Are Cognitive Screening Tools Sensitive and Specific Enough for Use After Stroke? A Systematic Literature Review
Stroke
Stolwyk, R. J., O'Neill, M. H., et al. (2014).
Stroke, 45(10), 3129-3134.
This systematic review examines the sensitivity, specificity, positive predictive value, and negative predictive value of cognitive screening tools for individuals with stroke.
Not stated
Up to December 27, 2013
Diagnostic accuracy studies
16
This review found that most studies did not support the Mini Mental Status Exam (MMSE) for clinical use while the Montreal Cognitive Assessment (MoCA), Cognistat, the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), and the Barrow Neurological Institute (BNI) demonstrated initial promise for use with the adult stroke population. Additional key findings indicated that:
<ul>
<li>most studies reported inadequate sensitivity and specificity for the MMSE;</li>
<li>some studies (3/5) reported consistent acceptable sensitivity and specificity for the MoCA;</li>
<li>the Cognistat demonstrated acceptable sensitivity and specificity;</li>
<li>the RBANS demonstrated acceptable sensitivity and specificity and;</li>
<li>the BNI demonstrated acceptable sensitivity and specificity for stroke patients age 55 and older.</li>
</ul>
While the findings provide preliminary support for the use of the MoCA, BNI, Cognistat and RBANS as cognitive screening tools for individuals with stroke, there were several methodological concerns which included:
<ul>
<li>failure to report positive and negative predictive values in some studies;</li>
<li>negative predictive values of >80%;</li>
<li>use of different cutoff points to constitute acceptable sensitivity and specificity and;</li>
<li>lack of screening for various cognitive difficulties (calculation, praxis, and information processing speed).</li>
</ul>
Additional research of high methodological quality, as well as consistent parameters for what is considered acceptable sensitivity and specificity, is warranted.
