Cognitive Assessment is Feasible After Acute Stroke and Can Identify Co-occurrence of Spatial Neglect
Sabrina Hickle1, Janice Convoy-Hellmann2, David Loring3, Jessica Saurman4, Karima Benameur4, Shilpa Krishnan4, Fadi Nahab4, A. Barrett5
1Emory University School of Medicine, 2Emory Healthcare, 3Neurology, Emory University School of Medicine, 4Emory University School of Medicine, 5UMass Memorial
Objective:
1) Determine whether beside screening of aphasia, delirium, spatial neglect (SN), global cognitive impairment (GCI), and depression is feasible in the stroke unit. 2) Determine the incidence and co-occurrence of these disorders
Background:
Most people are unaware of cognitive problems. Aphasia, delirium, SN, global cognitive impairment (GCI), and depression are common in the days after stroke, however even experienced clinicians can miss signs without systematic cognitive assessment. It is crucial to identify co-occurrence of these conditions; the disorders are individually associated with worse functional outcomes.
Design/Methods:
Bedside psychometric assessments were completed during acute stroke care (606 patients) with standardized and validated screening: 1) 3D-CAM for delirium, 2) Language Screening Test for aphasia, 3) Catherine Bergego Scale (short form) for SN, 4) Montreal cognitive assessment for GCI, and 5) Patient Health Questionnaire-8 for depression. We used standardized cutoffs to identify deficits, and summary statistics to determine the incidence/co-occurrence of deficits.
Results:
More than 98% of patients could be assessed with at least one screener, with > 95% completion rate on each measure (good feasibility). Of 565 patients completing all screening instruments, 94% met criterion for GCI, 53% for SN, 27% for aphasia, 22% for depression, and 15% for delirium; 9% of patients presented with no deficits, 30% had one deficit and 61% had two or more deficits. Of the 183 individuals with two deficits, the most common combination (116 patients, 63%) was SN and GCI.
Conclusions:
Bedside assessment of cognitive disorders is feasible after acute stroke. Multiple deficits are common: more than half of patients assessed had two or more deficits. SN and GCI commonly occurred together after stroke. Future research can examine whether stroke patients with abnormal MoCA scores may have undiagnosed SN and how co-occurring deficits affect risk of later dementia, functional decline and increased caregiver burden.