OXFORD COGNITIVE SCREEN (OCS) FEASIBILITY IN THE STROKE UNIT SETTING

Objectives: Cognitive screening is not widely used in acute stroke patients,\r\nand usually is based on tests developed for dementia. Our aim was\r\nto explore the feasibility of a new tool designed for stroke survivors, as\r\nthe Oxford Cognitive Screen (OCS).\r\nMaterials: 3–10 days after stroke, patients underwent the OCS, providing\r\na five domain-specific cognitive profile: attention and executive\r\nfunction, language, memory, number processing and praxis. Pre-morbid\r\nfunctional and cognitive status was evaluated by caregiver interview. The\r\nNational Institute of Health and Stroke Scale (NIHSS) estimated the\r\nstroke severity.\r\nMethod: This cross-sectional study consecutively enrolled stroke patients\r\n(both ischemic and hemorrhagic). Exclusion criteria: Pre-morbid\r\ncognitive decay, difficulties with the Italian language, visual impairment\r\nor other preexisting conditions affecting cognitive status. OCS was considered\r\nnon-applicable when patients failed the preliminary subtest.\r\nIschemic brain lesions were classified according to the Bamford criteria:\r\nTotal Anterior Circulation Stroke (TACS), Partial Anterior Circulation\r\nStroke (PACS), Posterior Circulation Syndrome (POCS), Lacunar\r\nSyndrome (LACS).\r\nResults: Between October and December 2019, 45 out of 62 patients\r\nadmitted to the Stroke Unit of Poliambulanza Foundation of Brescia were\r\nenrolled. Eight patients were non-eligible, 2 died, and 7 did not fit the\r\ntime window inclusion criteria. Characteristics of the sample were: 43\r\n(95.6%) Italian born, 33 (73.3%) male, 37 (82.2%) with ischemic stroke,\r\nmean age (years) 68.00 (DS 15.45), mean initial NIHSS score 7.02 (DS\r\n7.67). Overall, 25 (55.6%) patients had a left sided brain lesion, 13/37\r\n(35%) were affected by TACS, 19 (42.2%) were discharged at home\r\nwithout any cognitive follow-up indications, and 9 (20%) were transferred\r\nto neurologic rehabilitation. OCS was applicable in 37/45\r\n(82.2%) patients. Twenty-eight (75.7%) patients showed at least one impaired\r\ncognitive domain. At multivariate logistic regression analyses,\r\nhigher age (OR 1.33; 95% CI 1.02-1.74, p= 0.038) and higher NIHSS\r\nscore (for every 1-point increase, OR 1.56; 95% CI 1.05-2.33, p= 0.029)\r\nwere significantly associated to OCS non-applicability, after adjusting for\r\ntype of stroke (ischemic vs hemorrhagic). In the ischemic subgroup, having\r\nTACS (compared to PACS, POCS, or LACS) showed a significant\r\nassociation to OCS non-applicability (OR 13.50, 95%CI 1.19-153.33, p=\r\n0.036). Brain lesion side wasn’t a significant factor.\r\nDiscussion: OCS confirmed a very good applicability in acute stroke\r\nsetting, uncontaminated by aphasia and neglect. Age, stroke severity and\r\nlesion extension (but not side) emerged as major determinants of its\r\napplicability.\r\nConclusions: OCS seems a promising tool in acute stroke setting.