Comparative validity of informant tools for assessing pre-stroke cognitive impairment

Taylor-Rowan, M. , McGuire, L., Hafdi, M., Evans, J. , Stott, D. J. , Wetherall, K., Elliott, E., Drozdowska, B. and Quinn, T. J. (2022) Comparative validity of informant tools for assessing pre-stroke cognitive impairment. International Journal of Geriatric Psychiatry, 37(4), pp. 1-10. (doi: 10.1002/gps.5700) (PMID:35278006)

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Abstract

Objectives: Various informant-based questionnaires are used in clinical practice to screen for pre-stroke cognitive problems. However, there is no guidance on which tool should be preferred. We compared the validity of the two most commonly used informant-based tools. Methods: We recruited consecutively admitted stroke patients. Patients' informants completed the Informant Questionnaire for Cognitive Decline in the Elderly Short Form (IQCODE-SF, 16-item) and Ascertain Dementia 8 (AD8). We assessed construct validity (accuracy) against a semi-structured clinical interview for dementia or mild cognitive impairment (MCI), describing test accuracy metrics and comparing area under ROC curves (AUROC). We described criterion validity by evaluating associations between test scores and neuroimaging markers of dementia and overall ‘brain frailty’. Finally, we described prognostic validity comparing ROC curves for 18-month clinical outcomes of dementia, death, stroke, and disability. Results: One-hundred-thirty-seven patient-informant dyads were recruited. At usual clinical cut-points, the IQCODE-SF had comparable sensitivity to the AD8 (both = 92%) for pre-stroke dementia, but superior specificity (IQCODE-SF: 82% vs. AD8: 58%). Youden index suggested that the optimal AD8 threshold for diagnosis of dementia is ≥4. The IQCODE-SF demonstrated stronger associations with markers of generalised and medial-temporal lobe atrophy, neurovascular disease, and overall brain frailty. IQCODE-SF also demonstrated greater accuracy for predicting future dementia (IQCODE-SF AUROC = 0.903, 95% CI = 0.798–1.00; AD8 AUROC = 0.821, 95% CI = 0.664–0.977). Conclusions: Both IQCODE-SF and AD8 are valid measures of pre-stroke dementia. Higher cut points for AD8 may improve performance in the acute stroke setting. Based on consistent superiority across a range of validity analyses, IQCODE-SF may be preferable to AD8 for pre-stroke dementia screening.

Item Type:Articles
Additional Information:Research Funding: NHSGGC Endowment Fellowship Funding Award. Grant Number: Project ref: GN20ST405. Stroke Association and Chief Scientist Office of Scotland. Grant Number: funding reference: PPA 2015/01_CSO.
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Taylor-Rowan, Mr Martin and Evans, Professor Jonathan and Hafdi, Melanie and Quinn, Dr Terry and Wetherall, Miss Kirsty and Elliott, Emma and Stott J, Professor David and Drozdowska, Bogna
Authors: Taylor-Rowan, M., McGuire, L., Hafdi, M., Evans, J., Stott, D. J., Wetherall, K., Elliott, E., Drozdowska, B., and Quinn, T. J.
College/School:College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > General Practice and Primary Care
College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Mental Health and Wellbeing
College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Robertson Centre
Journal Name:International Journal of Geriatric Psychiatry
Publisher:Wiley
ISSN:0885-6230
ISSN (Online):1099-1166
Published Online:04 March 2022
Copyright Holders:Copyright © 2022 The Authors
First Published:First published in International Journal of Geriatric Psychiatry 37(4):1-10
Publisher Policy:Reproduced under a Creative Commons Licence

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
172806Improving assessment, prediction and understanding of the short, medium and longer term neuropsychological consequences of strokeTerence QuinnStroke Association (STROKEAS)PPA2015/01_CSOInstitute of Cardiovascular & Medical Sciences