Test Accuracy of Short Screening Tests for Diagnosis of Delirium or Cognitive Impairment in an Acute Stroke Unit Setting

Abstract

Background and Purpose-Guidelines recommend cognitive screening in acute stroke. Various instruments are available, with no consensus on a preferred tool. We aimed to describe test accuracy of brief screening tools for diagnosis of cognitive impairment and delirium in acute stroke. Methods-We collected data on sequential stroke unit admission in a single center. Four assessors trained in cognitive testing independently performed screening and reference tests. Brief assessments comprised the following: 10-and 4-point Abbreviated Mental Test (AMT-10; AMT-4); 4-A Test (4AT); Clock Drawing Test (CDT); Cog-4; and Glasgow Coma Scale (GCS). We also recorded the multidisciplinary team's informal review using single question (SQ). We compared against reference standards of Montreal Cognitive Assessment (MoCA) and Confusion Assessment Method for delirium using usual diagnostic cutpoints. For MoCA, we described effects of lowering the diagnostic threshold to MoCA <24 and MoCA <20. We described sensitivity, specificity, and positive and negative predictive values. Results-Over a 10-week period, 111 subjects had cognitive assessment data. Subjects were 50% male (n=55), and median age was 74 years (interquartile range, 64-85). AMT-4, AMT-10, and SQ all had excellent (1.00) specificity for detection of cognitive impairment, although sensitivity was poor (all <0.60). The 4AT had greatest sensitivity for detecting delirium (

Evaluation of delirium screening tools in geriatric medical inpatients: a diagnostic test accuracy study

“…Some investigators have reported better performance of the 4AT; this assessment has been reported to have very high sensitivity (100%) and good specificity (82%) within the acute stroke unit setting [18]. However, this was in a smaller patient sample (n=108) than our study.…”

Prevalence for delirium in stroke patients: A prospective controlled study

“…The CAM has been validated for the assessment of delirium (Inouye et al, 1990), and can be used for patients after stroke (Dahl, Ronning, & Thommessen, 2010;Lees et al, 2013;McManus et al, 2009;Miu & Yeung, 2013) with a good sensitivity and specifity and has got a strong interrater reliability (Inouye et al, 1990). In case, patients had a severe aphasia and/or dementia and could not respond to simple questions, the presence of disorientated behavior and its fluctuation in 24 hr was rated as criteria for delirium (Gustafson, Eriksson, Sture, Bucht, & Gösta, 1991) and confirmed by families by asking them for new onset of such behavior.…”

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

“…[53][54][55] Two articles were graded high risk of bias and applicability concerns because of case-control methodology and patient inclusion.…”