Prospective cognitive assessment of stroke patients before inpatient rehabilitation. The relationship of the Neurobehavioral Cognitive Status Examination to functional improvement.

Abstract

Prospective studies establish cognitive status as an important determinant of post-stroke rehabilitation success. The Neurobehavioral Cognitive Status Examination (NCSE) briefly assesses cognition in the ability areas of language, constructions, memory, calculation and reasoning. The NCSE, as well as the commonly used Mini-Mental State Examination and Albert's Test, were administered to 38 stroke patients before inpatient rehabilitation to determine the extent to which they predict rehabilitation outcome. Rehabilitation outcome was measured as the difference between initial and discharge Barthel Index score. The NCSE was shown to be a more sensitive indicator of impairment than the Mini-Mental State Examination and Albert's Test, especially in subsections of orientation and memory (X2 = 8.690, df = 1, P less than 0.005; X2 = 13.348, df = 1, P less than 0.001, respectively). Stepwise multiple regression revealed that attention, calculations and judgement were in association the best predictors of improvement in the Barthel Index scores. Therefore, the NCSE provides both a rapid and sensitive measure of cognitive function and it appears to predict functional status change as a result of inpatient stroke rehabilitation.