacunes and chronic infarctions) were retrospectively assessed while reviewers were blinded to other imaging (eg, computed tomography angiography, computed tomography perfusion) or outcome variables. All analyses were done between December 1, 2022, and January 31, 2023.ExposuresAll patients received EVT and were randomized to IV nerinetide (2.6 mg/kg of body weight) and alteplase (if indicated) treatment vs best medical management.Main Outcome and MeasuresThe primary outcome was the proportion of the total effect of age on 90-day outcome, mediated by neuroimaging frailty. A combined mediation was also examined by clinical features associated with frailty and neuroimaging markers (total frailty). Structural equation modeling was used to create latent variables as potential mediators, adjusting for baseline, early ischemic changes; stroke severity; onset-to-puncture time; nerinetide treatment; and alteplase treatment.ResultsAmong a total of 1105 patients enrolled in the study, 1102 (median age, 71 years [IQR, 61-80 years]; 554 [50.3%] male) had interpretable imaging at baseline. Of these participants, 549 (49.8%) were treated with IV nerinetide. The indirect effect of age on 90-day outcome, mediated by neuroimaging frailty, was associated with 85.1% of the total effect (β coefficient, 0.04 per year [95% CI, 0.02-0.06 per year]; P &lt; .001). When including both frailty constructs, the indirect pathway was associated with essentially 100% of the total effect (β coefficient, 0.07 per year [95% CI, 0.03-0.10 per year]; P = .001).Conclusions and RelevanceIn this cohort study, a secondary analysis of the ESCAPE-NA1 trial, most of the association between age and 90-day outcome was mediated by neuroimaging frailty, underscoring the importance of features like brain atrophy and small vessel disease, as opposed to chronological age alone, in predicting poststroke outcomes. Future trials could include such frailty features to stratify randomization or improve adjustment in outcome analyses.

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Rasch modeling of IQCODE scores in people with dementia

Byrne

2022

Int. Psychogeriatr.

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Accuracy of the Informant Questionnaire on Cognitive Decline in the Elderly for Detecting Preexisting Dementia in Transient Ischemic Attack and Stroke

Cited by 13 publications

References 37 publications

Comparative validity of informant tools for assessing pre‐stroke cognitive impairment

Comparative validity of informant tools for assessing pre‐stroke cognitive impairment

Mediation of Age and Thrombectomy Outcome by Neuroimaging Markers of Frailty in Patients With Stroke

Rasch modeling of IQCODE scores in people with dementia

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