Who is classified as untestable on brief cognitive screens in an acute stroke setting?

Elliott, E., Drozdowska, B. A. , Taylor-Rowan, M. , Shaw, R. C., Cuthbertson, G. and Quinn, T. J. (2019) Who is classified as untestable on brief cognitive screens in an acute stroke setting? Diagnostics, 9(3), 95. (doi: 10.3390/diagnostics9030095)

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Abstract

Full completion of cognitive screening tests can be problematic in the context of a stroke. Our aim was to examine the completion of various brief cognitive screens and explore reasons for untestability. Data were collected from consecutive stroke admissions (May 2016–August 2018). The cognitive assessment was attempted during the first week of admission. Patients were classified as partially untestable (≥1 test item was incomplete) and fully untestable (where assessment was not attempted, and/or no questions answered). We assessed univariate and multivariate associations of test completion with: age (years), sex, stroke severity (National Institutes of Health Stroke Scale (NIHSS)), stroke classification, pre-morbid disability (modified Rankin Scale (mRS)), previous stroke and previous dementia diagnosis. Of 703 patients admitted (mean age: 69.4), 119 (17%) were classified as fully untestable and 58 (8%) were partially untestable. The 4A-test had 100% completion and the clock-draw task had the lowest completion (533/703, 76%). Independent associations with fully untestable status had a higher NIHSS score (odds ratio (OR): 1.18, 95% CI: 1.11–1.26), higher pre-morbid mRS (OR: 1.28, 95% CI: 1.02–1.60) and pre-stroke dementia (OR: 3.35, 95% CI: 1.53–7.32). Overall, a quarter of patients were classified as untestable on the cognitive assessment, with test incompletion related to stroke and non-stroke factors. Clinicians and researchers would benefit from guidance on how to make the best use of incomplete test data.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Taylor-Rowan, Dr Martin and Elliott, Emma and Drozdowska, Bogna and Shaw, Mr Robert and Quinn, Professor Terry
Creator Roles:
Quinn, T. J.Conceptualization, Writing – review and editing, Supervision
Elliott, E.Formal analysis, Writing – original draft, Writing – review and editing
Drozdowska, B. E.Writing – review and editing
Taylor-Rowan, M.Writing – review and editing
Shaw, R. C.Writing – review and editing
Authors: Elliott, E., Drozdowska, B. A., Taylor-Rowan, M., Shaw, R. C., Cuthbertson, G., and Quinn, T. J.
College/School:College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
Journal Name:Diagnostics
Publisher:MDPI
ISSN:2075-4418
ISSN (Online):2075-4418
Published Online:14 August 2019
Copyright Holders:Copyright © 2019 The Authors
First Published:First published in Diagnostics 9(3): 95
Publisher Policy:Reproduced under a Creative Commons License

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
693431Improving assessment, prediction and understanding of the short, medium and longer term neuropsychological consequences of strokeTerence QuinnStroke Association (STROKEAS)PPA2015/01_CSORI CARDIOVASCULAR & MEDICAL SCIENCES