Donovan Neila J, Kendall Diane L, Heaton Shelley C, Kwon Sooyeon, Velozo Craig A, Duncan Pamela W
VA HSR&D/RR&D Rehabilitation Outcomes Research Center, Gainesville, FL 32608, USA.
Neurorehabil Neural Repair. 2008 Mar-Apr;22(2):122-35. doi: 10.1177/1545968307306239. Epub 2007 Aug 30.
Up to 65% of individuals demonstrate poststroke cognitive impairments, which may increase hospital stay and caregiver burden. Randomized stroke clinical trials have emphasized physical recovery over cognition. Neuropsychological assessments have had limited utility in randomized clinical trials. These issues accentuate the need for a measure of functional cognition (the ability to accomplish everyday activities that rely on cognitive abilities, such as locating keys, conveying information, or planning activities).
The aim of the study was to present the process used to establish domains of functional cognition for development of computer adaptive measure of functional cognition for stroke.
Functional cognitive domains involved in identifying relevant neuropsychological constructs from the literature were conceptualized and finalized after advisory panel feedback from experts in neurology, neuropsychology, aphasiology, clinical trials, and epidemiology.
The following 17 domains were proposed: receptive aphasia, expressive aphasia, agraphia, alexia, calculation, visuospatial, visuoperceptual, visuoconstruction, attention, language usage, executive functions, orientation, processing speed, memory, working memory, mood, awareness and abstract reasoning. The advisory panel recommended retaining the first 12 domains. Recommended changes included: to address only encoding and retrieval of recent information in the memory domain; to add domains for limb apraxia and poststroke depression; and to keep orientation as a separate domain or reclassify it under memory or attention. The final 10 domains included: language, reading and writing, numeric/calculation, limb praxis, visuospatial function, social use of language, emotional function, attention, executive function, and memory.
Conceptualizing domains of functional cognition is the first step in developing a computer adaptive measure of functional cognition for stroke. Additional steps include developing, refining, and field-testing items, psychometric analysis, and computer adaptive test programming.
高达65%的个体在中风后会出现认知障碍，这可能会延长住院时间并增加照顾者负担。中风随机临床试验一直强调身体恢复而非认知恢复。神经心理学评估在随机临床试验中的作用有限。这些问题凸显了对功能性认知进行测量的必要性（功能性认知是指完成依赖认知能力的日常活动的能力，如找到钥匙、传达信息或规划活动）。
本研究的目的是介绍用于建立功能性认知领域的过程，以开发中风功能性认知的计算机自适应测量方法。
从文献中识别相关神经心理学结构所涉及的功能性认知领域，在神经病学、神经心理学、失语症学、临床试验和流行病学专家组成的咨询小组提供反馈后进行概念化和最终确定。
提出了以下17个领域：接受性失语、表达性失语、失写症、失读症、计算、视觉空间、视觉感知、视觉构建、注意力、语言使用、执行功能、定向、处理速度、记忆、工作记忆、情绪、意识和抽象推理。咨询小组建议保留前12个领域。建议的修改包括：在记忆领域仅涉及近期信息的编码和检索；增加肢体失用症和中风后抑郁的领域；将定向作为一个单独的领域保留或在记忆或注意力下重新分类。最终的10个领域包括：语言、读写、数字/计算、肢体运用、视觉空间功能、语言的社会使用、情绪功能、注意力、执行功能和记忆。
对功能性认知领域进行概念化是开发中风功能性认知计算机自适应测量方法的第一步。其他步骤包括开发、完善和现场测试项目、心理测量分析以及计算机自适应测试编程。
