Wall Kylie J, Isaacs Megan L, Copland David A, Cumming Toby B
The University of Queensland, Clinical Centre for Research, Royal Women's & Children's Hospital Campus, Herston, Qld, Australia.
Stroke, The Florey Institute for Neuroscience and Mental Health, The University of Melbourne, Melbourne, Vic, Australia.
Int J Stroke. 2015 Jul;10(5):665-71. doi: 10.1111/ijs.12506. Epub 2015 May 11.
Cognitive impairments post-stroke are common. Assessment of cognition typically involves pen-and-paper tasks, which are often reliant on linguistic and motor function, creating barriers for many stroke survivors. The characteristics of stroke survivors excluded from cognitive assessments have never been investigated.
(1) To determine if the stroke samples included in studies evaluating clinimetric properties of cognitive assessments represent the stroke population, (2) to identify the different modes of cognitive assessments, and (3) to ascertain whether the different modes of cognitive assessments influence the stroke samples used in the studies.
We systematically reviewed studies that evaluated at least one clinimetric property of a cognitive assessment in adult stroke survivors from January 2000 to October 2013. Eligibility criteria, reasons for drop-outs and missing data were extracted. A theming process was employed to synthesize the data. From the initial yield of 3731 articles, 109 were included. Six broad categories describing reasons for exclusion were identified. Cognitive impairments were the most common (68%), then communication issues (62%), endurance problems (42%), sensory loss (39%), psychiatric illness (38%) and motor limitations (27%). The most prevalent assessment mode was pen-and-paper (73%), then virtual reality (11%), computer (6%), observational functional performance (5%), informant (3%) and telephone (3%). Regardless of mode, issues with cognition and communication were the most frequently used exclusion criteria.
Our findings indicate that cognitive assessments are not tested in representative stroke samples. Research is needed to identify valid and reliable cognitive assessments that are feasible in a wider range of stroke survivors.
中风后认知障碍很常见。认知评估通常涉及纸笔任务，这往往依赖语言和运动功能，给许多中风幸存者造成了障碍。从未有人研究过被排除在认知评估之外的中风幸存者的特征。
（1）确定评估认知评估临床测量特性的研究中所纳入的中风样本是否代表中风人群，（2）识别认知评估的不同模式，以及（3）确定不同的认知评估模式是否会影响研究中使用的中风样本。
我们系统回顾了2000年1月至2013年10月间评估成年中风幸存者认知评估至少一项临床测量特性的研究。提取了纳入标准、退出原因和缺失数据。采用主题分析过程对数据进行综合。从最初的3731篇文章中，纳入了109篇。确定了描述排除原因的六大类。认知障碍最为常见（68%），其次是沟通问题（62%）、耐力问题（42%）、感觉丧失（39%）、精神疾病（38%）和运动受限（27%）。最普遍的评估模式是纸笔（73%），其次是虚拟现实（11%）、计算机（6%）、观察性功能表现（5%）、 informant（3%）和电话（3%）。无论评估模式如何，认知和沟通问题是最常用的排除标准。
我们的研究结果表明，认知评估并非在具有代表性的中风样本中进行测试。需要开展研究以确定在更广泛的中风幸存者中可行的有效且可靠的认知评估方法。
