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Performance of the NINDS-CSN 5-Minute Protocol in a National Population-Based Sample

Published online by Cambridge University Press:  27 August 2014

Richard E. Kennedy*
Department of Medicine, University of Alabama Birmingham, Birmingham, Alabama
Virginia G. Wadley
Department of Medicine, University of Alabama Birmingham, Birmingham, Alabama
Leslie A. McClure
Department of Biostatistics, University of Alabama Birmingham, Birmingham, Alabama
Abraham J. Letter
WL Gore and Associates, Flagstaff, Arizona
Frederick W. Unverzagt
Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana
Michael Crowe
Department of Psychology, University of Alabama Birmingham, Birmingham, Alabama
David Nyenhius
Hauenstein Neuroscience Center, Mercy Health Saint Mary’s, Grand Rapids, Michigan
Brendan J. Kelley
Department of Neurology, Ohio State University, Columbus, Ohio
Bhumika Kana
Department of Medicine, University of Alabama Birmingham, Birmingham, Alabama
Janice Marceaux
Department of Psychology, University of Alabama Birmingham, Birmingham, Alabama
Manjula Kurella Tamura
Department of Medicine, Stanford University, Stanford, California
Virginia Howard
Department of Epidemiology, University of Alabama Birmingham, Birmingham, Alabama
George Howard
Department of Medicine, University of Alabama Birmingham, Birmingham, Alabama
Correspondence and reprint requests to: Richard E. Kennedy, Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, University of Alabama at Birmingham, 933 19th Street South, CH19-218R, Birmingham, AL. E-mail:


In 2006, the National Institute of Neurological Disorders and Stroke-Canadian Stroke Network (NINDS-CSN) Vascular Cognitive Impairment Harmonization Standards recommended a 5-Minute Protocol as a brief screening instrument for vascular cognitive impairment (VCI). We report demographically adjusted norms for the 5-Minute Protocol and its relation to other measures of cognitive function and cerebrovascular risk factors. We performed a cross-sectional analysis of 7199 stroke-free adults in the REasons for Geographic And Racial Differences in Stroke (REGARDS) study on the NINDS-CSN 5-Minute Protocol score. Total scores on the 5-Minute Protocol were inversely correlated with age and positively correlated with years of education, and performance on the Six-Item Screener, Word List Learning, and Animal Fluency (all p-values <.001). Higher cerebrovascular risk on the Framingham Stroke Risk Profile (FSRP) was associated with lower total 5-Minute Protocol scores (p <.001). The 5-Minute Protocol also differentiated between participants with and without confirmed stroke and with and without stroke symptom histories (p <.001). The NINDS-CSN 5-Minute Protocol is a brief, easily administered screening measure that is sensitive to cerebrovascular risk and offers a valid method of screening for cognitive impairment in populations at risk for VCI. (JINS, 2014, 20, 1–12)

Research Articles
Copyright © The International Neuropsychological Society 2014 

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Akaike, H. (1974). A new look at the statistical model identification. IEEE Transactions on Automatic Control, 19, 716723.CrossRefGoogle Scholar
Callahan, C.M., Unverzagt, F.W., Hui, S.L., Perkins, A.J., & Hendrie, H.C. (2002). Six-item screener to identify cognitive impairment among potential subjects for clinical research. Medical Care, 40, 771781.Google Scholar
Christie, J.D., Biester, R.C.P., Taichman, D.B., Shull, W.H. Jr., Hansen-Flaschen, J., Shea, J.A., & Hopkins, R.O. (2006). Formation and validation of a telephone battery to assess cognitive function in acute respiratory distress syndrome survivors. Journal of Critical Care, 21, 125132.Google Scholar
Ciol, M.A., Hoffman, J.M., Dudgeon, B.J., Shumway-Cook, A., Yorkston, K.M., & Chan, L. (2006). Understanding the use of weights in the analysis of data from multistage surveys. Archives of Physical Medicine and Rehabilitation, 87, 299303.CrossRefGoogle ScholarPubMed
D’Agostino, R.B., Wolf, P.A., Belanger, A.J., & Kannel, W.B. (1994). Stroke risk profile: Adjustment for antihypertensive medication. The Framingham Study. Stroke, 25, 4043.CrossRefGoogle ScholarPubMed
DeLong, E.R., DeLong, D.M., & Clarke-Pearson, D.L. (1988). Comparing the areas under two or more correlated receiver operating characteristic curves: A nonparametric approach. Biometrics, 44, 837845.Google Scholar
Elias, M.F., Sullivan, L.M., D’agostino, R.B., Elias, P.K., Beiser, A., Au, R., … Wolf, P.A. (2004). Framingham stroke risk profile and lowered cognitive performance. Stroke, 35, 404409.CrossRefGoogle ScholarPubMed
Freitas, S., Simões, M.R., Alves, L., & Santana, I. (2012). Montreal Cognitive Assessment: Influence of sociodemographic and health variables. Archives of Clinical Neuropsychology, 27, 165175.CrossRefGoogle ScholarPubMed
Freitas, S., Simões, M.R., Alves, L., Vicente, M., & Santana, I. (2012). Montreal Cognitive Assessment (MoCA): Validation study for vascular dementia. Journal of the International Neuropsychological Society, 18, 10311040.Google Scholar
Gorelick, P.B., Scuteri, A., Black, S.E., Decarli, C., Greenberg, S.M., Iadecola, C., … Council on Cardiovascular Surgery and Anesthesia (2011). Vascular contributions to cognitive impairment and dementia: A statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 42, 26722713.Google Scholar
Hachinski, V., Iadecola, C., Petersen, R.C., Breteler, M.M., Nyenhuis, D.L., Black, S.E., … Leblanc, G.G. (2006). National Institute of Neurological Disorders and Stroke-Canadian Stroke Network vascular cognitive impairment harmonization standards. Stroke, 37, 22202241.CrossRefGoogle ScholarPubMed
Hannah, M., & Quigley, P. (1996). Presentation of Ordinal Regression Analysis on the Original Scale. Biometrics, 52, 771775.CrossRefGoogle Scholar
Hasimoto, R., Meguro, K., Yamaguchi, S., Ishizaki, J., Ishii, H., Meguro, M., & Sekita, Y. (2004). Executive dysfunction can explain word-list learning disability in very mild Alzheimer’s disease: The Tajiri project. Psychiatry and Clinical Neurosciences, 58, 5460.CrossRefGoogle Scholar
Howard, V.J., Cushman, M., Pulley, L., Gomez, C.R., Go, R.C., Prineas, R.J., … Howard, G. (2005). The REasons for Geographic and Racial Differences in Stroke study: Objectives and design. Neuroepidemiology, 25, 135143.Google Scholar
Howard, V.J., Kleindorfer, D.O., Judd, S.E., McClure, L.A., Safford, M.M., Rhodes, J.D., … Howard, G. (2011). Disparities in stroke incidence contributing to disparities in stroke mortality. Annals of Neurology, 69, 619627.CrossRefGoogle ScholarPubMed
Ivnik, R.J., Smith, G.E., Petersen, R.C., Boeve, B.F., Kokmen, E., & Tangalos, E.G. (2000). Diagnostic accuracy of four approaches to interpreting neuropsychological test data. Neuropsychology, 14, 163177.Google Scholar
Jones, W.J., Williams, L.S., & Meschia, J.F. (2001). Validating the Questionnaire for Verifying Stroke-Free Status (QVSFS) by neurological history and examination. Stroke, 32, 22322236.Google Scholar
Kelley, B.J., McClure, L.A., Letter, A.J., Wadley, V.G., Unverzagt, F.W., Kissela, B.M., & Howard, G. (2013). Report of stroke-like symptoms predicts incident cognitive impairment in a stroke-free cohort. Neurology, 81, 113118.CrossRefGoogle Scholar
Kleindorfer, D., Judd, S., Howard, V.J., McClure, L., Safford, M.M., Cushman, M., … Howard, G. (2011). Self-reported stroke symptoms without a prior diagnosis of stroke or transient ischemic attack: A powerful new risk factor for stroke. Stroke, 42, 31223126.Google Scholar
Li, C., & Shepherd, B.E. (2012). A new residual for ordinal outcomes. Biometrika, 99, 473480.CrossRefGoogle ScholarPubMed
Melchior, L.A., Huba, G.J., Brown, V.B., & Reback, C.J. (1993). A short depression index for women. Educational and Psychological Measurement, 53, 11171125.CrossRefGoogle Scholar
Meschia, J.F., Brott, T.G., Chukwudelunzu, F.E., Hardy, J., Brown, R.D., Meissner, I., … O’Brien, P.C. (2000). Verifying the stroke-free phenotype by structured telephone interview. Stroke, 31, 10761080.CrossRefGoogle ScholarPubMed
Meschia, J.F., Lojacono, M.A., Miller, M.J., Brott, T.G., Atkinson, E.J., & O’Brien, P.C. (2004). Reliability of the questionnaire for verifying stroke-free status. Cerebrovascular Diseases, 17, 218223.CrossRefGoogle ScholarPubMed
Mitrushina, M.N., Boon, K.B., & D’Elia, L.F. (1999). Handbook of normative data for neuropsychological assessment. New York: Oxford University Press.Google Scholar
Mitsis, E.M., Jacobs, D., Luo, X., Andrews, H., Andrews, K., & Sano, M. (2010). Evaluating cognition in an elderly cohort via telephone assessment. International Journal of Geriatric Psychiatry, 25, 531539.Google Scholar
Morris, J.C., Heyman, A., Mohs, R.C., Hughes, J.P., van Belle, G., Fillenbaum, G., … Clark, C. (1989). The Consortium to Establish a Registry for Alzheimer’s Disease (CERAD). Part I. Clinical and neuropsychological assessment of Alzheimer’s disease. Neurology, 39, 11591165.Google Scholar
Nagelkerke, N.J.D. (1991). A note on a general definition of the coefficient of determination. Biometrika, 78, 691692.CrossRefGoogle Scholar
Nasreddine, Z.S., Phillips, N.A., Bédirian, V., Charbonneau, S., Whitehead, V., Collin, I., … Chertkow, H. (2005). The Montreal Cognitive Assessment, MoCA: A brief screening tool for mild cognitive impairment. Journal of the American Geriatrics Society, 53, 695699.Google Scholar
Prineas, R.J., Le, A., Soliman, E.Z., Zhang, Z.-M., Howard, V.J., Ostchega, Y., … Reasons for Geographic and Racial Differences in Stroke (REGARDS) Investigators. (2012). United States national prevalence of electrocardiographic abnormalities in black and white middle-age (45- to 64-Year) and older (≥65-Year) adults (from the Reasons for Geographic and Racial Differences in Stroke Study). American Journal of Cardiology, 109, 12231228.CrossRefGoogle ScholarPubMed
Radloff, L. (1977). The CES-D scale: A self report depression scale for research in the general population. Applied Psychological Measurement, 1, 385401.Google Scholar
Rapp, S.R., Legault, C., Espeland, M.A., Resnick, S.M., Hogan, P.E., Coker, L.H., … CAT Study Group. (2012). Validation of a cognitive assessment battery administered over the telephone. Journal of the American Geriatrics Society, 60, 16161623.Google Scholar
Shafer, A.B. (2006). Meta-analysis of the factor structures of four depression questionnaires: Beck, CES-D, Hamilton, and Zung. Journal of Clinical Psychology, 62, 123146.Google Scholar
Soliman, E.Z., Howard, G., Prineas, R.J., McClure, L.A., & Howard, V.J. (2010). Calculating Cornell voltage from nonstandard chest electrode recording site in the Reasons for Geographic And Racial Differences in Stroke study. Journal of Electrocardiology, 43, 209214.CrossRefGoogle ScholarPubMed
Strauss, E., Sherman, E.M.S., & Spreen, O. (2006). A compendium of neuropsychological tests. New York: Oxford University Press.Google Scholar
Taichman, D.B., Christie, J., Biester, R., Mortensen, J., White, J., Kaplan, S., … Hopkins, R.O. (2005). Validation of a brief telephone battery for neurocognitive assessment of patients with pulmonary arterial hypertension. Respiratory Research, 6, 39.Google Scholar
Tsivgoulis, G., Alexandrov, A.V., Wadley, V.G., Unverzagt, F.W., Go, R.C., Moy, C.S., … Howard, G. (2009). Association of higher diastolic blood pressure levels with cognitive impairment. Neurology, 73, 589595.CrossRefGoogle ScholarPubMed
Tsivgoulis, G., Judd, S., Letter, A.J., Alexandrov, A.V., Howard, G., Nahab, F., … Wadley, V.G. (2013). Adherence to a Mediterranean diet and risk of incident cognitive impairment. Neurology, 80, 16841692.Google Scholar
Unverzagt, F.W., McClure, L.A., Wadley, V.G., Jenny, N.S., Go, R.C., Cushman, M., … Howard, G. (2011). Vascular risk factors and cognitive impairment in a stroke-free cohort. Neurology, 77(19), 17291736.CrossRefGoogle Scholar
Unverzagt, F.W., Monahan, P.O., Moser, L.R., Zhao, Q., Carpenter, J.S., Sledge, G.W. Jr., … Champion, V.L. (2007). The Indiana University telephone-based assessment of neuropsychological status: A new method for large scale neuropsychological assessment. Journal of the International Neuropsychological Society, 13, 799806.Google Scholar
Wadley, V.G., Unverzagt, F.W., McGuire, L.C., Moy, C.S., Go, R., Kissela, B., … Howard, G. (2011). Incident cognitive impairment is elevated in the stroke belt: The REGARDS study. Annals of Neurology, 70, 229236.CrossRefGoogle ScholarPubMed
Wilson, R.S., Leurgans, S.E., Foroud, T.M., Sweet, R.A., Graff-Radford, N., Mayeux, R., … National Institute on Aging Late-Onset Alzheimer’s Disease Family Study Group (2010). Telephone assessment of cognitive function in the late-onset Alzheimer’s disease family study. Archives of Neurology, 67, 855861.CrossRefGoogle ScholarPubMed
Wolf, P.A., D’Agostino, R.B., Belanger, A.J., & Kannel, W.B. (1991). Probability of stroke: A risk profile from the Framingham Study. Stroke, 22, 312318.CrossRefGoogle ScholarPubMed
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