Abstract NS16: Performance-based Testing Identifies Cognitive Deficits Missed by Screening Methods Used in Mild Stroke

Abstract

Background: Recent data suggests that approximately 50 % of ischemic strokes are in the mild range (NIHSS ≤ 6). Persons with mild stroke have minimal motor, language or sensory impairment and often receive no rehab services. However about 30 % these patients are unable to fully return to pre-stroke roles and responsibilities due to subtle but disabling cognitive impairment. Aim: To assess the contribution of performance based testing (PBT) to the identification of executive function (EF) deficits undetected by traditional screening methods in a cohort of individuals with mild stroke reporting difficulties in participation as measured by the Stroke Impact Scale (SIS) Methods: The Impact of Mild Stroke on Community Reintegration and Quality of Life study followed a cohort of persons with first ischemic stroke with NIHSS scores ≤ 5 from acute admission to 1 yr follow-up. Neurocognitive, functional ,and self-report measures were administered at baseline, day 90, 6 mo. and 1 yr. PBTs assessing executive function were administered at 6-mo follow-up; The Executive Function Performance Test (EFPT) evaluates 4 complex IADL task s and The Multiple Errands Test (MET) requires performance of a series of tasks in a dynamic real-world environment . A score of < 80 on the SIS Participation scale SIS indicates failure to fully resume roles and responsibilities. Results: 90 patients (Mdn NIHSS=3; Mean age 60 ± 10.8 ) with first ischemic stroke were evaluated . All had MRS scores ≤ 1; 89 % were independent on the FIM (≥108) and normal cognition ( Short Blessed Test ≤ 4). Of these, 39 % reported scores less than 80 on SIS Participation. The EFPT identified 46 % of this group as performing in the impaired range. Further assessment of those unimpaired on the EFPT with the more demanding MET found an additional 22 % as impaired: 68% of patients scoring as “normal” on standard measures had impaired PBT scores. Conclusions: We identified individuals with occupational therapy rehabilitation needs unrecognized by standard measures. We recommend a hierarchical approach to evaluation of persons with mild stroke reporting difficulties in participation with PBT used in those scoring unimpaired/independent on standard outcome measures