Paper publication on the validity of the Oxford Cognitive Screen Plus (OCS+) to detect subtle post-stroke impairments. 

This paper, entitledValidation of the UK English Oxford cognitive screen-plus in sub-acute and chronic stroke survivorswas 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. 

Paper publication on lesion-symptom mapping in stroke.

This paper, entitled “Lesion symptom mapping of domain-specific cognitive impairments using routine imaging in stroke” was a joint effort of Margaret Jane Moore and Nele Demeyere. Below is a summary of the paper for the general public.

In this study, the researchers aimed to investigate if specific changes in thinking skills after stroke (Language, Attention, Praxis, Number, and Memory) could be mapped to specific brain regions. It had been well established that areas of the brain are responsible for specific mental abilities however, the researchers wanted to investigate if the functional structure was being adequately detected by a short cognitive screen and routine clinical brain imaging taken post-stoke. They investigated the association by gathering cognitive screen data from the Oxford Cognitive Screen (OCS) and routine pot-stroke imaging from 573 acute stroke survivors. A Voxel-Based Lesion Symptom Mapping (VLSM) analysis was implemented to establish the relationship between the precise lesion location and the deficits that were present on the cognitive screen.

The analysis results demonstrated that different impairments are related to specific regions of the brain. More specifically:

  1. Language deficits were most associated with damage in the left frontal/temporal areas.
  2. Visual field deficits were associated with damage to posterior occipital areas.
  3. Left visuospatial neglect was associated with damage to the right temporo-parietal region.
  4. Right visuospatial neglect, executive dysfunction, and praxis were not associated with specific damage in any of the examined regions.
  5. The OCS assessment alone was able to reliably identify post-stroke cognitive deficits.

These findings further validate the OCS as an effective method for identifying domain-specific rather than domain-general deficits. The results demonstrate the use of post-stroke cognitive assessment for detecting and differentiating between distinct patterns of cognitive impairments.

Citation: Moore, M. J., & Demeyere, N. (2022). Lesion symptom mapping of domain-specific cognitive impairments using routine imaging in stroke. Neuropsychologia, 167, 108159.

Paper publication on cognitive impairment and fatigue after acquired brain injury.

This paper, entitled “Is there evidence for a relationship between cognitive impairment and fatigue after acquired brain injury: a systematic review and meta-analysis” was a joint team effort led by PhD student Avril Dillon, with a wider supervisory team across Oxford Brookes, the University of Oxford and the University of Nottingham. Below is a summary of the paper for the general public.  

In this systematic review, the team aimed to better understand the relationship between the severity of fatigue and cognitive impairment after Acquired Brain Injury (including stroke) by analyzing and summarizing existing research findings in the literature.  

Fatigue is a highly problematic and persistent consequence of acquired brain injury. Acquired Brain Injury was defined to include Stroke, Traumatic Brain Injury, and subarachnoid Haemorrhage (SAH). Many survivors report that fatigue is their most severe symptom as it negatively affects their participation in everyday activities. Mental fatigue especially is very often reported. This typically occurs when engaging in a thinking task that requires a lot of concentration.  

In this work, sixteen research papers in which 1,745 participants were studied were included. All the studies researched the relationship between thinking problems and fatigue. The analysis found that fatigue was most strongly related to slower cognitive processing and sustained attention, and weaker relations with planning and memory processes.  

This study is important as it provided evidence for a relationship between cognitive processes and fatigue after brain injury. The results suggest that managing changes in thinking abilities during recovery may improve fatigue and participation in meaningful activities after stroke, traumatic brain injury or subarachnoid hemorrhage. 


Citation: Dillon, A., Casey, J., Gaskell, H., Drummond, A., Demeyere, N., & Dawes, H. (2022). Is there evidence for a relationship between cognitive impairment and fatigue after acquired brain injury: a systematic review and meta-analysis. Disability and Rehabilitation, 1-14. 

UKSF 2022

At UKSF, our principal investigator Nele Demeyere gave a talk on the relationship between cognition and emotional problems after stroke. Nele presented findings from several research projects where we found that stroke survivors who experience difficulties with their thinking abilities were more prone to develop depressive symptoms (but not anxious ones) than those whose thinking skills were less affected by their stroke. Nele further presented the findings wo studies that looked at the mechanism by which mood is influenced post-stroke. One of the studies showed that a higher level of awareness of thinking difficulties led to greater emotional distress. However, when thinking skills improved over the first 6 months after stroke, survivors experienced less emotional distress. A further mechanism shown to impact cognition was illness perception Overall though, the relationship between difficulties in thinking abilities and emotional changes was consistently found present in the early stages, at 6 months, and in the long-term post-stroke. These findings highlight the need for cognitive rehabilitation and support after discharge and provide targets for intervention. 



Andrea Kusec presented her research on the roles of both objective and subjective thinking difficulties to post-stroke depression from early to long-term stroke. Andrea found that at 6 months after stroke, the objective amount of thinking difficulties someone has (e.g., in attention, memory, language) can negatively affect mood. However, in long-term stroke (>2 years after), this changes – how stroke survivors subjectively feel about their thinking difficulties plays a much stronger role in predicting levels of depression and low mood. This is important because in the earlier stages of stroke, working on reducing the amount of thinking difficulties can improve mood, but in the long-term working with stroke survivors on how they feel about their thinking difficulties may be more important to work on in therapy for low mood after stroke. 



Sam Webb presented work regarding how the new computer tablet shopping task (OxMET), which measures higher-level cognitive abilities, relates to functional outcomes in stroke survivors. That is, they collected data from stroke survivors whilst they were in a rehab unit and followed them up 6-months later to see if their performance on the game related to how they functioned in daily life. They found that the shopping game can predict someone’s functional recovery. Whilst the relationship was not 1:1, meaning if you failed the shopping task you didn’t always have poor functioning, it nevertheless can help inform and can give clinicians an indication of how someone ‘might’ be, and they can tailor rehabilitation approaches.