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首页> 外文期刊>Journal of stroke and cerebrovascular diseases: The official journal of National Stroke Association >Cog-4 has limited diagnostic test accuracy and validity for cognitive assessment in stroke survivors
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Cog-4 has limited diagnostic test accuracy and validity for cognitive assessment in stroke survivors

机译：Cog-4对中风幸存者进行认知评估的诊断测试准确性和有效性有限

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Background Guidelines recommend cognitive screening for all stroke survivors but do not suggest a preferred tool. Certain elements (orientation, executive function, language, and inattention) of the impairment scale, National Institutes of Health Stroke Scale (NIHSS), have been suggested as a short cognitive screening test - Cog-4. We aimed to describe accuracy and validity of Cog-4 against a more detailed cognitive assessment (Montreal Cognitive Assessment [MoCA]). Methods We assessed consecutive acute stroke unit admissions in 2 hospitals over 3 months. Four independent blinded assessors performed NIHSS and MoCA between days 1 and 4 poststroke. We described test properties of Cog-4 for MoCA-defined cognitive impairment using usual thresholds (Cog-4 ≥ 1 and MoCA < 26 of 30) and described the correlations of individual Cog-4 components with broadly equivalent MoCA domains. Results We assessed 173 participants; 166 had Cog-4 data and 148 MoCA. MoCA described 84% (n = 124) of assessed participants as having cognitive impairment and the Cog-4, 37% (n = 62). Cog-4 had a sensitivity of.36 (95% confidence interval [CI]:.28-.45) and a specificity of.96 (95% CI:.80-.99) (positive predictive value:.98, negative predictive value:.23) for MoCA-defined cognitive impairment. Individual Cog-4 items correlated with certain MoCA domains, but the strength of association was modest (r = -.44 orientation, -.37 language, -.19 for inattention, and no significant correlation for executive function, P =.72). Conclusions Our data suggest that many stroke survivors with MoCA-defined cognitive problems would not be detected by Cog-4. Subtest correlations suggest that Cog-4 may not be a valid measure of the cognitive domains that it purports to describe. Other brief cognitive screening tests may be better suited to acute stroke.
机译：背景指南建议对所有中风幸存者进行认知筛查，但不建议使用首选工具。美国国立卫生研究院卒中量表（NIHSS）已建议使用障碍量表的某些要素（方向，执行功能，语言和注意力不集中）作为简短的认知筛查测试-Cog-4。我们旨在针对更详细的认知评估（蒙特利尔认知评估[MoCA]）描述Cog-4的准确性和有效性。方法我们评估了3个月中2所医院连续入院的急性中风病住院率。四名独立的盲人评估者在卒中后第1至4天进行了NIHSS和MoCA。我们使用常规阈值（Cog-4≥1和MoCA <26 of 30）描述了Cog-4对MoCA定义的认知障碍的测试性质，并描述了各个Cog-4组分与广泛等同的MoCA域的相关性。结果我们评估了173名参与者。 166个具有Cog-4数据和148个MoCA。 MoCA描述了84％（n = 124）的评估参与者患有认知障碍，而Cog-4则为37％（n = 62）。 Cog-4的灵敏度为0.36（95％置信区间[CI] :. 28-.45），特异性为0.96（95％CI：.80-.99）（阳性预测值：.98，阴性）预测价值：.23）对MoCA定义的认知障碍。单个Cog-4项与某些MoCA域相关，但关联强度适中（r = -.44方向，-。37语言，-0.1为注意力不集中，与执行功能无显着相关性，P = .72） 。结论我们的数据表明Cog-4无法检测到许多具有MoCA定义的认知问题的中风幸存者。子测试的相关性表明，Cog-4可能不是对其声称描述的认知域的有效度量。其他简短的认知筛查测试可能更适合急性中风。

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