Use this URL to cite or link to this record in EThOS: http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.589800
Title: An evaluation of screening measures for detecting low mood and cognitive impairment in acute stroke patients
Author: Bunton, Penelope Jessica Claudia
Awarding Body: University of Liverpool
Current Institution: University of Liverpool
Date of Award: 2008
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Abstract:
Objective: To determine the accuracy and appropriateness of screening measures for detecting low mood and cognitive impairment in acute stroke patients, by determination of their sensitivity, specificity and reliability. Methods: 114 English-speaking acute stroke patients completed a depression screening measure from the Mood Assessment Care Pathway (MACP), a battery of mood assessment measures and the Structured Clinical Interview for DSM-IV Axis 1 Disorders (SCID). Participants without significant physical or language impairment additionally completed the Middlesex Elderly Assessment of Mental State (MEAMS), an oral paradigm of the Trail Making Test (OTMT) and detailed neuropsychological assessment with the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), Rule Shift Card Test (BADS) and the Verbal Fluency Test (phonemic task). Results: 106 participants completed all of the mood assessment procedures. Sensitivity of the individual MACP measures was generally high for the detection of major and minor depression. Specificity varied widely between the measures ranging from 18% to 85% but was generally within acceptable levels (greater than 60%). A revised version of the MACP was proposed using optimal cut-off scores. The MACP-revised gave 100% sensitivity and 77% specificity for the detection of major depression and 81% sensitivity and 65% specificity for minor depression. Reliability as assessed by the Kappa coefficient was found to be generally low for either version of the MACP and the individual measures. 91 participants were assessed using the MEAMS. Convergent validity of the MEAMS with full assessment measures was not supported (r < .40). Overall, sensitivity of the MEAMS subtests and the overall MEAMS for the detection of impairment in any of the cognitive domains was generally low, except for the overall MEAMS with Immediate and Delayed Memory Impairment. Specificity was generally higher, but there were only two instances where subtests achieved acceptable levels of both sensitivity and specificity. The overall MEAMS failed to achieve acceptable levels of agreement for any of the cognitive domains assessed. 89 participants were assessed using the OTMT. Sensitivity of the OTMT-B for the detection of impairment in any of the cognitive domains was generally low (less than 60%). Specificity was generally higher (greater than 76%), but there were no instances where acceptable levels of sensitivity and specificity were both achieved. Agreement with full assessment measures was generally poor for any of the cognitive domains assessed. Conclusions: The overall MACP-revised was an acceptably valid screening battery for the assessment of major and minor depression in acute stroke patients and demonstrated a useful way of compiling mood screening batteries which allow the assessment of mood impairment for all stroke patients. Neither the MEAMS nor the OTMT were recommended as a measure for screening for cognitive problems after a stroke due to their low sensitivity. However, further investigation of the psychometric properties of the RBANS was indicated, as the current findings suggest that it can be successfully used to assess acute stroke patients for cognitive impairment.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID: uk.bl.ethos.589800  DOI: Not available
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