Screening for Stroke and Cognitive Impairment Chapter 5: When is Cognitive Screening Limited?

BRIEF COGNITIVE SCREENING: WHAT IT CAN DO Identify those individuals who might have cognitive impairment; Indicate the need for more comprehensive cognitive evaluation; Support concerns regarding the client’s safety or ability to function independently in their daily roles; Assist in understanding the client’s strengths and limitations 9.

BRIEF COGNITIVE SCREENING: WHAT IT CAN DO Screening can indicate possible deficits in an area of cognition (the process of knowing) e.g. o Memory; o Language; o Executive functions (cognitive processes that orchestrate complex & goal-directed activities) i.e. Sequencing, Organizing, Abstracting & Planning 9.

COGNITIVE SCREENING: WHAT IT CAN’T DO Diagnose a disease; Be 100% predictive (false positive’s & negatives can occur); Test all domains of cognition; Evaluate judgment & reasoning; Test decisional capacity 9.

COGNITIVE SCREENING: WHAT IT CAN’T DO Provide standardized accommodations for administration or interpretation when visual, language, or motor barriers are present; Pro-Rate or adjust scoring based on above barriers; Assess for capacity i.e., the ability to understand the information relevant to a decision and the ability to appreciate the foreseeable consequences of a decision or lack of decision 9.

Exercising Caution Caution must be taken in interpreting individual cognitive domains. WHY? Completion of test items can be affected by: Multiple cognitive processes, so a simple label is not always reflective. Motor deficits: e.g., patient is unable to hold a pencil due to hemiparesis. Language issues due to aphasia. Visual Perceptual Barriers. Screens are not meant to identify specific domains or diagnostic patterns.

Additional Screening Tools Clinicians are encouraged to communicate with the interprofessional team about other resources and next steps in terms of additional assessments that could be provided. The Canadian Best Practice Recommendations for Stroke Care make reference to additional assessments in Table 7.2B: Summary of Select Screening Tools for Assessment of Vascular Cognitive Impairment in Stroke Patients: Other resources the clinician may refer to are: o Stroke Engine o Evidenced Based Review of Stroke Rehabilitation: -