Cognitive and Mood Assessment in Stroke Research

Abstract

Background and Purpose—International guidelines recommend cognitive and mood assessments for stroke survivors; these assessments also have use in clinical trials. However, there is no consensus on the optimal assessment tool(s). We aimed to describe use of cognitive and mood measures in contemporary published stroke trials. Methods—Two independent, blinded assessors reviewed high-impact journals representing: general medicine (nϭ4), gerontology/rehabilitation (nϭ3), neurology (nϭ4), psychiatry (nϭ4), psychology (nϭ4), and stroke (nϭ3) January 2000 to October 2011 inclusive. Journals were hand-searched for relevant, original research articles that described cognitive/mood assessments in human stroke survivors. Data were checked for relevance by an independent clinician and clinical psychologist. Results—Across 8826 stroke studies, 488 (6%) included a cognitive or mood measure. Of these 488 articles, total number with cognitive assessment was 408 (83%) and mood assessment tools 247 (51%). Total number of different assessments used was 367 (cognitive, 300; mood, 67). The most commonly used cognitive measure was Folstein's Mini-Mental State Examination (nϭ180 articles, 37% of all articles with cognitive/mood outcomes); the most commonly used mood assessment was the Hamilton Rating Scale of Depression(nϭ43 [9%]). Conclusions—Cognitive and mood assessments are infrequently used in stroke research. When used, there is substantial heterogeneity and certain prevalent assessment tools may not be suited to stroke cohorts. Research and guidance on the optimal cognitive/mood assessment strategies for clinical practice and trials is required. (Stroke. 2012;43:1678-1680.) Key Words: cognition Ⅲ depression Ⅲ methodology Ⅲ neuropsychology Ⅲ outcomes Ⅲ scales Ⅲ stroke Ⅲ trials C ognitive and mood disorders are common stroke se-quelae, each affecting approximately one third of stroke survivors. 1 These complications can impair functional recov-ery 2,3 and are important to patients. A recent national priority setting exercise identified " psychological problems " (partic-ularly dementia and depression) as the most important but underresearched issues for stroke survivors and caregivers. 4 The importance of cognition and mood is recognized in international guidelines, where their routine assessment is recommended for all stroke survivors. 5 In clinical stroke trials, end points are usually based around domains of physical function, quality of life, and mortality. 6 There is potential benefit in assessing cognition and mood, both at study recruitment and as the end point. For interven-tion trials, stroke survivors with substantial cognitive or mood deficits may be excluded. However, lesser problems with mood and cognition may still impact on activity and partic-ipation outcomes and should be described. Because they have potential effects on all aspects of recovery, some have argued that cognitive measures themselves may be a useful " global outcome " measure for trials. 7 Many cognitive/mood assessment instruments are avail-able, but at present, there is no consensus on optimal measure(s) for use in stroke practice or research. A literature around stroke trial assessment is emerging, although to date there has been limited research on the properties of common cognitive/mood assessments in stroke. We first have to know which tools are commonly used. We sought to describe the cognitive/mood assessments used in contemporary published stroke trials.