A streamlined multi-staged cognitive screening approach: validity of the Multistage Cognitive Screening app for Stroke (MCS-Stroke)

Research summary

Following informed consent/consultee declaration,a member of the research will collect relevant clinical and demographic information from the participant and their clinical notes (e.g. age,gender,ethnicity,highest level of education,clinical diagnosis,month and year of stroke,previous strokes (yes/no),cognitive status). These will be recorded on the Trial Entry Form. Participants contact details and preferred mode of contact will also be recorded in the Trial Entry Form. The Trial Entry Form will be shared with the research team using the Microsoft OneDrive server link hosted by the University of Oxford. Cognitive tests already completed as part of standard clinical practice (e.g.,the paper OCS) will be obtained from medical notes,if completed within 1 week of MCS-Stroke completion. The stroke survivor will then be administered the MCS-Stroke. Each subtask should take a few minutes and at least three subtasks will be administered from 6 sections of the test (sections include: memory,language,attention,praxis,number,and executive function). The first task is supposed to be of medium difficulty. Depending on whether the stroke survivor passes within normal performance ranges on the test,they will be given a harder or an easier task. Easier tasks are given to differentiate problems relating to the section measures (e.g.,memory) versus confounding problems (e.g.,vision impairment). Harder tasks are given to tease out potential problems in a given ability (e.g.,memory) that are more subtle or easy to miss on conventional testing. The same procedure applies once more,so in total per section a stroke survivor will do a medium task,an easier/harder task,and then a final easier/harder task. The exception to this is if two tasks are failed in a row,we will stop measurement of the section (e.g.,memory) and move onto another section to not demoralise the participant or fatigue them when enough information has already been gained. Following administration of the MCS-Stroke,we will administer comparison tasks from established and accurate measurements to compare to the MCS-Stroke. This enables us to see how well our new test does in detecting problems in comparison to existing tests. Comparison tests will be different per stroke survivor as they will perform differently and not all necessarily get the same selection of tests per section on the MCS-Stroke. Thus,only comparison tests for MCS-Stroke subtests actually completed will be administered to reduce fatigue and burden on participants. Comparison tasks include tests such as the paper OCS and BCoS subtasks,and other general tests like the well validated Montreal Cognitive Assessment,amongst other matched to each MCS-Stroke subtask. Tests will always be attempted,even if the participant is likely to fail them,as this is useful information for feasibility of our assessment. But we will never make a participant complete any task they are clearly not wanting to complete,regardless of capacity to consent (e.g.,if a participant pushes the tablet away,or drops the pen and doesn’t want it back etc). All session lengths will be determined by the researcher in conjunction with the stroke survivor and relevant healthcare team to ensure the best performance of the participant. Objectives: 1) To psychometrically validate the MCS-Stroke assessments,and 2) To assess feasibility and cost-effectiveness of MCS-Stroke.

Principal Investigator

Dr Sam Webb

Contact us

Email: Rachel.teal@ouh.nhs.uk

IRAS number

348606