Abstract
Background: Cognitive impairment is common following stroke. The Oxford Cognitive Screen (OCS) was designed to assess focal post-stroke cognitive deficits in five domains. Here, we investigated whether results generated by the OCS vs the domain-general Montreal Cognitive Assessment (MoCA) at baseline impacted patient outcomes at 6 months follow-up. Methods: Patients <2 months post-stroke were randomized to receive either the OCS and corresponding information leaflet or standard care with the MoCA at baseline. After 6 months, patients received both the OCS and MoCA. The primary registered outcome measures were the Stroke Impact Scale (SIS) and change in stroke severity (National Institutes of Health Stroke Scale; NIHSS) at 6 months. The secondary outcome was change in cognitive performance from baseline to 6-month follow-up. The relationship between scores from the two cognitive screens at follow-up was also explored. Results: A total of 821 patients from 37 different hospital or rehabilitation sites (England, UK) were recruited to the OCS-CARE study, with 467 completing 6-month follow-up. Patient outcomes defined by overall SIS scores and changes in NIHSS did not differ between the OCS or MoCA groups. There were high accordance rates between the OCS and MoCA at 6 months, with severity of cognitive impairment reflected in both screening tools. Cognitive performance in both groups over the 6-month follow-up declined in 22% of patients. A larger proportion of OCS group patients demonstrated improvements in cognitive scores (49% vs 40% in MoCA). Conclusions: The type of cognitive screening test did not impact broad stroke outcome measures, and the two screening tools showed a high overall accordance. The results suggest that more of the domain-specific deficits in OCS recover subacutely, providing a more granular picture of cognitive recovery as well as decline. Registration: ISRCTN50857950; registered on 27/03/2014.
Highlights
Cognitive impairment is a common consequence of stroke
Trial design In this noninferiority randomized controlled study, subacute stroke patients were assigned at a 1:1 allocation ratio to either (a) cognitive profiling with the domain-specific Oxford Cognitive Screen (OCS) and tailored management advice or (b) standard care domain-general cognitive screening with the Montreal Cognitive Screen (MoCA) within 10 weeks following stroke
The OCS-CARE study set out to investigate cognitive outcomes at 6 months based on domain-specific versus domain general cognitive screening within 10 weeks of stroke
Summary
Cognitive impairment is a common consequence of stroke. Studies reporting the prevalence of early post-stroke cognitive impairments suggest most patients experience at least one cognitive domain deficit (Demeyere et al, 2015; Jaillard et al, 2009). Domain-specific cognitive screening targeting common post-stroke impairments, such as aphasia, apraxia, and hemi-spatial neglect, allows for a more comprehensive assessment of the specific problems and the relationships between them. As above to explain the motivation of the study, more discussion is needed as to why the authors might expect the administration of a cognitive screen to change stroke outcome scores on functional/neurological measures such as the NIHSS and Barthel. We investigated whether results generated by the OCS vs the domain-general Montreal Cognitive Assessment (MoCA) at baseline impacted patient outcomes at 6 months follow-up. There were high accordance rates between the OCS and MoCA at 6 months, with severity of cognitive impairment reflected in both screening tools Cognitive performance in both groups over the 6-month follow-up declined in 22% of patients. The results suggest that more of the domain-specific deficits in OCS recover subacutely, providing a more
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