This paper, entitled “Validation of the UK English Oxford cognitive screen-plus in sub-acute and chronic stroke survivors” was published in December 2022 by the European Stroke Journal. It was a joint effort of Sam Webb, Georgina Hobden, Rebecca Roberts, Evangeline Chiu, Sarah King and Nele Demeyere. Below is a summary of the paper for the general public.
In this study, we aimed to examine the effectiveness of a brief tablet-based cognitive screen (OCS-Plus) designed to detect subtle post-stroke cognitive impairments. As cognitive impairment is very common post-stroke, multiple UK national and international guidelines identify cognitive screening as an essential part of post-stroke assessment and planning. However, the commonly used tools for post-stroke screening are not as sensitive to subtle cognitive impairments frequently associated with stroke as they were primarily developed to detect more general dementia (e.g. MoCA) or early stroke-specific cognitive impairments (OCS). The OCS-Plus is a computer-tablet-based cognitive screening tool that was developed to screen for subtle post-stroke cognitive impairment (in particular, impairments in executive function and memory). The OCS-Plus can be seen as an extension of the OCS, which is routinely used in clinical practice to screen for early stroke-specific cognitive deficits.
Completing the OCS-Plus screen takes approximately 25min. and in this study 347 stroke survivors took part. Everyone was originally recruited from the John Radcliffe acute stroke unit and the Oxfordshire Stroke Rehabilitation Unit.
We found that OCS-Plus detected cognitive impairments where traditional first-line screening tools like MoCA and OCS did not pick this up. Whilst a short screen, the OCS-Plus subtasks demonstrated similar sensitivity to standardised neuropsychological testing, demonstrating its ability to detect more subtle cognitive problems in a time-efficient manner.
We highlighted some potential advantages of using the OCS-Plus:
- The OCS-Plus report gives clear information about both domain-general and domain-specific cognitive performance.
- It is available on a platform-independent app that provides standardised administration instructions for the user and automatically scores participants against age-adjusted impairment cut-offs.
- It takes <25 min to administer which means a substantial time advantage relative to extensive neuropsychological test batteries, with a similar sensitivity
In the context of clinical practice:
- Clinicians could use fine-grained information about domain-specific and domain-general cognitive functioning to detail prognosis and recovery and inform conversations around adjustment to living life post-stroke.
- Because the OCS-Plus app provides standardised administration instructions, it could be used in clinical practice by a range of health professionals, without the need for specific neuropsychology training.
- Having an automatically scored tool could accelerate the assessment process and return crucial time to clinicians for other aspects of assessment, providing potential cost savings.
- Overall, the paper demonstrates that OCS-Plus is a valid and sensitive cognitive screening tool that can detect more subtle cognitive impairment in stroke survivors. The OCS-Plus may be a valuable cognitive screening tool for use in clinical practice, particularly in stroke survivors who may present with a mixture of domain-specific and domain-general cognitive changes.
Citation: Webb, S. S., Hobden, G., Roberts, R., Chiu, E. G., King, S., & Demeyere, N. (2022). Validation of the UK English Oxford cognitive screen-plus in sub-acute and chronic stroke survivors. European Stroke Journal, 7(4), 476-486.