Use of Cognitive Screening Tools to Detect Cognitive Impairment After an Ischaemic Stroke: a Systematic Review

Abstract

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.