Original Research ARTICLE
USING THE OXFORD COGNITIVE SCREEN (OCS) TO DETECT COGNITIVE IMPAIRMENT IN STROKE PATIENTS: A COMPARISON WITH THE MINI-MENTAL STATE EXAMINATION
- 1Neurologic Rehabilitation, Clinica di Riabilitazione Toscana Spa, Italy
- 2Experimental Psychology, University of Oxford, United Kingdom
- 3Department of Neurological, Biomedical and Movement Sciences, University of Verona, Italy
- 4Department of Psychology, Sapienza Università di Roma, Italy
- 5Fondazione Santa Lucia (IRCCS), Italy
- 6Auxilium Vitae Volterra S.p.A., Italy
- 7Department of Medical and Surgical, Magna Græcia University, Italy
- 8Neuropsycholgy Unit, Servizio Sanitario Nazionale (SSN), Italy
- 9Department of Neuroscience, Azienda Ospedaliero Universitaria Ospedali Riuniti, Italy
- 10Department of Life, Health and Environmental Sciences, University of L'Aquila, Italy
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 MMSE or the MOCA, 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 nine-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 cut-off (<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 POCI category than in the other categories.
Conclusions: 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: stroke rehabilitation, cognitive assessment, Oxford Cognitive Screen, MMSE, Neuropsychological Tests
Received: 28 Sep 2017;
Accepted: 12 Feb 2018.
Edited by:Sung-Rae Cho, Yonsei University, South Korea
Reviewed by:Joseph Bleiberg, WRNMMC, NICoE, United States
Francisco Capani, Institute of Cardiological Research, School of Medicine, University of Buenos Aires, Argentina
Copyright: © 2018 Mancuso, Demeyere, Abbruzzese, Damora, Varalta, Pirrotta, Antonucci, Matano, Caputo, Caruso, Pontiggia, Coccia, Ciancarelli and Zoccolotti. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Dr. Mauro Mancuso, Clinica di Riabilitazione Toscana Spa, Neurologic Rehabilitation, MOntevarchi, Italy, firstname.lastname@example.org