The validity of the Addenbrooke’s Cognitive Examination-Revised (ACE-R) in acute stroke

Morris, Katie; Hacker, Vicki L.; Lincoln, Nadina B.

doi:10.3109/09638288.2011.591884

Cited by 32 publications

(30 citation statements)

References 42 publications

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“…From analysis of paired summary received operating characteristic curves, the overall accuracy was better for those studies where assessment was performed within the acute period (online-only Data Supplement VII). Comparing clinical dementia reference standard 21,24,40,47,52 against neuropsychological battery 23,32,33,36,39,41,45,46 suggested no difference in test properties dependent on the reference standard used, with relative sensitivity of 0.86 (95% CI, 0.67-1.11) and relative specificity of 1.05 (95% CI, 0.95-1.16). Where >1 test threshold was described, we present the primary data.…”

Section: Heterogeneitymentioning

confidence: 99%

“…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. Twenty-three different tests were described, commonest MMSE (n=16 articles) and MoCA (n=8; Tables 1-2; online-only Data Supplement III).…”

Section: -53mentioning

confidence: 99%

“…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. Twenty-three different tests were described, commonest MMSE (n=16 articles) and MoCA (n=8; Tables 1-2; online-only Data Supplement III).…”

Section: Accuracy Of Screening Tools For Diagnosis Of Cognitive Impaimentioning

confidence: 99%

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

Lees

Selvarajah

Fenton

et al. 2014

Stroke

162

149

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S troke-survivors are at particular risk of cognitive decline. Three month dementia prevalence is ≥30%, and even minor stroke events have cognitive sequel.1,2 Poststroke cognitive impairment is associated with increased mortality, disability, and institutionalization. 3 The importance of cognitive change is highlighted by stroke-survivors themselves. In a national priority setting exercise, cognitive impairment was voted the single most important topic for stroke research. 4 A first step in management of cognitive problems is recognition and diagnosis. Informal clinician assessment will miss important cognitive problems, 5 and formal cognitive testing is recommended. [6][7][8] The ideal would be expert, multidisciplinary assessment informed by comprehensive investigations. This approach is not feasible at a population level. In practice, a 2-step system is adopted, with baseline cognitive testing used for screening or triage and specialist assessment to define the cognitive problem offered depending on the results.Although there is general agreement on the merits of poststroke cognitive assessment, there is no consensus on a preferred testing strategy. [6][7][8] Various cognitive screening tools are available with substantial variation in test used. 9,10 The clinical meaning of cognitive problems after stroke will vary according to test context. Cognitive impairment diagnosed in the first days post stroke may reflect a mix of delirium, strokespecific impairments, and prestroke cognitive decline. 2,11,12 In the longer term, assessments aim to make or refute a dementia diagnosis. Common to all test situations is a final diagnosis of presence/absence of clinically important impairments. A screening assessment should detect this clinical syndrome of all-cause, poststroke multidomain cognitive impairment.Background and Purpose-Guidelines recommend screening stroke-survivors for cognitive impairments. We sought to collate published data on test accuracy of cognitive screening tools. Methods-Index test was any direct, cognitive screening assessment compared against reference standard diagnosis of (undifferentiated) multidomain cognitive impairment/dementia. We used a sensitive search statement to search multiple, crossdisciplinary databases from inception to January 2014. Titles, abstracts, and articles were screened by independent researchers. We described risk of bias using Quality Assessment of Diagnostic Accuracy Studies tool and reporting quality using Standards for Reporting of Diagnostic Accuracy guidance. Where data allowed, we pooled test accuracy using bivariate methods. Results-From 19 182 titles, we reviewed 241 articles, 35 suitable for inclusion. There was substantial heterogeneity: 25 differing screening tests; differing stroke settings (acute stroke, n=11 articles), and reference standards used (neuropsychological battery, n=21 articles). One article was graded low risk of bias; common issues were case-control methodology (n=7 articles) and missing data (n=22 Lees et al Cognitive Screening in S...

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Section: Heterogeneitymentioning

confidence: 99%

Section: -53mentioning

confidence: 99%

Section: Accuracy Of Screening Tools For Diagnosis Of Cognitive Impaimentioning

confidence: 99%

See 1 more Smart Citation

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

Lees

Selvarajah

Fenton

et al. 2014

Stroke

162

149

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“…Certain commonly used cognitive measures, although validated in other settings, may not be appropriate for stroke survivors. Folstien’s MMSE does not perform consistently well in the stroke [19–21] and ignores executive functioning, a common deficit in stroke populations; Hodkinson’s Abbreviated Mental Test has not been validated in stroke and the properties of Addenbrooke’s Cognitive Examination in stroke survivors is sensitive to timing of assessment [11,22]. For mood measures, there is a lack of research in the acute stroke setting [23] and we have no validated established norms for most tests in stroke populations [21,24].…”

Section: Discussionmentioning

confidence: 99%

“…Recent analysis of cognitive and mood assessment in stroke research has suggested substantial heterogeneity in assessment tool choice [10]. Screening and assessment tools that are validated and popular in non-stroke settings may not be appropriate in stroke survivors, who are more likely to have language, physical and cognitive impairments or to be medically unwell in the acute phase [5,11,12]. …”

Section: Introductionmentioning

confidence: 99%

Questionnaire assessment of usual practice in mood and cognitive assessment in Scottish stroke units

Lees¹,

Broomfield

Quinn³

2013

Disability and Rehabilitation

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PurposeNational and International guidelines recommend cognition and mood assessment for all stroke survivors. However, there is no consensus on preferred screening tool or method of assessment. We aimed to describe clinical practice in cognitive and mood assessment across Scottish stroke services.MethodWe used a questionnaire based survey. After local piloting, we distributed the questionnaire using mixed methodologies (online and paper) across all Stroke Managed Clinical Networks in Scotland. We also distributed the questionnaire to specialist societies representing stroke physicians, nurses and allied health professionals and through the UK Stroke Forum delegate pack.ResultsWe received 174 responses from nurses, physiotherapists, psychologists, occupational therapists and medical staff. Medical staff made up the largest group of respondents (61, 35%). Of the respondents 148 (85%) routinely assess cognition and 119 (72%) mood. A variety of tools were used (cognitive n = 45 tools; mood n = 17); Mini Mental State Examination (n = 103, 59% of respondents) and the Hospital Anxiety and Depression Scale (n = 76, 44%) were the most commonly employed tools.ConclusionResponse rate was modest but included all mainland Scottish regions with active stroke services. Although the majority of responders are assessing cognition and mood there is substantial heterogeneity in measures used and certain commonly used tools are not validated or appropriate for use in stroke. We suggest development of evidence based, standardised assessment protocols.Implications for RehabilitationScreening stroke survivor’s for cognitive and mood issues is recommended but there is little guidance on the preferred assessment strategyAcross Scottish stroke services there is a lack of consensus in assessment and management of cognition and mood post strokeSixty-two different cognitive/mood assessment tools were found to be in use across the countryCareful consideration must be given when inspecting assessment tools and use of caution when interpreting results

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References

2011

Psychological Management of Stroke

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The validity of the Addenbrooke’s Cognitive Examination-Revised (ACE-R) in acute stroke

Cited by 32 publications

References 42 publications

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

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

Questionnaire assessment of usual practice in mood and cognitive assessment in Scottish stroke units

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