Comprehensive cognitive neurological assessment in stroke

Background –  Cognitive syndromes (CS) after stroke may be important to measure and monitor for management and emerging therapies. Aim –  To incorporate known behavioral neurological and neuropsychiatric syndromes into a bedside cognitive assessment in patients with stroke. Methods –  A validated cognitive examination (comprehensive cognitive neurological test in stroke, Coconuts) was administered during the first month of stroke presentation and analyzed according to five large-scale networks for cognition and correlated with neuropsychological tests. Validity testing of the test was performed for overall sensitivity, specificity, positive predictive value and negative predictive value to stroke in comparison with MRI diagnosis of stroke as well as discriminant validity, construct validity and inter-rater reliability. Results –  Overall the sensitivity of the Coconuts scale was 91% and specificity 35%, PPV 88% and NPV 41% vs stroke lesions using MRI. Cognitive syndrome frequencies: frontal network syndrome frequency was 908/1796 (51%), left hemisphere network syndrome frequency was 646/1796 (36%), right hemisphere network included 275/1796 (15.3%), occipitotemporal network for complex visual processing 107/1796 (6%), the hippocampal limbic network for amnesias and emotional disorders 397/1796 (22%) and miscellaneous network syndromes 481/1796 (27%). Conclusion –  The Coconuts is a valid and practical test of a comprehensive array of known behavioral neurological and neuropsychiatric syndromes in patients with stroke.