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London, United Kingdom 2013 Poster Session Red Cerebrovasc Dis 2013; 35 (suppl 3)1-854 501 407 Behavioral disorders and post-stroke dementia Diagnostic test accuracy of various brief screening tools for detection of cognitive impairment or delirium in an acute stroke setting R. Lees1, S. Corbet2, J. Lua3, C. Johnston4, E. Melling5, Y. Miao6, E. Moffitt7, G. Shaw8, J. Tan9, T.J. Quinn10 Lecturer, Institute of Cardiovascular & Medical Sciences, School of Medicine, University of Glasgow, Glasgow, UNITED KINGDOM1, Lecturer, Institute of Cardiovascular & Medical Sci-ences, School of Medicine, University of Glasgow, Glasgow, UNITED KINGDOM2, Lecturer, Insti-tute of Cardiovascular & Medical Sciences, School of Medicine, University of Glasgow, Glasgow, UNITED KINGDOM3, Lecturer, Institute of Cardiovascular & Medical Sciences, School of Med-icine, University of Glasgow, Glasgow, UNITED KINGDOM4, Lecturer, Institute of Cardiovascu-lar & Medical Sciences, School of Medicine, University of Glasgow, Glasgow, UNITED KING-DOM5, Lecturer, Institute of Cardiovascular & Medical Sciences, School of Medicine, University of Glasgow, Glasgow, UNITED KINGDOM6, Lecturer, Institute of Cardiovascular & Medical Sci-ences, School of Medicine, University of Glasgow, Glasgow, UNITED KINGDOM7, Lecturer, Insti-tute of Cardiovascular & Medical Sciences, School of Medicine, University of Glasgow, Glasgow, UNITED KINGDOM8, Lecturer, Institute of Cardiovascular & Medical Sciences, School of Medi-cine, University of Glasgow, Glasgow, UNITED KINGDOM9,Lecturer, Institute of Cardiovascular & Medical Sciences, School of Medicine, University of Glasgow, Glasgow, UNITED KINGDOM10 Background: International guidelines recommend screening for cognitive issues in acute stroke and various instruments are available. For routine use in a busy clinical environment, brief assessments would be preferred. We aimed to describe test accuracy of brief (less than 2 minutes) screening tools for diagnosis of cognitive impairment and delirium in acute stroke. Methods: We collected data on sequential stroke unit admission in a city teaching hospital. Asses-sors were four students trained in cognitive testing. Brief assessments comprised:10 point abbreviat-ed mental test (AMT10); 4 point AMT (AMT4); 4-A test (4AT); Cog-4; Clock Drawing test (CDT); Glasgow coma scale (GCS) and single question (SQ). We also recorded the multidisciplinary team’s informal review (MDT). We performed reference standard of Montreal cognitive assessment (MocA) and confusion assessment method for delirium (CAM) blinded to results of brief screening tests and using usual diagnostic cutpoints. We described sensitivity, specificity with corresponding 95% confidence intervals (95%CI). Results: Over a ten week period, 111 subjects were admitted; 102 had cognitive data. Subjects were 50% male (n=55); median age:74 (IQR:64-85). For delirium detection, the 4AT had greatest sensi-tivity (0.96 95%CI:0.70-1.00) and reasonable specificity (0.82 95%CI:0.72-0.88). For detection of cognitive impairment, most brief screening tools were specific but lacked sensitivity (Table). Conclusions: Our data suggest that 4AT is a reasonable choice for delirium screening in acute stroke. The diagnostic properties of various cognitive screening tools were suboptimal, with poor sensitivity limiting clinical utility. A stroke specific brief cognitive screen may be required. Table 1: Comparison of brief cognitive screening assessments with MoCA and CAM MoCA +ve CAM +ve Sensitivity Specificity Sensitivity Specificity 4AT 0.34 (0.24-0.43) 0.98 (0.84-1.00) 0.96 (0.70-1.00) 0.82 (0.72-0.88) AMT10 0.49 (0.38-0.60) 0.98 (0.84-1.00) 0.81 (0.52-0.95) 0.65 (0.54-0.74) AMT4 0.50 (0.39-0.61) 0.98 (0.83-1.00) 0.72 (0.43-0.90) 0.64 (0.53-0.73) COG4 0.59 (0.48-0.69) 0.60 (0.41-0.77) 0.67 (0.35-0.88) 0.44 (0.34-0.54) CDT 0.59 (0.47-0.71) 0.96 (0.81-0.99) 0.8 0.38-0.96 0.63 0.51-0.73 GCS 0.09 (0.03-0.21) 0.95 (0.66-1.00) 0.33 (0.06-0.80) 0.93 (0.83-0.98) MDT 0.26 (0.17-0.36) 0.98 (0.62-1.00) 0.64 (0.35-0.84) 0.85 (0.76-0.91) SQ 0.44 (0.33-0.55) 0.88 (0.70-0.96) 0.46 (0.23-0.71) 0.65 (0.54-0.74)


Karger_ESC London_2013
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