ABSTRACT
Background: The Clock Drawing Test (CDT) is used to screen for Alzheimer's disease and other dementia disorders. Normative scores on the version from the Montreal Cognitive Assessment (MoCA) do not exist in the Nordic countries. Objective: To examine the normative scores of the CDT among adults aged 70 years and older. Methods: We included 4,023 cognitively healthy persons aged 70-97 years from a population survey in Norway. They were examined with the CDT, which has a total score between zero and three. A multiple multinominal regression model was applied with a CDT score as the dependent categorical variable and estimated the probabilities of scoring a particular score, stratified by age, sex, and education. These probabilities correspond to an expected proportion of the normative population scoring at, or below a given percentile. Results: None scored zero, 2.1% scored one, 14.9% scored two, and 83% scored three. Higher age, female sex and fewer years of schooling were associated with poorer performance. Scores of zero and one deviated from the normative score regardless of age, sex and education. A score of two was within the norm for a female older than 81 and a male older than 85. Conclusions: The majority (83%) of people 70 years and older had a score of three on the CDT. Lower age, male sex, and higher education were associated with a better performance. Scores of zero and one were below the normative score. Except for the very old, a score of two was also well below the normative score.
Subject(s)
Neuropsychological Tests , Humans , Aged , Male , Female , Norway , Aged, 80 and over , Neuropsychological Tests/statistics & numerical data , Neuropsychological Tests/standards , Mental Status and Dementia Tests/statistics & numerical data , Reference Values , Educational StatusABSTRACT
BACKGROUND: The CERAD Word List Memory Test (WLMT) is widely used in the assessment of older adults with suspected dementia. Although normative data of the WLMT exist in many different regions of the world, normative data based on large population-based cohorts from the Scandinavian countries are lacking. OBJECTIVE: To develop normative data for the WLMT based on a large population-based Norwegian sample of healthy older adults aged 70 years and above, stratified by age, gender, and education. METHODS: A total of 6,356 older adults from two population-based studies in Norway, HUNT4 70â+âand HUNT4 Trondheim 70+, were administered the WLMT. Only persons with normal cognitive function were included. We excluded persons with a diagnosis of mild cognitive impairment (MCI) and dementia, and persons with a history of stroke and/or depression. This resulted in 3,951 persons aged between 70 and 90 years, of whom 56.2% were females. Regression-based normative data were developed for this sample. RESULTS: Age, gender, and education were significant predictors of performance on the WLMT list-learning subtests and the delayed recall subtest, i.e., participants of younger age, female sex, and higher education level attained higher scores compared to participants of older age, male sex, and lower level of education. CONCLUSION: Regression-based normative data from the WMLT, stratified by age, gender, and education from a large population-based Norwegian sample of cognitively healthy older adults aged 70 to 90 years are presented. An online norm calculator is available to facilitate scoring of the subtests (in percentiles and z-scores).
Subject(s)
Cognitive Dysfunction , Dementia , Humans , Male , Female , Aged , Aged, 80 and over , Neuropsychological Tests , Memory , Cognitive Dysfunction/diagnosis , Cognitive Dysfunction/epidemiology , Norway/epidemiology , Dementia/diagnosis , Dementia/epidemiologyABSTRACT
BACKGROUND: Several studies have found that normative scores on the Montreal Cognitive Assessment Scale (MoCA) vary depending on the person's education and age. The evidence for different normative scores between sexes is poor. OBJECTIVE: The main aim of the study was to determine normative scores on the MoCA for Norwegian older adults stratified by educational level, age, and sex. In addition, we aimed to explore sex differences in greater detail. METHODS: From two population-based studies in Norway, we included 4,780 people age 70 years and older. People with a diagnosis of dementia or mild cognitive impairment, a history of stroke, and depression were excluded. Trained health personnel tested the participants with the MoCA. RESULTS: The mean MoCA score varied between 22 and 27 and was highest among women 70-74 years with education >13 years and lowest among men age 85 and older with education ≤10 years. Education, age, and sex were significant predictors of MoCA scores. CONCLUSION: In the present study of cognitively healthy Norwegian adults 70 years and older, we found that the normative score on the MoCA varied between 22 and 27 depending on a person's education, age, and sex. We suggest that normative scores should be determined taking these three variables into consideration.
Subject(s)
Cognitive Dysfunction , Aged , Aged, 80 and over , Cognition , Cognitive Dysfunction/diagnosis , Cognitive Dysfunction/epidemiology , Educational Status , Female , Humans , Male , Mental Status and Dementia Tests , Neuropsychological TestsABSTRACT
OBJECTIVE: To identify prognostic factors associated with functional outcome at 13 months in a sample of stroke rehabilitation patients. Specifically, we hypothesized that cognitive functioning early after stroke would predict long-term functional outcome independently of other factors. METHODS: 163 stroke rehabilitation patients underwent a structured neuropsychological examination 2-3 weeks after hospital admittance, and their functional status was subsequently evaluated 13 months later with the modified Rankin Scale (mRS) as outcome measure. Three predictive models were built using linear regression analyses: a biological model (sociodemographics, apolipoprotein E genotype, prestroke vascular factors, lesion characteristics and neurological stroke-related impairment); a functional model (pre- and early post-stroke cognitive functioning, personal and instrumental activities of daily living, ADL, and depressive symptoms), and a combined model (including significant variables, with p value <0.05, from the biological and functional models). RESULTS: A combined model of 4 variables best predicted long-term functional outcome with explained variance of 49%: neurological impairment (National Institute of Health Stroke Scale; ß = 0.402, p < 0.001), age (ß = 0.233, p = 0.001), post-stroke cognitive functioning (Repeatable Battery of Neuropsychological Status, RBANS; ß = -0.248, p = 0.001) and prestroke personal ADL (Barthel Index; ß = -0.217, p = 0.002). Further linear regression analyses of which RBANS indexes and subtests best predicted long-term functional outcome showed that Coding (ß = -0.484, p < 0.001) and Figure Copy (ß = -0.233, p = 0.002) raw scores at baseline explained 42% of the variance in mRS scores at follow-up. CONCLUSIONS: Early post-stroke cognitive functioning as measured by the RBANS is a significant and independent predictor of long-term functional post-stroke outcome.
Subject(s)
Cognition/physiology , Stroke Rehabilitation , Stroke/psychology , Activities of Daily Living , Adult , Age Factors , Aged , Aged, 80 and over , Biomarkers , Cognition Disorders/etiology , Cognition Disorders/psychology , Educational Status , Female , Follow-Up Studies , Humans , Male , Middle Aged , Neuropsychological Tests , Predictive Value of Tests , Prognosis , Recovery of Function , Sex Factors , Socioeconomic Factors , Surveys and Questionnaires , Treatment OutcomeABSTRACT
BACKGROUND: Although depression is known to be frequently associated with stroke, it is nonetheless underdiagnosed and under-treated in this patient population. Its effect on outcome for stroke patients is thought to be substantial, but prediction is complicated by other pre- and post stroke factors. The aims of this study was to describe changes in depressive symptoms in elderly stroke patients across a timespan of one year, to examine risk factor for such changes and to explore whether depressive symptoms have any independent impact upon one year mortality and nursing home placement. METHODS: 194 patients diagnosed with an ischaemic or hemorrhagic stroke was recruited from the Stroke Rehabilitation Unit, Ullevaal University Hospital, Oslo, Norway during the period between March 2005 and August 2006 and followed up for a period of 13 months. Pre-stroke assessment was accomplished by means of the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE), the Frenchay Activities Index (FAI), the Barthel ADL Index and patient's medical history. Post-stroke assessment at inclusion and follow-up examination was performed with the Mini Mental State Examination (MMSE), the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), the Star Cancellation Test, the Barthel ADL Index, the modified Rankin Scale (mRS) and the National Institute of Health Stroke Scale (NIHSS). Information was collected from the patients' records. RESULTS: Institutionalization at 13 months was predicted by more depression (MADRS) and cognitive impairment (RBANS) at baseline, together with lower pre-stroke social activity levels (FAI). Two factors predicted death at 13 months: Cognitive impairment (MMSE) and greater age. The prevalence of depression was relatively unchanged from baseline (56%) to 13 month follow-up (48%). Among the patients who were depressed at baseline 55% still had MADRS score above six (persistent depression) at 13 months, while 35% in the non-depressed group at baseline had developed depression (incident depression). Persistent depression was significantly predicted by lower pre-stroke social activity levels (FAI) together with a more severe stroke (NIHSS) and worse overall function (mRS) at baseline. Incident depression was predicted by receipt of municipal home help before the stroke and a lower score on the delayed memory tasks on RBANS at baseline.
Subject(s)
Depressive Disorder/diagnosis , Depressive Disorder/psychology , Stroke Rehabilitation , Stroke/psychology , Activities of Daily Living/classification , Activities of Daily Living/psychology , Aged , Aged, 80 and over , Cognition Disorders/diagnosis , Cognition Disorders/mortality , Cognition Disorders/psychology , Depressive Disorder/mortality , Female , Follow-Up Studies , Home Care Services/statistics & numerical data , Humans , Male , Mental Status Schedule/statistics & numerical data , Middle Aged , Norway , Psychometrics , Referral and Consultation , Rehabilitation Centers , Risk Factors , Social Adjustment , Stroke/mortality , Survival Analysis , Utilization ReviewABSTRACT
OBJECTIVE: To examine the relationship between the ApoE epsilon4 allele and cognitive impairment 13 months after stroke. METHODS: One hundred four stroke rehabilitation patients were cognitively tested on average 18 days after hospital admission and again 13 months later with the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). The following potential risk factors for post-stroke cognitive impairment (defined by a RBANS total index score below 77.5 points) at 13 months follow-up were analyzed in bivariate and logistic regression analyses: ApoE-genotype, socio-demographic variables, pre-stroke cognitive reduction (The Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE)), vascular factors, lesion characteristics, and neurological impairment (The National Institute of Health Stroke Scale (NIHSS)). Differences in general cognitive performance (pre-stroke, baseline, and follow-up) across patients with different ApoE-genotypes were analyzed, and lastly differences between epsilon4-carriers and non-carriers for changes in performance in various cognitive domains over the 13 months period were examined. RESULTS: Significant risk factors for cognitive impairment at 13 months were ApoE epsilon4, pre-stroke cognitive reduction (IQCODE 3.44+), previous stroke, and neurological impairment (NIHSS Total Score >5). A significant dose-dependent effect of the ApoE-genotype in relation to overall post-stroke cognitive functioning was found at baseline and follow-up, but not pre-stroke. The epsilon4 carriers showed a significant decline in tests related to verbal learning and memory compared to the non-carriers. CONCLUSIONS: The ApoE epsilon4-allele constitutes an independent risk factor for cognitive impairment at 13 months post-stroke, and is associated with progression of cognitive decline in tasks related to verbal learning and memory.
Subject(s)
Apolipoprotein E4/genetics , Cognition Disorders/genetics , Genetic Predisposition to Disease/genetics , Stroke/complications , Activities of Daily Living , Aged , Aged, 80 and over , Cognition Disorders/epidemiology , Cognition Disorders/physiopathology , Female , Follow-Up Studies , Genotype , Humans , Logistic Models , Longitudinal Studies , Male , Neuropsychological Tests , Risk FactorsABSTRACT
BACKGROUND AND PURPOSE: The understanding of the contribution of genetic factors to cognitive impairment after stroke is incomplete. The aim of the study was to examine whether the apolipoprotein E epsilon4 allele (ApoE epsilon4) is a risk factor for cognitive impairment in the early phase after stroke. METHODS: The sample comprised 152 Norwegian stroke rehabilitation inpatients (mean age 76.8 years, SD 10.5) examined at a mean of 18.3 days (SD 13.4) after hospital admission. Post-stroke cognitive impairment was assessed with the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). The following proposed risk factors were analysed: ApoE genotype, demographics (age, sex, education), pre-stroke cognitive reduction [Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE)], pre-stroke vascular factors (including previous stroke), stroke characteristics (type, location), and neurological stroke-related impairment [National Institutes of Health Stroke Scale (NIHSS)]. Cognitive impairment was defined as an RBANS total index score < or =1.5 SD below the mean. Multiple logistic regression analyses were performed to find risk factors for post-stroke cognitive impairment. RESULTS: Four variables were found to be independent risk factors for cognitive impairment after stroke: ApoE epsilon4 (OR = 3.7; 95% CI = 1.2-11.6), IQCODE score > or =3.44 (OR = 9.2; 95% = CI 2.3-37.2), total or partial anterior stroke syndromes (OR = 3.2; 95% CI = 1.3-8.0), and NIHSS total score >5 (OR = 7.3; 95% CI = 2.7-19.7). No association between ApoE epsilon4 and pre-stroke cognitive reduction (IQCODE) was found. CONCLUSIONS: The presence of one or two ApoE epsilon4 alleles may be a significant independent risk factor for cognitive impairment in the early phase after stroke.
Subject(s)
Apolipoprotein E4/genetics , Cognition Disorders/etiology , Cognition Disorders/genetics , Stroke/complications , Stroke/genetics , Aged , Aphasia/etiology , Aphasia/physiopathology , Apolipoproteins E/genetics , Brain Ischemia/complications , Cardiovascular Diseases/epidemiology , Cardiovascular Diseases/genetics , Cerebral Hemorrhage/complications , Cerebrovascular Circulation/physiology , DNA/genetics , Female , Genotype , Humans , Logistic Models , Male , Middle Aged , Neuropsychological Tests , Psychomotor Performance/physiology , Risk Factors , Stroke/etiologyABSTRACT
BACKGROUND: Depression is frequent in elderly stroke patients, and the pathophysiology may involve psychological as well as organic mechanisms. AIM: To explore construct validity of the Montgomery Aasberg Depression Rating Scale using factor analysis and investigate whether symptom clusters of depression after stroke are associated with patient characteristics. METHODS: A sample of 163 stroke patients was assessed by the Montgomery Aasberg Depression Rating Scale. Pre-stroke assessment was accomplished by means of the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE), the Barthel ADL Index and patient's medical history. Post-stroke assessment was performed with the Mini Mental State Examination (MMSE), the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), the Star Cancellation Test, the Barthel ADL Index, the modified Rankin Scale (mRS) and the National Institute of Health Stroke Scale (NIHSS). Information was collected from the patients' records. A principal components factor analysis followed by oblique rotation was performed. RESULTS: Among the patients, 56.4% scored between 7 and 19 on the Montgomery Aasberg Depression Rating Scale, and 13% had a score above 19. The factor analysis resulted in three factors, called anhedonia (lassitude, inability to feel, suicidal thoughts, loss of appetite), sadness (observed sadness, reported sadness, pessimism) and agitation (inner tension, lack of concentration, disturbed sleep). Anhedonia correlated with cognitive impairment, whereas sadness correlated with sensorimotor and cranial nerve deficits. Agitation had low internal reliability and did not correlate with any systematic patients characteristics. CONCLUSION: We found three distinct factors. The factor anhedonia is related to cognitive impairment, sadness to neurological impairment due to the stroke and agitation to somatic factors not directly related to the stroke.
Subject(s)
Depressive Disorder/etiology , Psychiatric Status Rating Scales/standards , Stroke/psychology , Adult , Aged , Aged, 80 and over , Cognition Disorders/etiology , Depressive Disorder/diagnosis , Factor Analysis, Statistical , Female , Humans , Male , Middle Aged , Mood Disorders/etiology , Psychiatric Status Rating Scales/statistics & numerical data , Psychomotor Agitation/etiology , Young AdultABSTRACT
OBJECTIVE: To assess the concurrent validity of three screening tests for focal cognitive impairments after stroke. DESIGN: Comparison of results from the screening tests with those from a more comprehensive neuropsychological battery. SETTING: Stroke rehabilitation wards of a general hospital and a rehabilitation hospital. SUBJECTS: Forty-nine stroke patients (25-91 years, 35% women). MEASURES: Screening tests were the Cognistat, the Screening Instrument for Neuropsychological Impairments in Stroke (SINS) and the Clock Drawing Test. Health professionals, blind to the results of the reference method, did the screening. Reference method was a neuropsychological assessment based on the Norwegian Basic Neuropsychological Assessment, classifying the patients as ;impaired' or ;not impaired' within the following cognitive domains: language, visuospatial function, attention and neglect, apraxia, speed in unaffected arm, and memory. RESULTS: The best sensitivity (95% confidence interval) was achieved for language problems by Cognistat, naming (80%, 44-98); for visuospatial dysfunction, attention deficits and reduced speed, all by SINS visuocognitive (82%, 60-95, 72%, 39-94, and 78%, 56-93, respectively); and for memory problems by Cognistat memory (69%, 52-87). The data were insufficient to assess any subtest for apraxia. Sensitivity in detecting deficits in any domain was 82% (71-94) for the Cognistat composite score, 71% (57-85) for the SINS composite score, and 63% (49-78) for the most sensitive score of the Clock Drawing Test. CONCLUSION: The Cognistat and the SINS may be used as screening instruments for cognitive deficits after stroke, but cannot replace a neuropsychological assessment. The Clock Drawing Test added little to the detection of cognitive deficits.