The need for post-stroke cognitive screening - the rationale behind the Hungarian adaptation of the Oxford Cognitive Screen (OCS) and its pilot study

There is no gold standard screening tool available to assess post-stroke cognitive impairment (PSCI). PSCI is a common and under-recognised global problem in stroke patients that may eventually lead to post-stroke dementia (PSD). Two major issues in PSCI research include the lack of a clear-cut definition and a lack of highly specific and sensitive screening tools that accurately predict PSCI. To identify the most appropriate cognitive screening tool to be used in the diagnosis of PSCI. MEDLINE and “The Cochrane Library” were searched for articles published between January 2000 and August 2016 that contained the keywords “post-stroke cognitive impairment”, “post-stroke dementia” or “cognitive tools after stroke” or “cognitive impairment after stroke”. Abstracts were selected using predetermined inclusion and exclusion criteria, and full-text reviews were performed. Publications on cognitive screening tools and PSCI or PSD were pooled separately for the review process. A total of 22 publications discussing cognitive screening tools in PSCI and PSD were identified. Only two publications discussed the use of multidomain cognitive tools. Some publications reported that domain-specific cognitive screening tools had higher sensitivity and specificity when compared to commonly use cognitive screening tools such as the Montreal Cognitive Assessment (MOCA) and Mini-Mental State Examination (MMSE). The superiority of one available tool was not evident in studies that performed a meta-analysis. The Oxford Cognitive Screen (OCS), a multidomain tool, was found to be a better predictor of PSCI/PSD than the MOCA or MMSE. To date, the literature on PSCI has primarily focused on nonspecific cognitive screening tools, although there has been a recent move towards domain-specific screening tools. Multidomain screening tools such as the OCS may be better than existing tools in the diagnosis of PSD and PSCI.

Validation of the American-Spanish Oxford Cognitive Screen (OCS-Sp): Normative data and psychometric properties in acute stroke patients.

The computerized version of the Hong Kong Oxford Cognitive Screen for dementia (HK-OCSd): Estimates of concurrent validity and reliability

Cognitive deficits occur in most stroke patients and cognitive impairment is an important predictor of adverse long term outcome. However, current screening measures, such as the Mini Mental State Examination or the Montreal Cognitive Assessment, do not provide information tuned for evaluating the impact of cognitive impairment in the early phase after stroke. The Oxford Cognitive Screen (OCS) represents an important new development in this regard. The OCS is now available for assessment of Italian individuals and the aim of this study is to standardize the OCS on a large sample of healthy Italian participants stratified for age, gender and education level. Results confirmed the influence of these factors in several of the OCS tasks. Age-, education- and gender-adjusted norms are provided for the ten sub-tests of the test. The availability of normative data represents an important prerequite for the reliable use of OCS with stroke patients.

No stroke-specific cognitive screen currently exists for community-dwelling chronic stroke survivors, with primary care and community settings relying on dementia tools which often do not consider specific post-stroke impairments. The Oxford Cognitive Screen (OCS) was developed for use in acute stroke, but its administration time is prohibitive for brief screening. Here, we aimed to develop, standardise and psychometrically validate the Mini-Oxford Cognitive Screen (Mini-OCS), a brief (<8 min) cognitive screen aimed for use in chronic stroke. Existing full OCS data for 464 English participants who were ⩾6 months post-stroke were analysed for the possibility of a short-form. Theoretical choices were made to adapt the short-form to be suitable for use in chronic stroke. The Mini-OCS was then completed by 164 neurologically healthy controls (Mage = 68.66; SD = 12.18, Myears of education 15.40; SD = 3.64, 61% female), and 89 chronic stroke survivors (Mage = 69.86; SD = 14.83, Myears education = 14.29; SD = 4.01, 44.94% female, Mdays since stroke = 597.02; SD = 881.12, 78.57% ischaemic, Median NIHSS = 6.5 (IQR = 4-11)). In addition, the original OCS, the Montreal Cognitive Assessment, and an extended neuropsychological battery were administered. Psychometric properties of the Mini-OCS were evaluated via construct validity and retest reliability. Normative data for the Mini-OCS is provided and known-group discrimination demonstrates increased sensitivity in the memory and executive function domains compared to the OCS. The Mini-OCS further met all appropriate benchmarks for evidence of retest reliability and construct validity. The Mini-OCS is a short-form standardised cognitive screening tool with initial evidence of good psychometric properties for use in a chronic stroke population.

IntroductionNo stroke-specific cognitive screen currently exists for community-dwelling chronic stroke survivors, with primary care and community settings relying on dementia tools which often do not consider specific post-stroke impairments. The Oxford Cognitive Screen (OCS) was developed for use in acute stroke, but its administration time is prohibitive for brief screening. Here, we aimed to develop, standardise, and psychometrically validate the Mini-Oxford Cognitive Screen (Mini-OCS), a brief (&amp;lt;8 minute) cognitive screen aimed for use in chronic stroke. MethodExisting full OCS data for 464 participants who were &amp;gt;= 6 months post-stroke were analysed for the possibility of a short-form. Theoretical choices were made to adapt the short-form to be suitable for use in chronic stroke. The Mini-OCS was then completed by 164 neurologically healthy controls (Mage = 68.66(SD=12.18), Myrs of education 15.40(SD=3.64), 61% Female), and 89 chronic stroke survivors (Mage = 69.86(SD=14.83), Myrs education = 14.29(SD=4.01), 44.94% Female, Mdays since stroke = 597.02(SD=881.12), 78.57% ischaemic, Median NIHSS = 6.5(IQR=4-11)). In addition, the original OCS, the Montreal Cognitive Assessment, and an extended neuropsychological battery were administered. Psychometric properties of the Mini-OCS were evaluated via construct validity and retest reliability. FindingsNormative data for the Mini-OCS is provided and known-group discrimination demonstrates increased sensitivity in the memory and executive function domains compared to the OCS. The Mini-OCS further met all appropriate benchmarks for evidence of retest reliability and construct validity.Discussion and conclusionThe Mini-OCS is a short-form standardized cognitive screening tool with good psychometric properties for use in a chronic stroke population.

No stroke-specific cognitive screen currently exists for community-dwelling chronic stroke survivors, with primary care and community settings relying on dementia tools which often do not consider specific post-stroke impairments. The Oxford Cognitive Screen (OCS) was developed for use in acute stroke, but its administration time is prohibitive for brief screening. Here, we aimed to develop, standardise and psychometrically validate the Mini-Oxford Cognitive Screen (Mini-OCS), a brief (<8 min) cognitive screen aimed for use in chronic stroke. Existing full OCS data for 464 English participants who were ⩾6 months post-stroke were analysed for the possibility of a short-form. Theoretical choices were made to adapt the short-form to be suitable for use in chronic stroke. The Mini-OCS was then completed by 164 neurologically healthy controls (M age = 68.66; SD = 12.18, M years of education 15.40; SD = 3.64, 61% female), and 89 chronic stroke survivors (M age = 69.86; SD = 14.83, M years education = 14.29; SD = 4.01, 44.94% female, M days since stroke = 597.02; SD = 881.12, 78.57% ischaemic, Median NIHSS = 6.5 (IQR = 4-11)). In addition, the original OCS, the Montreal Cognitive Assessment, and an extended neuropsychological battery were administered. Psychometric properties of the Mini-OCS were evaluated via construct validity and retest reliability. Normative data for the Mini-OCS is provided and known-group discrimination demonstrates increased sensitivity in the memory and executive function domains compared to the OCS. The Mini-OCS further met all appropriate benchmarks for evidence of retest reliability and construct validity. The Mini-OCS is a short-form standardised cognitive screening tool with initial evidence of good psychometric properties for use in a chronic stroke population.

ObjectivesThe accuracy of cognitive screening tools to detect poststroke cognitive impairment (PSCI) was investigated using various neuropsychological definitions.MethodsHospital‐based stroke patients underwent a comprehensive neuropsychological assessment. The rate of PSCI was estimated using thresholds of 1, 1.5, or 2 standard deviations below the normal control and memory impairment defined by a single or multiple tests. Meanwhile, the diagnostic accuracy of cognitive screening through face‐to‐face assessment using the Mini‐Mental State Examination (MMSE) and the Montreal Cognitive Assessment Scale (MoCA), and telephone assessment using a 5‐minute NINDS‐Canadian Stroke Network (NINDS‐CSN) scale and a six‐item screener (SIS), was both tested under different definitions, with the optimal cutoff selected based on the highest Youden index.ResultsIn stroke patients, the rate of PSCI ranged from 46.3% to 76.3% upon different definitions. The face‐to‐face MoCA was more consistent with the comprehensive cognitive assessment compared to MMSE. The optimal cutoff of PSCI was MMSE ≤ 27 and MoCA ≤ 19. For the telephone tests, the 5‐minute NINDS‐CSN assessment was more reliable, and the optimal cutoff was ≤23, while for SIS ≤ 4.ConclusionsCognitive screening tools including the face‐to‐face MMSE and MoCA, together with the telephone assessment of NINDS‐CSN 5‐minute protocol and SIS, were simple and effective for detecting PSCI in stroke patients. The corresponding threshold values for PSCI were 27 points, 19 points, 23 points, and 4 points.

There is currently no existing freely available short screen for cognitive problems that targets stroke survivors specifically. We have developed a short cognitive screen, the Oxford Cognitive Screen (OCS), to be completed in 15-20 min, designed for use with stroke patients. To maximize inclusion, the test is aphasia- and neglect friendly and covers domains of cognition where deficits frequently occur after stroke, including apraxia and unilateral neglect as well as memory, language, executive function, and number abilities. Domain-specific scores are returned to help direct rehabilitation. This article presents the normative data in a large sample of 140 neurologically healthy participants, a report on incidences of impairments in a sample of 208 acute stroke patients (within 3 weeks of stroke onset), measures of test-retest reliability on an alternate form and convergent and divergent validity. In addition, the full test materials are made freely available for clinical use.

Background &lt;br/&gt;Stroke-induced cognitive impairments are critical predictors of poor functional outcomes. They adversely affect recovery and reduce independent performance of basic activities of daily living (ADL) and instrumental ADL (Zinn et al., 2004). Choices of cognitive assessment tools specific to the Cantonese speaking stroke population in Hong Kong are limited. The Cantonese version of the Western Aphasia Battery (Cantonese-WAB) was specifically developed for examining language impairments. The Cantonese version of MMSE (Cantonese-MMSE) and Hong Kong Montreal Cognitive Assessment (HK-MoCA), designed to detect cognitive deficits associated with dementia, lacked important measures of writing, neglect, and praxis where impairments were commonly found in stroke. More critically, most tasks in these two screeners required relatively intact auditory comprehension and verbal responses from participants. Presence of aphasia can, therefore, lead to underestimation of cognitive abilities. &lt;br/&gt; &lt;br/&gt;Aims &lt;br/&gt;Extending Chan et al.’s (2013) development of a Cantonese version of the Birmingham Cognitive Screen (BCoS) to be used in Hong Kong, our first aim was to validate the Oxford Cognitive Screen (OCS), built on similar principles to the BCoS test but is shorter (15 minutes) and can be used in acute settings, for Cantonese-speaking stroke survivors. This tool, including assessment of aphasia, apraxia, attention, memory, and spatial neglect, was designed to be neglect- and aphasia-friendly by using multi-modal presentation, forced-choice testing procedures, and vertical layouts. The second aim was to determine which cognitive domain(s) in HK-OCS would best predict functional outcomes. &lt;br/&gt; &lt;br/&gt;Procedures &lt;br/&gt;Seventy normal individuals were recruited to establish the normative data of HK-OCS. Norm was developed for three age groups (&lt; 50, 50-59, and &gt;59 years). Direct percentile conversions for each sub-test scores were used and cut-off scores were set at the top 5th percentile. Forty six native Cantonese-speaking stroke participants (aged 21-83 years; 72% left hemispheric stroke) participated and received a short test of gestural production (Goldenberg, 1996), Albert’s test of visual neglect, Chinese version of the Modified Barthel Index, and Hong Kong Chinese version of Lawton Instrumental Activities of Daily Living scale, Cantonese-WAB, Cantonese-MMSE, HK-MoCA, and HK-OCS. &lt;br/&gt; &lt;br/&gt;Results &lt;br/&gt;Cut-off scores for most HK-OCS sections were comparable across the three age groups. Paired-sample t-tests revealed the stroke group achieved significantly lower scores across most sections than matched controls. The tool demonstrated strong concurrent validity with positive and significant correlations across related cognitive subtests in other batteries (Table 1). The HK-OCS also had excellent intra-rater and inter-rater, good test-retest reliability, and acceptable internal consistency. Regarding its predictive values on functional outcomes, while semantics and episodic memory best predicted basic ADL, number writing and orientation best predicted complex ADL. &lt;br/&gt;

Cognitive assessments after stroke are typically short form tests developed for dementia that generates pass/fail classifications (e.g. the MoCA). The Oxford Cognitive Screen (OCS) provides a domain-specific cognitive profile designed for stroke survivors. This study compared the use of the MoCA and the OCS in acute stroke with respect to symptom specificity and aspects of clinical utility. A cross-sectional study with a consecutive sample of 200 stroke patients within 3 weeks of stroke completing MoCA and OCS. Demographic data, lesion side and Barthel scores were recorded. Inclusivity was assessed in terms of completion rates and reasons for non-completion were evaluated. The incidence of cognitive impairments on both the MoCA and OCS sub-domains was calculated and differences in stroke specificity, cognitive profiles and independence of the measures were addressed. The incidence of acute cognitive impairment was high: 76 % of patients were impaired on MoCA, and 86 % demonstrated at least one impairment on the cognitive domains assessed in the OCS. OCS was more sensitive than MoCA overall (87 vs 78 % sensitivity) and OCS alone provided domain-specific information on prevalent post-stroke cognitive impairments (neglect, apraxia and reading/writing ability). Unlike the MOCA, the OCS was not dominated by left hemisphere impairments but gave differentiated profiles across the contrasting domains. The OCS detects important cognitive deficits after stroke not assessed in the MoCA, it is inclusive for patients with aphasia and neglect and it is less confounded by co-occurring difficulties in these domains.

The Oxford Cognitive Screen (OCS) was recently developed with the aim of describing the cognitive deficits after stroke. The scale consists of 10 tasks encompassing five cognitive domains: attention and executive function, language, memory, number processing, and praxis. OCS was devised to be inclusive and un-confounded by aphasia and neglect. As such, it may have a greater potential to be informative on stroke cognitive deficits of widely used instruments, such as the Mini-Mental State Examination (MMSE) or the Montreal Cognitive Assessment, which were originally devised for demented patients. The present study compared the OCS with the MMSE with regards to their ability to detect cognitive impairments post-stroke. We further aimed to examine performance on the OCS as a function of subtypes of cerebral infarction and clinical severity. 325 first stroke patients were consecutively enrolled in the study over a 9-month period. The OCS and MMSE, as well as the Bamford classification and NIHSS, were given according to standard procedures. About a third of patients (35.3%) had a performance lower than the cutoff (<22) on the MMSE, whereas 91.6% were impaired in at least one OCS domain, indicating higher incidences of impairment for the OCS. More than 80% of patients showed an impairment in two or more cognitive domains of the OCS. Using the MMSE as a standard of clinical practice, the comparative sensitivity of OCS was 100%. Out of the 208 patients with normal MMSE performance 180 showed impaired performance in at least one domain of the OCS. The discrepancy between OCS and MMSE was particularly strong for patients with milder strokes. As for subtypes of cerebral infarction, fewer patients demonstrated widespread impairments in the OCS in the Posterior Circulation Infarcts category than in the other categories. Overall, the results showed a much higher incidence of cognitive impairment with the OCS than with the MMSE and demonstrated no false negatives for OCS vs MMSE. It is concluded that OCS is a sensitive screen tool for cognitive deficits after stroke. In particular, the OCS detects high incidences of stroke-specific cognitive impairments, not detected by the MMSE, demonstrating the importance of cognitive profiling.

Screening for Dementia in Audiology Clinics – Advantages, Pitfalls, and Recommendations

BackgroundThe existing cognitive screening tests used to assess cognitive disorders after stroke in Türkiye face limitations in scope and user applicability. Therefore, this study aimed to address these limitations by adapting the stroke-specific cognitive screening test, the Oxford Cognitive Screen (OCS), into Turkish. Additionally, validity and reliability studies were conducted.MethodsA total of 114 stroke survivors and 92 healthy individuals participated in the study. Data were collected using the “Participant Information Form,” “Oxford Cognitive Screen Turkish Version (OCS-TR),” “Aphasia Language Assessment Test (ADD),” “Montreal Cognitive Assessment Test- Turkish (MOCA-TR),” “Barthel Activities of Daily Living Index (BGYAI)” and “Beck Depression Scale.” The team followed an established and detailed step by step process guided by the OCS Concept Elaboration document. Statistical analyses were conducted with IBM SPSS Statistics. Validity and reliability studies, including content validity, known-groups validity, convergent and divergent validity, concurrent validity, internal consistency reliability, test-retest reliability, inter-rater reliability, intra-rater reliability, and parallel forms reliability were conducted to assess the robustness of the measurement instruments.ResultsThe language and cultural adaptation process underwent content analysis, adhering to ISPOR and ISOQOL guidelines, resulting in minimal content changes post-pilot study. Notable differences in subtest scores between healthy and stroke participants in both A and B forms of OCS-TR demonstrate known-groups validity, emphasizing superior performance in healthy participants. Strong convergent validity was evidenced by significant correlations with MOCA-TR (rs=0.18 to 0.81) and BGYAI (rs=0.19 to 0.51), while divergent validity was supported by weak correlations with overall BGYAI scores. Noteworthy correlations between specific subtests of OCS-TR and ADD underscore concurrent validity, with high inter- and intra-rater reliability, internal consistency (α = 0.90 for stroke, α = 0.65 for healthy) and test-retest reliability (rs=0.89 to 0.99). Parallel forms reliability was high in both healthy and stroke participants, though significant differences were observed on specific subtests.ConclusionThe results confirm that the OCS-TR scale can be considered a valid and reliable instrument for assessing cognitive functions in stroke survivors. This stroke-specific tool offers clinicians a comprehensive and inclusive brief cognitive screening tool tailored to the needs of stroke patients.

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 &lt;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.