TY - JOUR
T1 - Comparative validity of informant tools for assessing pre-stroke cognitive impairment
AU - Taylor-Rowan, Martin
AU - McGuire, Lucy
AU - Hafdi, Melanie
AU - Evans, Jonathan
AU - Stott, David J.
AU - Wetherall, Kirsty
AU - Elliott, Emma
AU - Drozdowska, Bogna
AU - Quinn, Terence J.
N1 - Funding Information: We would like to thank out funders Study funding: Stroke Association and Chief Scientist Office of Scotland; funding reference: PPA 2015/01_CSO. NHSGGC Endowment Fellowship Funding Award; Project ref: GN20ST405. Funding Information: We would like to thank out funders Study funding: Stroke Association and Chief Scientist Office of Scotland; funding reference: PPA 2015/01_CSO. NHSGGC Endowment Fellowship Funding Award; Project ref: GN20ST405. Publisher Copyright: © 2022 The Authors. International Journal of Geriatric Psychiatry published by John Wiley & Sons Ltd.
PY - 2022/4/1
Y1 - 2022/4/1
N2 - OBJECTIVES: Various informant-based questionnaires are used in clinical practice to screen for pre-stroke cognitive problems. However, there is no guidance on which tool should be preferred. We compared the validity of the two most commonly used informant-based tools. METHODS: We recruited consecutively admitted stroke patients. Patients' informants completed the Informant Questionnaire for Cognitive Decline in the Elderly Short Form (IQCODE-SF, 16-item) and Ascertain Dementia 8 (AD8). We assessed construct validity (accuracy) against a semi-structured clinical interview for dementia or mild cognitive impairment (MCI), describing test accuracy metrics and comparing area under ROC curves (AUROC). We described criterion validity by evaluating associations between test scores and neuroimaging markers of dementia and overall 'brain frailty'. Finally, we described prognostic validity comparing ROC curves for 18-month clinical outcomes of dementia, death, stroke, and disability. RESULTS: One-hundred-thirty-seven patient-informant dyads were recruited. At usual clinical cut-points, the IQCODE-SF had comparable sensitivity to the AD8 (both = 92%) for pre-stroke dementia, but superior specificity (IQCODE-SF: 82% vs. AD8: 58%). Youden index suggested that the optimal AD8 threshold for diagnosis of dementia is ≥4. The IQCODE-SF demonstrated stronger associations with markers of generalised and medial-temporal lobe atrophy, neurovascular disease, and overall brain frailty. IQCODE-SF also demonstrated greater accuracy for predicting future dementia (IQCODE-SF AUROC = 0.903, 95% CI = 0.798-1.00; AD8 AUROC = 0.821, 95% CI = 0.664-0.977). CONCLUSIONS: Both IQCODE-SF and AD8 are valid measures of pre-stroke dementia. Higher cut points for AD8 may improve performance in the acute stroke setting. Based on consistent superiority across a range of validity analyses, IQCODE-SF may be preferable to AD8 for pre-stroke dementia screening.
AB - OBJECTIVES: Various informant-based questionnaires are used in clinical practice to screen for pre-stroke cognitive problems. However, there is no guidance on which tool should be preferred. We compared the validity of the two most commonly used informant-based tools. METHODS: We recruited consecutively admitted stroke patients. Patients' informants completed the Informant Questionnaire for Cognitive Decline in the Elderly Short Form (IQCODE-SF, 16-item) and Ascertain Dementia 8 (AD8). We assessed construct validity (accuracy) against a semi-structured clinical interview for dementia or mild cognitive impairment (MCI), describing test accuracy metrics and comparing area under ROC curves (AUROC). We described criterion validity by evaluating associations between test scores and neuroimaging markers of dementia and overall 'brain frailty'. Finally, we described prognostic validity comparing ROC curves for 18-month clinical outcomes of dementia, death, stroke, and disability. RESULTS: One-hundred-thirty-seven patient-informant dyads were recruited. At usual clinical cut-points, the IQCODE-SF had comparable sensitivity to the AD8 (both = 92%) for pre-stroke dementia, but superior specificity (IQCODE-SF: 82% vs. AD8: 58%). Youden index suggested that the optimal AD8 threshold for diagnosis of dementia is ≥4. The IQCODE-SF demonstrated stronger associations with markers of generalised and medial-temporal lobe atrophy, neurovascular disease, and overall brain frailty. IQCODE-SF also demonstrated greater accuracy for predicting future dementia (IQCODE-SF AUROC = 0.903, 95% CI = 0.798-1.00; AD8 AUROC = 0.821, 95% CI = 0.664-0.977). CONCLUSIONS: Both IQCODE-SF and AD8 are valid measures of pre-stroke dementia. Higher cut points for AD8 may improve performance in the acute stroke setting. Based on consistent superiority across a range of validity analyses, IQCODE-SF may be preferable to AD8 for pre-stroke dementia screening.
KW - dementia
KW - informant
KW - screening
KW - stroke
UR - http://www.scopus.com/inward/record.url?scp=85126389199&partnerID=8YFLogxK
U2 - https://doi.org/10.1002/gps.5700
DO - https://doi.org/10.1002/gps.5700
M3 - Article
C2 - 35278006
SN - 0885-6230
VL - 37
JO - International journal of geriatric psychiatry
JF - International journal of geriatric psychiatry
IS - 4
M1 - GPS5700
ER -