The Cog-4 Subset of the National Institutes of Health Stroke Scale as a Measure of Cognition: Relationship with Baseline Factors and Functional Outcome after Stroke Using Data from the Virtual International Stroke Trials Archive
Background. Assessing poststroke cognitive impairment is complex. A subscale of the NIHSS, the Cog-4, has been proposed as a quick test of “cognitive impairment.” but a study of its properties in a larger dataset is lacking. Methods. Data from 9,147 patients with acute stroke from the VISTA archive...
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| Format: | Article |
| Language: | English |
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Wiley
2013-01-01
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| Series: | Stroke Research and Treatment |
| Online Access: | http://dx.doi.org/10.1155/2013/562506 |
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| author | Sandeep Ankolekar Cheryl Renton Nikola Sprigg Philip M. W. Bath |
| author_facet | Sandeep Ankolekar Cheryl Renton Nikola Sprigg Philip M. W. Bath |
| author_sort | Sandeep Ankolekar |
| collection | DOAJ |
| description | Background. Assessing poststroke cognitive impairment is complex. A subscale of the NIHSS, the Cog-4, has been proposed as a quick test of “cognitive impairment.” but a study of its properties in a larger dataset is lacking. Methods. Data from 9,147 patients with acute stroke from the VISTA archive was used to generate Cog-4 scores. The statistical properties of Cog-4, its relationship with baseline clinical characteristics, and other functional outcome measures at day 90 were assessed. Results. Mean age of patients was 69.2 years and 45.8%, were females. Day-90 Cog-4 was highly positively skewed (skewness 0.926). Patients with left hemispheric stroke had higher day-90 Cog-4 score (P<0.001). Age, stroke severity, and previous stroke were significant predictors of Cog-4. Cog-4 was significantly correlated with dependency (modified Rankin Scale, rs=0.512), and disability (Barthel Index, rs=−0.493). Conclusions. The Cog-4 scale at day 90 cannot be considered a useful test of cognition since it only superficially measures cognition. It is heavily dependent on the side of stroke, is inevitably associated with functional outcome (being a subset of the NIHSS), and suffers from a profound “floor” effect. Specific and validated measures are more appropriate for the assessment of poststroke cognition than Cog-4. |
| format | Article |
| id | doaj-art-67530a120b074bc2aaf160e1ef4881c6 |
| institution | Kabale University |
| issn | 2090-8105 2042-0056 |
| language | English |
| publishDate | 2013-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Stroke Research and Treatment |
| spelling | doaj-art-67530a120b074bc2aaf160e1ef4881c62025-02-03T01:04:26ZengWileyStroke Research and Treatment2090-81052042-00562013-01-01201310.1155/2013/562506562506The Cog-4 Subset of the National Institutes of Health Stroke Scale as a Measure of Cognition: Relationship with Baseline Factors and Functional Outcome after Stroke Using Data from the Virtual International Stroke Trials ArchiveSandeep Ankolekar0Cheryl Renton1Nikola Sprigg2Philip M. W. Bath3Stroke Trials Unit, Division of Stroke, University of Nottingham, City Hospital Campus, Nottingham NG5 1PB, UKStroke Trials Unit, Division of Stroke, University of Nottingham, City Hospital Campus, Nottingham NG5 1PB, UKStroke Trials Unit, Division of Stroke, University of Nottingham, City Hospital Campus, Nottingham NG5 1PB, UKStroke Trials Unit, Division of Stroke, University of Nottingham, City Hospital Campus, Nottingham NG5 1PB, UKBackground. Assessing poststroke cognitive impairment is complex. A subscale of the NIHSS, the Cog-4, has been proposed as a quick test of “cognitive impairment.” but a study of its properties in a larger dataset is lacking. Methods. Data from 9,147 patients with acute stroke from the VISTA archive was used to generate Cog-4 scores. The statistical properties of Cog-4, its relationship with baseline clinical characteristics, and other functional outcome measures at day 90 were assessed. Results. Mean age of patients was 69.2 years and 45.8%, were females. Day-90 Cog-4 was highly positively skewed (skewness 0.926). Patients with left hemispheric stroke had higher day-90 Cog-4 score (P<0.001). Age, stroke severity, and previous stroke were significant predictors of Cog-4. Cog-4 was significantly correlated with dependency (modified Rankin Scale, rs=0.512), and disability (Barthel Index, rs=−0.493). Conclusions. The Cog-4 scale at day 90 cannot be considered a useful test of cognition since it only superficially measures cognition. It is heavily dependent on the side of stroke, is inevitably associated with functional outcome (being a subset of the NIHSS), and suffers from a profound “floor” effect. Specific and validated measures are more appropriate for the assessment of poststroke cognition than Cog-4.http://dx.doi.org/10.1155/2013/562506 |
| spellingShingle | Sandeep Ankolekar Cheryl Renton Nikola Sprigg Philip M. W. Bath The Cog-4 Subset of the National Institutes of Health Stroke Scale as a Measure of Cognition: Relationship with Baseline Factors and Functional Outcome after Stroke Using Data from the Virtual International Stroke Trials Archive Stroke Research and Treatment |
| title | The Cog-4 Subset of the National Institutes of Health Stroke Scale as a Measure of Cognition: Relationship with Baseline Factors and Functional Outcome after Stroke Using Data from the Virtual International Stroke Trials Archive |
| title_full | The Cog-4 Subset of the National Institutes of Health Stroke Scale as a Measure of Cognition: Relationship with Baseline Factors and Functional Outcome after Stroke Using Data from the Virtual International Stroke Trials Archive |
| title_fullStr | The Cog-4 Subset of the National Institutes of Health Stroke Scale as a Measure of Cognition: Relationship with Baseline Factors and Functional Outcome after Stroke Using Data from the Virtual International Stroke Trials Archive |
| title_full_unstemmed | The Cog-4 Subset of the National Institutes of Health Stroke Scale as a Measure of Cognition: Relationship with Baseline Factors and Functional Outcome after Stroke Using Data from the Virtual International Stroke Trials Archive |
| title_short | The Cog-4 Subset of the National Institutes of Health Stroke Scale as a Measure of Cognition: Relationship with Baseline Factors and Functional Outcome after Stroke Using Data from the Virtual International Stroke Trials Archive |
| title_sort | cog 4 subset of the national institutes of health stroke scale as a measure of cognition relationship with baseline factors and functional outcome after stroke using data from the virtual international stroke trials archive |
| url | http://dx.doi.org/10.1155/2013/562506 |
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