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Evaluating High-Functioning Young Stroke Survivors with Cognitive Complaints

Published online by Cambridge University Press:  17 June 2021

Alexander D. Rebchuk
Affiliation:
Division of Neurosurgery, University of British Columbia, Vancouver, BC, Canada
Leah E. Kuzmuk
Affiliation:
Vancouver Stroke Program, Vancouver, BC, Canada
Halina M. Deptuck
Affiliation:
Faculty of Education, University of British Columbia, Vancouver, BC, Canada
Noah D. Silverberg
Affiliation:
Department of Psychology, University of British Columbia, Vancouver, BC, Canada Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
Thalia S. Field*
Affiliation:
Vancouver Stroke Program, Vancouver, BC, Canada Division of Neurology, University of British Columbia, Vancouver, BC, Canada Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
*
Correspondence to: Thalia S. Field, MD FRCPC MHSc, Associate Professor, University of British Columbia, Stroke Neurologist, Vancouver Stroke Program, S169-2211 Wesbrook Mall, Vancouver, BC V6T 2B5, Canada. Email: thalia.field@ubc.ca

Abstract:

Background:

The Montreal Cognitive Assessment (MoCA) is a commonly used cognitive outcome in stroke trials. However, it may be insufficiently sensitive to detect impairment in high-functioning stroke survivors. The National Institutes of Health (NIH) Toolbox Cognition Battery (NIHTB-CB), a 30-min comprehensive tablet-based cognitive assessment, may be a better choice to characterize cognitive issues in this cohort.

Methods:

We compared MoCA and NIHTB-CB performance in young stroke survivors (18–55 years) with excellent functional outcomes (modified Rankin Scale 0–1) reporting subjective cognitive complaints to that of age-matched healthy controls. We recruited 53 stroke survivors and 53 controls. We performed a sensitivity analysis in those participants with normal MoCA scores (≥26).

Results:

Median MoCA scores were not significantly different between stroke survivors (27.0 vs. 28.0) and healthy controls. Mean T scores for NIHTB-CB fluid (44.9 vs. 54.2), crystallized (53.8 vs. 60.0), and total cognition (49.1 vs. 58.4) components were significantly lower in stroke survivors compared to healthy controls (p < 0.001 for all). In participants scoring within normal range (≥26) on the MoCA, NIHTB-CB scores for all components remained significantly lower in stroke survivors.

Conclusions:

In young stroke survivors with excellent functional outcomes and subjective cognitive complaints, the NIHTB-CB, but not the MoCA, was able to detect differences in cognitive performance between stroke survivors and healthy controls. The NIHTB-CB may be a suitable outcome measure for cognition in clinical trials examining higher-functioning young stroke survivors.

Résumé :

RÉSUMÉ :

Évaluer des jeunes survivants d’un AVC qui donnent à voir un haut niveau de fonctionnement mais qui font état de déficiences cognitives.

Contexte :

Le test cognitif de Montréal (ou MoCA) est un outil couramment utilisé à la suite d’AVC. Il peut cependant s’avérer insuffisamment sensible pour détecter les déficiences qui affectent les survivants d’un AVC qui donnent à voir un haut niveau de fonctionnement. À cet effet, il est possible que le NIH Toolbox Cognition Battery (NIHTB-CB), une évaluation cognitive complète de 30 minutes effectuée sur une tablette, soit plus indiqué pour caractériser les déficiences cognitives présentes chez ces patients.

Méthodes :

Nous avons ainsi comparé les performances au MoCA et au NIHTB-CB de jeunes survivants d’un AVC qui étaient âgés de 18 à 55 ans et qui donnaient à voir d’excellents résultats en matière de fonctionnement à l’échelle modifiée de Rankin (0-1) tout en faisant état de déficiences cognitives par rapport à des témoins en santé appariés en fonction de l’âge. Pour ce faire, nous avons recruté 53 survivants d’un AVC et 53 témoins. Nous avons aussi effectué une analyse de sensibilité chez les participants dont les scores au MoCA étaient normaux (≥ 26).

Résultats :

Les scores médians au MoCA ne se sont pas révélés notablement différents entre les survivants d’un AVC (27,0) et les témoins en santé (28,0). Les scores T moyens au NIHTB-CB pour les habiletés fluides (44,9 contre 54,2), les habiletés cristallisées (53,8 contre 60,0) et la cognition totale (49,1 contre 58,4) se sont par ailleurs avérés significativement plus faibles chez les survivants d’un AVC par rapport aux témoins en santé (p< 0,001 pour tous ces volets évalués). Chez les participants dont les scores au MoCA étaient situés dans la fourchette normale (≥ 26), les scores au NIHTB-CB pour tous les volets évalués sont demeurés significativement plus bas chez les survivants d’un AVC.

Conclusions :

Chez des jeunes survivants d’un AVC donnant à voir un haut niveau de fonctionnement et se plaignant néanmoins de déficiences cognitives, le NIHTB-CB, et non le test MoCA, a permis de détecter des différences de performance cognitive entre les survivants d’un AVC et des témoins en santé. Le NIHTB-CB peut ainsi être un outil d’évaluation approprié de la cognition dans le cadre d’études cliniques portant sur des jeunes survivants d’un AVC qui donnent à voir un haut niveau de fonctionnement.

Type
Original Article
Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of The Canadian Journal of Neurological Sciences Inc

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Supplementary material: File

Rebchuk et al. supplementary material

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