Using the Oxford Cognitive Screen to Detect Cognitive Impairment in Stroke Patients: A Comparison with the Mini-Mental State Examination

Mauro Mancuso, Nele Demeyere, Laura Abbruzzese, Alessio Damora, Valentina Varalta, Fabio Pirrotta, Gabriella Antonucci, Alessandro Matano, Marina Caputo, Maria Giovanna Caruso, Giovanna Teresa Pontiggia, Michela Coccia, Irene Ciancarelli, Pierluigi Zoccolotti, Italian OCS Group, Chiara Beni, Fabio Giovannelli, Ivana Bureca, Mauro Zampolini, Adonella Benedetti, Nicola Smania, Cristina Fonte, Elisa Ghirardi, Maurizio Iocco, Federica Galli, Laura Prospero, Adriana Gadaleta, Maristella Scattaglia, Franco Valluzzi, Nicoletta Caputi, Serena De Pellegrin, Michelangelo Bartolo, Chiara Zucchella, Pietro Spinelli, Irene Aprile, Caterina Pistarini, Valeria Pingue, Mirco Soda, Mauro Mancuso, Nele Demeyere, Laura Abbruzzese, Alessio Damora, Valentina Varalta, Fabio Pirrotta, Gabriella Antonucci, Alessandro Matano, Marina Caputo, Maria Giovanna Caruso, Giovanna Teresa Pontiggia, Michela Coccia, Irene Ciancarelli, Pierluigi Zoccolotti, Italian OCS Group, Chiara Beni, Fabio Giovannelli, Ivana Bureca, Mauro Zampolini, Adonella Benedetti, Nicola Smania, Cristina Fonte, Elisa Ghirardi, Maurizio Iocco, Federica Galli, Laura Prospero, Adriana Gadaleta, Maristella Scattaglia, Franco Valluzzi, Nicoletta Caputi, Serena De Pellegrin, Michelangelo Bartolo, Chiara Zucchella, Pietro Spinelli, Irene Aprile, Caterina Pistarini, Valeria Pingue, Mirco Soda

Abstract

Background: 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.

Objective: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

Keywords: Mini-Mental State Examination; Oxford Cognitive Screen; cognitive assessment; cognitive screening; stroke.

Figures

Figure 1
Figure 1
Incidence of impairment at Mini-Mental State Examination (MMSE) and Oxford Cognitive Screen (OCS) (at least one domain) as a function of NIHSS severity (minor = NIHSS 1–4, moderate = 5–15, moderate-severe = 16–20). Too few patients were in the severe NIHSS category to allow for reliable comparisons.
Figure 2
Figure 2
Percentage of Oxford Cognitive Screen domain impairments for each of the four Bamford categories.

References

    1. Jokinen H, Melkas S, Ylikoski R, Pohjasvaara T, Kaste M, Erkinjuntti T, et al. Post-stroke cognitive impairment is common even after successful clinical recovery. Eur J Neurol (2015) 22:1288–94.10.1111/ene.12743
    1. SPREAD. Stroke Prevention and Educational Awareness Diffusion. 8th ed (2017). AN: L.T.COM.09.2016.1690 cod. Art. 86145856.
    1. Liman TG, Heuschmann PU, Endres M, Floel A, Schwab S, Kolominsky-Rabas PL. Changes in cognitive function over 3 years after first-ever stroke and predictors of cognitive impairment and long-term cognitive stability: the Erlangen Stroke Project. Dement Geriatr Cogn Disord (2011) 31:291–9.10.1159/000327358
    1. Douiri A, Rudd AG, Wolfe CD. Prevalence of post stroke cognitive impairment: South London Stroke Register 1995-2010. Stroke (2013) 44:138–45.10.1161/STROKEAHA.112.670844
    1. Tatemichi TK, Desmond DW, Stern Y, Paik M, Sano M, Bagiella E. Cognitive impairment after stroke: frequency, patterns, and relationship to functional abilities. J Neurol Neurosurg Psychiatry (1994) 57:202–7.10.1136/jnnp.57.2.202
    1. Nys GMS, van Zandvoort MJE, de Kort PLM, Jansen BPW, de Haan EHF, Kappelle LJ. Cognitive disorders in acute stroke: prevalence and clinical determinants. Cerebrovasc Dis (2007) 23:408–16.10.1159/000101464
    1. Jaillard A, Naegele B, Trabucco-Miguel S, LeBas JF, Hommel M. Hidden dysfunctioning in subacute stroke. Stroke (2009) 40:2473–9.10.1161/STROKEAHA.108.541144
    1. Middleton LE, Lam B, Fahmi H, Black SE, McIlroy WE, Stuss DT, et al. Frequency of domain-specific cognitive impairment in sub-acute and chronic stroke. NeuroRehabilitation (2014) 34:305–12.10.3233/NRE-131030
    1. Dafer RM, Rao M, Shareef A, Sharma A. Post-stroke depression. Top Stroke Rehabil (2008) 15:13–21.10.1310/tsr1501-13
    1. Nys GMS, van Zandvoort MJE, de Kort PLM, van der Worp HB, Jansen BPW, Algra A, et al. The prognostic value of domain-specific cognitive abilities in acute first-ever stroke. Neurology (2005) 64:821–7.10.1212/01.WNL.0000152984.28420.5A
    1. Paolucci S, Matano A, Bragoni M, Coiro P, De Angelis D, Fusco FR, et al. Rehabilitation of left brain-damaged ischemic patients: the role of comprehension language deficits. Cerebrovasc Dis (2005) 20:400–6.10.1159/000088671
    1. Hochstenbach JB, Anderson PG, van Limbeek J, Mulder TT. Is there a relation between neuropsychologic variables and quality of life after stroke? Arch Phys Med Rehabil (2001) 82:1360–6.10.1053/apmr.2001.25970
    1. Hachinski V, Iadecola C, Petersen RC, Breteler MM, Nyenhuis DL, Black SE, et al. National Institute of Neurological Disorders and Stroke-Canadian Stroke Network vascular cognitive impairment harmonization standards. Stroke (2006) 37:2220–41.10.1161/01.STR.0000237236.88823.47
    1. Magni E, Binetti G, Bianchetti A, Rozzini R, Trabucchi M. Mini-Mental State Examination: a normative study in Italian elderly population. Eur J Neurol (1996) 3:198–202.10.1111/j.1468-1331.1996.tb00423.x
    1. Cumming TB, Bernhardt J, Linden T. The Montreal cognitive assessment short cognitive evaluation in a large stroke trial. Stroke (2011) 42:2642–4.10.1161/STROKEAHA.111.619486
    1. Demeyere N, Riddoch MJ, Slavkova ED, Jones K, Reckless I, Mathieson P, et al. Domain-specific versus generalized cognitive screening in acute stroke. J Neurol (2016) 263:306–15.10.1007/s00415-015-7964-4
    1. Tombaugh TN, McIntyre NJ. The mini-mental state examination: a comprehensive review. J Am Geriatr Soc (1992) 40:922–35.10.1111/j.1532-5415.1992.tb01992.x
    1. Nys GMS, van Zandvoort MJE, de Kort PLM, Jansen BPW, Kappelle LJ, de Haan EHF. Restrictions of the mini-mental state examination in acute stroke. Arch Clin Neuropsychol (2005) 20:623–9.10.1016/j.acn.2005.04.001
    1. Bour A, Rasquin S, Boreas A, Limburg M, Verhey F. How predictive is the MMSE for cognitive performance after stroke? J Neurol (2010) 257:630–7.10.1007/s00415-009-5387-9
    1. Dong Y, Sharma VK, Chan BPL, Venketasubramanian N, Teoh HL, Seet RCS, et al. The Montreal Cognitive Assessment (MoCA) is superior to the Mini-Mental State Examination (MMSE) for the detection of vascular cognitive impairment after acute stroke. J Neurol Sci (2010) 299:15–8.10.116/j.jns.2010.08.051
    1. Arciniegas DB, Kellermeyer GF, Bonifer NM, Anderson-Salvi KM, Anderson CA. Screening for cognitive decline following single known stroke using the mini-mental state examination. Neuropsychiat Dis Treat (2011) 7:189–96.10.2147/NDT.SI7886
    1. Godefroy O, Fickl A, Roussel M, Auribault C, Bugnicourt JM, Lamy C, et al. Is the montreal cognitive assessment superior to the mini-mental state examination to detect post stroke cognitive impairment? Stroke (2011) 42:1712–6.10.1161/STOKEAHA.110.606277
    1. Barnay JL, Wauquiez G, Bonnin-Koang HY, Anquetil C, Pérennou D, Piscitelli C, et al. Feasibility of the cognitive assessment scale for stroke patients (CASP) vs. MMSE and MoCa in aphasic left hemispheric stroke patients. Ann Phys Rehabil Med (2014) 57:422–35.10.1016/j.rehab.2014.05.010
    1. Jacquin A, Binquet C, Rouaud O, Graule-Petot A, Daubail B, Osseby GV, et al. Post-stroke cognitive impairment: high prevalence and determining factors in a cohort of mild stroke. J Alzheimers Dis (2014) 40:1029–38.10.3233/JAD-131580
    1. Benaim C, Barnay JL, Wuaquiez G, Bonnin-Koang HY, Anquetil C, Pérennou D, et al. The cognitive assessment scale for stroke patients (CASP) vs. MMSE and MoCa in non-aphasic hemispheric stroke patients. Ann Phys Rehabil Med (2015) 58:78–85.10.1016/j.rehab.2014.12.001
    1. Zhang H, Zhang XN, Zhang HL, Huang L, Chi QQ, Zhang X, et al. Differences in cognitive profiles between traumatic brain injury and stroke: a comparison of the Montreal Cognitive Assessment and Mini-Mental State Examination. Chin J Traumatol (2016) 19:271–4.10.1016/j.cjtee.2015.03.007
    1. Delavaran H, Jönsson AC, Lövkvist H, Iwarsson S, Elmståhl S, Norrving B, et al. Cognitive function in stroke survivors: a 10-year follow-up study. Acta Neurol Scand (2017) 136:187–94.10.1111/ane.12709
    1. Arba F, Quinn T, Hankey GJ, Ali M, Lees KR, Inzitari D. Cerebral small vessel disease, medial temporal lobe atrophy, and cognitive status in patients with ischaemic stroke and transient ischaemic attack. Eur J Neurol (2017) 24:276–82.10.1111/ene.13191
    1. Stephan BCM, Minett T, Muniz-Terrera G, Harrison SL, Matthews FE, Brayne C. Neuropsychological profiles of vascular disease and risk of dementia: implications for defining vascular cognitive impairment no dementia (VCI-ND). Age Ageing (2017) 46:755–60.10.1093/ageing/afx016
    1. You S, Wang X, Lindley RI, Robinson T, Anderson CS, Cao Y, et al. Early cognitive impairment after intracerebral hemorrhage in the INTERACT1 Study. Cerebrovasc Dis (2017) 44:320–4.10.1159/000481443
    1. Tan HH, Xu J, Teoh HL, Chan BPL, Seet RCS, Venketasubramanian N, et al. Decline in changing Montreal Cognitive Assessment (MoCA) scores is associated with post-stroke cognitive decline determined by a foral neuropsychological evaluation. PLoS One (2017) 12(3):e0173291.10.1371/journal.pone.0173291
    1. Fu C, Jin X, Chen B, Niu H, Guo R, Chen Z, et al. Comparison of the mini-mental state examination and montreal cognitive assessment executive subtest in detecting post-stroke cognitive impairment. Geriatr Gerontol Int (2017) 17(12):2329–35.10.1111/ggi.13069
    1. Wang A, Liu J, Meng X, Li J, Wang H, Wang Y, et al. Association between oxidized low-density lipoprotein and cognitive impairment in patients with ischemic stroke. Eur J Neurol (2018) 25(1):185–91.10.1111/ene.13497
    1. National Institute for Clinical Excellence. Stroke Rehabilitation: Long-Term Rehabilitation after Stroke. NICE Clinical Guidelines CG162. London: National Institute for Health and Clinical Excellence; (2013).
    1. Demeyere N, Riddoch MJ, Slavkova ED, Bickerton WL, Humphreys GW. The Oxford Cognitive Screen (OCS): validation of a stroke-specific short cognitive screening tool. Psychol Assess (2015) 27:883–94.10.1037/pas0000082
    1. Bamford J, Sandercock P, Dennis M, Burn J, Warlow C. Classification and natural history of clinically identifiable subtypes of cerebral infarction. Lancet (1991) 337:1521–6.10.1016/0140-6736(91)93206-O
    1. Brott T, Adams HP, Olinger CP, Marler JR, Barsan WG, Biller J, et al. Measurements of acute cerebral infarction: a clinical examination scale. Stroke (1989) 20:864–70.10.1161/01.STR.20.7.864
    1. Mancuso M, Varalta V, Sardella L, Capitani D, Zoccolotti P, Antonucci G, et al. Italian normative data for a stroke specific cognitive screening tool: the Oxford Cognitive Screen (OCS). Neurol Sci (2016) 37:1713–21.10.1007/s10072-016-2650-6
    1. Pendlebury ST, Cuthbertson FC, Welch SJV, Mehta Z, Rothwell PM. Underestimation of cognitive impairment by mini-mental state examination versus the montreal cognitive assessment in patients with transient ischemic attack and stroke. A population-based study. Stroke (2010) 41:1290–3.10.1161/STROKEAHA.110.579888
    1. Chan E, Khan S, Oliver R, Gill SK, Werring DJ, Cipolotti L. Underestimation of cognitive impairments by the Montreal Cognitive Assessment (MoCA) in an acute stroke unit population. J Neurol Sci (2014) 343:176–9.10.1016/j.jns.2014.05.005
    1. Nasreddine ZS, Phillips NA, Bédirian V, Charbonneau S, Whitehead V, Collin I, et al. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc (2005) 53:695–9.10.1111/j.1532-5415.2005.53221.x
    1. Cumming TB, Churilov L, Linden T, Bernhardt J. Montreal cognitive assessment and mini-mental state examination are both valid cognitive tools in stroke. Acta Neurol Scand (2013) 128:122–9.10.1111/ane.12084
    1. Lees R, Selvarajah J, Fenton C, Pendlebury ST, Langhorne P, Stott DJ, et al. Test accuracy of cognitive screening tests for diagnosis of dementia and multidomain cognitive impairment in stroke. Stroke (2014) 45:3008–18.10.1161/STROKEAHA.114.005842/-/DC1
    1. Burton L, Tyson SF. Screening for cognitive impairment after stroke: a systematic review of psychometric properties and clinical utility. J Rehabil Med (2015) 47:193–203.10.2340/16501977-1930
    1. Bickerton WL, Demeyere N, Francis D, Kumar V, Remoundou M, Balani A, et al. The BCoS cognitive profile screen: utility and predictive value for stroke. Neuropsychology (2015) 29:638–48.10.1037/neu0000160
    1. Von Campe G, Regli F, Bogousslavsky J. Heralding manifestations of basilar artery occlusion with lethal or severe stroke. J Neurol Neurosurg Psychiatry (2003) 74:1621–6.10.1136/jnnp.74.12.1621
    1. Kreiter KT, Copeland D, Bernardini GL, Bates JE, Peery S, Claassen J, et al. Predictors of cognitive dysfunction after subarachnoid hemorrhage. Stroke (2002) 33:200–8.10.1161/hs0102.101080

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